Community First Health Plans

Experimental/Investigational Services Pain Management Therapy/Rehabilitation Transplant Wound Care Ambulatory / Surgical Procedures Imaging Services/ Diagnostic Procedures Nursing Services (including initial evaluations) Abortion (According to HHSC guidelines) Dental Oral maxillofacial surgery (including orthognathic surgery) Dental extractions/rehabilitation in members 0-6 years old and children > 13 years and above and all third molars (general anesthesia and facility) – For all other members that do not fall in these age ranges, follow HHSC guidelines. Otoplasty (including Microtia repair) Rhinoplasty/Septoplasty Scar Revision Vagus Nerve Stimulation Varicose Vein Treatment Hysterectomy Bariatric Surgery - Codes Blepharoplasty Implantable devices (e.g. Interspinous Process Decompressors) – includes trials Mammoplasty (Male, Female) Laparoscopy, surgical, gastric restrictive procedure; with gastric bypass and Roux-en-Y gastroenterostomy (roux limb 150 cm or less) Laparoscopy, surgical, gastric restrictive procedure; with gastric bypass and small intestine reconstruction to limit absorption Laparoscopy, surgical, gastric restrictive procedure; placement of adjustable gastric restrictive device (eg, gastric band and subcutaneous port components) Laparoscopy, surgical, gastric restrictive procedure; revision of adjustable gastric restrictive device component only Laparoscopy, surgical, gastric restrictive procedure; removal of adjustable gastric restrictive device component only Laparoscopy, surgical, gastric restrictive procedure; removal and replacement of adjustable gastric restrictive device component only Laparoscopy, surgical, gastric restrictive procedure; removal of adjustable gastric restrictive device and subcutaneous port components Laparoscopy, surgical, gastric restrictive procedure; longitudinal gastrectomy (ie, sleeve gastrectomy) Gastric restrictive procedure, without gastric bypass, for morbid obesity; vertical-banded gastroplasty Gastric restrictive procedure, without gastric bypass, for morbid obesity; other than vertical-banded gastroplasty Gastric restrictive procedure with partial gastrectomy, pylorus-preserving duodenoileostomy and ileoileostomy (50 to 100 cm common channel) to limit absorption (biliopancreatic diversion with duodenal switch) Gastric restrictive procedure, with gastric bypass for morbid obesity; with short limb (150 cm or less) Roux-en-Y gastroenterostomy Gastric restrictive procedure, with gastric bypass for morbid obesity; with small intestine reconstruction to limit absorption Revision, open, of gastric restrictive procedure for morbid obesity, other than adjustable gastric restrictive device (separate procedure) Gastric restrictive procedure, open; revision of subcutaneous port component only Gastric restrictive procedure, open; removal of subcutaneous port component only Gastric restrictive procedure, open; removal and replacement of subcutaneous port component only Anesthesia for reconstructive procedures of eyelid (eg, blepharoplasty, ptosis surgery) Blepharoplasty, lower eyelid; Blepharoplasty, lower eyelid; with extensive herniated fat pad Blepharoplasty, upper eyelid; Blepharoplasty, upper eyelid; with excessive skin weighting down lid Canthoplasty (reconstruction of canthus) CPT Book Closure of vesicouterine fistula; with hysterectomy Total abdominal hysterectomy (corpus and cervix), with or without removal of tube(s), with or without removal of ovary(s Supracervical abdominal hysterectomy (subtotal hysterectomy), with or without removal of tube(s), with or without removal of ovary(s) Radical abdominal hysterectomy, with bilateral total pelvic lymphadenectomy and para-aortic lymph node sampling (biopsy), with or without removal of tube(s), with or without removal of ovary(s) Vaginal hysterectomy, for uterus 250 g or less; Vaginal hysterectomy, for uterus 250 g or less; with removal of tube(s), and/or ovary(s) Vaginal hysterectomy, for uterus 250 g or less; with removal of tube(s), and/or ovary(s), with repair of enterocele Vaginal hysterectomy, for uterus 250 g or less; with repair of enterocele Vaginal hysterectomy, with total or partial vaginectomy; Vaginal hysterectomy, with total or partial vaginectomy; with repair of enterocele Vaginal hysterectomy, radical (Schauta type operation) Vaginal hysterectomy, for uterus greater than 250 g; Vaginal hysterectomy, for uterus greater than 250 g; with removal of tube(s) and/or ovary(s) Vaginal hysterectomy, for uterus greater than 250 g; with removal of tube(s) and/or ovary(s), with repair of enterocele Vaginal hysterectomy, for uterus greater than 250 g; with repair of enterocele Laparoscopy, surgical, supracervical hysterectomy, for uterus 250 g or less; Laparoscopy, surgical, supracervical hysterectomy, for uterus greater than 250 g; Laparoscopy, surgical, with vaginal hysterectomy, for uterus 250 g or less; Laparoscopy, surgical, with vaginal hysterectomy, for uterus greater than 250 g; Laparoscopy, surgical, with total hysterectomy, for uterus 250 g or less; Laparoscopy, surgical, with total hysterectomy, for uterus 250 g or less; with removal of tube(s) and/or ovary(s) Laparoscopy, surgical, with total hysterectomy, for uterus greater than 250 g; with removal of tube(s) and/or ovary(s) Total abdominal hysterectomy (corpus and cervix), with or without removal of tube(s), with or without removal of ovary(s); with colpo-urethrocystopexy (eg, Marshall-Marchetti-Krantz, Burch) Total abdominal hysterectomy, including partial vaginectomy, with para-aortic and pelvic lymph node sampling, with or without removal of tube(s), with or without removal of ovary(s) Vaginal hysterectomy, for uterus 250 g or less; with colpo-urethrocystopexy (Marshall-Marchetti-Krantz type, Pereyra type) with or without endoscopic control Vaginal hysterectomy, for uterus greater than 250 g; with colpo-urethrocystopexy (Marshall-Marchetti-Krantz type, Pereyra type) with or without endoscopic control Laparoscopy, surgical, supracervical hysterectomy, for uterus 250 g or less; with removal of tube(s) and/or ovary(s) Laparoscopy, surgical, supracervical hysterectomy, for uterus greater than 250 g; with removal of tube(s) and/or ovary(s) 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 Laparoscopy, surgical, with vaginal hysterectomy, for uterus 250 g or less; with removal of tube(s) and/or ovary(s) Laparoscopy, surgical, with vaginal hysterectomy, for uterus greater than 250 g; with removal of tube(s) and/or ovary(s) Laparoscopy, surgical, total hysterectomy for resection of malignancy (tumor debulking), with omentectomy including salpingo-oophorectomy, unilateral or bilateral, when performed Resection (initial) of ovarian, tubal or primary peritoneal malignancy with bilateral salpingo-oophorectomy and omentectomy; with total abdominal hysterectomy, pelvic and limited para-aortic lymphadenectomy Bilateral salpingo-oophorectomy with omentectomy, total abdominal hysterectomy and radical dissection for debulking; Bilateral salpingo-oophorectomy with omentectomy, total abdominal hysterectomy and radical dissection for debulking; with pelvic lymphadenectomy and limited para-aortic lymphadenectomy Bilateral salpingo-oophorectomy with total omentectomy, total abdominal hysterectomy for malignancy Subtotal or total hysterectomy after cesarean delivery (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; first vein treated Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; first vein treated Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition t Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; first vein treated Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code fo Endovenous ablation therapy of incompetent vein, extremity, by transcatheter delivery of a chemical adhesive (eg, cyanoacrylate) remote from the access site, inclusive of all imaging guidance and monitoring, percutaneous; first vein treated Endovenous ablation therapy of incompetent vein, extremity, by transcatheter delivery of a chemical adhesive (eg, cyanoacrylate) remote from the access site, inclusive of all imaging guidance and monitoring, percutaneous; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Stab phlebectomy of varicose veins, 1 extremity; 10-20 stab incisions Stab phlebectomy of varicose veins, 1 extremity; more than 20 incisions Ligation, division, and/or excision of varicose vein cluster(s), 1 leg Allergen Immunotherapy Services

TMHP ie Checked STAR in GOLD- Code not in non covered SG 10.12.18 AR STAR - Codes moved to PA term. AR 10.12.18 Removed in GOLD. AR 10.12.18 Added term date in CPT / Svccode table of 12/31/2015 STAR - Not in STAR non covered SG. AR 10.12.18 This code is configured in STAR beneit term MED ALLERGY IMMUNOTHERAPY ADMIN and set to require PA in GOLD Validated not in Medicaid Non Covered list - GOLD AR 10.17.18 Yes, code in w/PA benefit terms - AR 10.17.18 Validated in w PA term. AR 10.17.18 Validated still listed in TMHP Medicaid Non Covered Per TMH Manual may be reimbursed, verify in QNXT, does not show up in Ben Term Sheet Star Per Amysis not a covered MA , Deny XZ, Verify in QNXT does not show in Noncovered for STAR - add to Medicaid Non Covered List Per Amysis not a covered MA , Deny XZ, Verify in QNXT does not show in Noncovered for STAR Per TMH is a covered service w/ Auth - need to remove from noncovered in QNXT for STAR - COMPLETE Per TMHP Manual is covered w/ auth- Remove from QNXT Noncovered list - COMPLETE QNXT set up under BEN AUTH SURGERY Cosmetic is that okay? Per TMHP Manual maybe covered for injury or trauma - Remove from QNXT Noncovered List - COMPLETE PER TMHP Manual is limited to 2 svc per lifetime (only for breast reconstruction)- Remove from QNXT is noncovered, PA flag set in QNXT for STAR - COMPLETE PER TMHP Manual is limited to 2 svc per lifetime (only for breast reconstruction)- Remove from QNXT noncovered, PA flag set in QNXT for STAR - COMPLETE Per TMHP Manual is covered - Remove from QNXT noncovered - COMPLETE Remove from QNXT noncovered - is set for PA on STAR Term - COMPLETE Noncovered for STAR - Should be added to QNXT noncovered - COMPLETE Remove from QNXT noncovered - is set for PA on STAR Term - COMPLETE. Remove from noncovered list QNXT Need to remove from QNXT non covered Need to removed from QNXT Noncovered - Needs PA Set Need to set PA Flag in QNXT Needs to be added to PA QNXT - is covered per TMHP - is on Noncovered list for QNXT Add to STAR TMHP Non Covered SG - Ann 10.12.18 Removed code form STAR TMHP Non Covered SG Added to CHIP Non Covered SG 10.17.18 AR Code added to PA terms in GOLD 10.17.18 AR Validated STAR TMHP Non Covered SG…. Code is Not listed in GOLD AR 10.17.18 I see it listed as Non Covered for Commercial fg CPT Codes Descriptions PA Set in QNXT Yes or No Oncology drugs when utilized for off label use UFCP UFCP ONLY Video EEG Monitoring Unlisted laparoscopy procedure, biliary tract Unlisted procedure, stomach Anesthesia for intraperitoneal procedures in upper abdomen including laparoscopy; gastric restrictive procedure for morbid obesity Vagus nerve blocking therapy (morbid obesity); laparoscopic implantation of neurostimulator electrode array, anterior and posterior vagal trunks adjacent to esophagogastric junction (EGJ), with implantation of pulse generator, includes programming Vagus nerve blocking therapy (morbid obesity); laparoscopic revision or replacement of vagal trunk neurostimulator electrode array, including connection to existing pulse generator Vagus nerve blocking therapy (morbid obesity); laparoscopic removal of vagal trunk neurostimulator electrode array and pulse generator Vagus nerve blocking therapy (morbid obesity); removal of pulse generator Vagus nerve blocking therapy (morbid obesity); replacement of pulse generator Vagus nerve blocking therapy (morbid obesity); neurostimulator pulse generator electronic analysis, includes reprogramming when performed Face-to-face behavioral counseling for obesity, 15 minutes Face-to-face behavioral counseling for obesity, group (2-10), 30 minutes Cancer Chemotherapy: requires preauthorization for allowable charges >$500 per dose Out-of -Network Bone Growth Stimulators Long Term Support Services (LTSS) – per State benefit Gastrectomy, total; with esophagoenterostomy with Roux-hyphenen-hyphenY reconstruction with formation of intestinal pouch, any type Gastrectomy, partial, distal; with gastroduodenostomy with gastrojejunostomy with formation of intestinal pouch Vagotomy when performed with partial distal gastrectomy (List separately in addition to code(s) for primary procedure) Biopsy of liver, needle; percutaneous [in the absence of signs or symptoms of liver disease (e.g., elevated liver enzymes, enlarged liver)] Biopsy of liver, needle; when done for indicated purpose at tine of other major procedure (list separately in addition to code for primary procedure) [in the absence of signs or symptoms of liver disease (e.g., elevated liver disease, enlarged liver)] Biopsy of liver, wedge [in the absence of signs or symptoms of liver disease (e.g., elevated liver disease, enlarged liver)] Cholecystectomy with exploration of common duct; with transduodenal sphincterotomy or sphincteroplasty, with or without cholangiography Cholecystectomy with exploration of common duct; with choledochoenterostomy Cholecystectomy with exploration of common duct; Cholecystectomy; with cholangiography Cholecystectomy; Laparoscopy, surgical; cholecystoenterostomy Laparoscopy, surgical; cholecystectomy with exploration of common duct Laparoscopy, surgical; cholecystectomy with cholangiography Laparoscopy, surgical; cholecystectomy Adjustment of gastric band diameter via subcutaneous port by injection or aspiration of saline Weight management classes, non-hyphenphysician provider, per session Exercise classes, non-hyphenphysician provider, per session Nutrition classes, non-hyphenphysician provider, per session Per 2019 Auth List Obesity Treatment and Surgery - ALL obesity treatment and surgery must be performed at University Hospital See important Endnotes. STAR

TMHP ie Checked STAR in GOLD- Code not in non covered SG 10.12.18 AR STAR - Codes moved to PA term. AR 10.12.18 Removed in GOLD. AR 10.12.18 Added term date in CPT / Svccode table of 12/31/2015 STAR - Not in STAR non covered SG. AR 10.12.18 This code is configured in STAR beneit term MED ALLERGY IMMUNOTHERAPY ADMIN and set to require PA in GOLD Validated not in Medicaid Non Covered list - GOLD AR 10.17.18 Yes, code in w/PA benefit terms - AR 10.17.18 Validated in w PA term. AR 10.17.18 Validated still listed in TMHP Medicaid Non Covered Per TMH Manual may be reimbursed, verify in QNXT, does not show up in Ben Term Sheet Star Per Amysis not a covered MA , Deny XZ, Verify in QNXT does not show in Noncovered for STAR - add to Medicaid Non Covered List Per Amysis not a covered MA , Deny XZ, Verify in QNXT does not show in Noncovered for STAR Per TMH is a covered service w/ Auth - need to remove from noncovered in QNXT for STAR - COMPLETE Per TMHP Manual is covered w/ auth- Remove from QNXT Noncovered list - COMPLETE QNXT set up under BEN AUTH SURGERY Cosmetic is that okay? Per TMHP Manual maybe covered for injury or trauma - Remove from QNXT Noncovered List - COMPLETE PER TMHP Manual is limited to 2 svc per lifetime (only for breast reconstruction)- Remove from QNXT is noncovered, PA flag set in QNXT for STAR - COMPLETE PER TMHP Manual is limited to 2 svc per lifetime (only for breast reconstruction)- Remove from QNXT noncovered, PA flag set in QNXT for STAR - COMPLETE Per TMHP Manual is covered - Remove from QNXT noncovered - COMPLETE Remove from QNXT noncovered - is set for PA on STAR Term - COMPLETE Noncovered for STAR - Should be added to QNXT noncovered - COMPLETE Remove from QNXT noncovered - is set for PA on STAR Term - COMPLETE. Remove from noncovered list QNXT Need to remove from QNXT non covered Need to removed from QNXT Noncovered - Needs PA Set Need to set PA Flag in QNXT Needs to be added to PA QNXT - is covered per TMHP - is on Noncovered list for QNXT Add to STAR TMHP Non Covered SG - Ann 10.12.18 Removed code form STAR TMHP Non Covered SG Added to CHIP Non Covered SG 10.17.18 AR Code added to PA terms in GOLD 10.17.18 AR Validated STAR TMHP Non Covered SG…. Code is Not listed in GOLD AR 10.17.18 I see it listed as Non Covered for Commercial fg CPT Codes Descriptions PA Set in QNXT Yes or No Oncology drugs when utilized for off label use UFCP UFCP ONLY Video EEG Monitoring Unlisted laparoscopy procedure, biliary tract Unlisted procedure, stomach Anesthesia for intraperitoneal procedures in upper abdomen including laparoscopy; gastric restrictive procedure for morbid obesity Vagus nerve blocking therapy (morbid obesity); laparoscopic implantation of neurostimulator electrode array, anterior and posterior vagal trunks adjacent to esophagogastric junction (EGJ), with implantation of pulse generator, includes programming Vagus nerve blocking therapy (morbid obesity); laparoscopic revision or replacement of vagal trunk neurostimulator electrode array, including connection to existing pulse generator Vagus nerve blocking therapy (morbid obesity); laparoscopic removal of vagal trunk neurostimulator electrode array and pulse generator Vagus nerve blocking therapy (morbid obesity); removal of pulse generator Vagus nerve blocking therapy (morbid obesity); replacement of pulse generator Vagus nerve blocking therapy (morbid obesity); neurostimulator pulse generator electronic analysis, includes reprogramming when performed Face-to-face behavioral counseling for obesity, 15 minutes Face-to-face behavioral counseling for obesity, group (2-10), 30 minutes Cancer Chemotherapy: requires preauthorization for allowable charges >$500 per dose Out-of -Network Bone Growth Stimulators Long Term Support Services (LTSS) – per State benefit Gastrectomy, total; with esophagoenterostomy with Roux-hyphenen-hyphenY reconstruction with formation of intestinal pouch, any type Gastrectomy, partial, distal; with gastroduodenostomy with gastrojejunostomy with formation of intestinal pouch Vagotomy when performed with partial distal gastrectomy (List separately in addition to code(s) for primary procedure) Biopsy of liver, needle; percutaneous [in the absence of signs or symptoms of liver disease (e.g., elevated liver enzymes, enlarged liver)] Biopsy of liver, needle; when done for indicated purpose at tine of other major procedure (list separately in addition to code for primary procedure) [in the absence of signs or symptoms of liver disease (e.g., elevated liver disease, enlarged liver)] Biopsy of liver, wedge [in the absence of signs or symptoms of liver disease (e.g., elevated liver disease, enlarged liver)] Cholecystectomy with exploration of common duct; with transduodenal sphincterotomy or sphincteroplasty, with or without cholangiography Cholecystectomy with exploration of common duct; with choledochoenterostomy Cholecystectomy with exploration of common duct; Cholecystectomy; with cholangiography Cholecystectomy; Laparoscopy, surgical; cholecystoenterostomy Laparoscopy, surgical; cholecystectomy with exploration of common duct Laparoscopy, surgical; cholecystectomy with cholangiography Laparoscopy, surgical; cholecystectomy Adjustment of gastric band diameter via subcutaneous port by injection or aspiration of saline Weight management classes, non-hyphenphysician provider, per session Exercise classes, non-hyphenphysician provider, per session Nutrition classes, non-hyphenphysician provider, per session Per 2019 Auth List Obesity Treatment and Surgery - ALL obesity treatment and surgery must be performed at University Hospital See important Endnotes. STAR

TMHP ie Checked STAR in GOLD- Code not in non covered SG 10.12.18 AR STAR - Codes moved to PA term. AR 10.12.18 Removed in GOLD. AR 10.12.18 Added term date in CPT / Svccode table of 12/31/2015 STAR - Not in STAR non covered SG. AR 10.12.18 This code is configured in STAR beneit term MED ALLERGY IMMUNOTHERAPY ADMIN and set to require PA in GOLD Validated not in Medicaid Non Covered list - GOLD AR 10.17.18 Yes, code in w/PA benefit terms - AR 10.17.18 Validated in w PA term. AR 10.17.18 Validated still listed in TMHP Medicaid Non Covered Per TMH Manual may be reimbursed, verify in QNXT, does not show up in Ben Term Sheet Star Per Amysis not a covered MA , Deny XZ, Verify in QNXT does not show in Noncovered for STAR - add to Medicaid Non Covered List Per Amysis not a covered MA , Deny XZ, Verify in QNXT does not show in Noncovered for STAR Per TMH is a covered service w/ Auth - need to remove from noncovered in QNXT for STAR - COMPLETE Per TMHP Manual is covered w/ auth- Remove from QNXT Noncovered list - COMPLETE QNXT set up under BEN AUTH SURGERY Cosmetic is that okay? Per TMHP Manual maybe covered for injury or trauma - Remove from QNXT Noncovered List - COMPLETE PER TMHP Manual is limited to 2 svc per lifetime (only for breast reconstruction)- Remove from QNXT is noncovered, PA flag set in QNXT for STAR - COMPLETE PER TMHP Manual is limited to 2 svc per lifetime (only for breast reconstruction)- Remove from QNXT noncovered, PA flag set in QNXT for STAR - COMPLETE Per TMHP Manual is covered - Remove from QNXT noncovered - COMPLETE Remove from QNXT noncovered - is set for PA on STAR Term - COMPLETE Noncovered for STAR - Should be added to QNXT noncovered - COMPLETE Remove from QNXT noncovered - is set for PA on STAR Term - COMPLETE. Remove from noncovered list QNXT Need to remove from QNXT non covered Need to removed from QNXT Noncovered - Needs PA Set Need to set PA Flag in QNXT Needs to be added to PA QNXT - is covered per TMHP - is on Noncovered list for QNXT Add to STAR TMHP Non Covered SG - Ann 10.12.18 Removed code form STAR TMHP Non Covered SG Added to CHIP Non Covered SG 10.17.18 AR Code added to PA terms in GOLD 10.17.18 AR Validated STAR TMHP Non Covered SG…. Code is Not listed in GOLD AR 10.17.18 I see it listed as Non Covered for Commercial fg CPT Codes Descriptions PA Set in QNXT Yes or No Oncology drugs when utilized for off label use UFCP UFCP ONLY Video EEG Monitoring Unlisted laparoscopy procedure, biliary tract Unlisted procedure, stomach Anesthesia for intraperitoneal procedures in upper abdomen including laparoscopy; gastric restrictive procedure for morbid obesity Vagus nerve blocking therapy (morbid obesity); laparoscopic implantation of neurostimulator electrode array, anterior and posterior vagal trunks adjacent to esophagogastric junction (EGJ), with implantation of pulse generator, includes programming Vagus nerve blocking therapy (morbid obesity); laparoscopic revision or replacement of vagal trunk neurostimulator electrode array, including connection to existing pulse generator Vagus nerve blocking therapy (morbid obesity); laparoscopic removal of vagal trunk neurostimulator electrode array and pulse generator Vagus nerve blocking therapy (morbid obesity); removal of pulse generator Vagus nerve blocking therapy (morbid obesity); replacement of pulse generator Vagus nerve blocking therapy (morbid obesity); neurostimulator pulse generator electronic analysis, includes reprogramming when performed Face-to-face behavioral counseling for obesity, 15 minutes Face-to-face behavioral counseling for obesity, group (2-10), 30 minutes Cancer Chemotherapy: requires preauthorization for allowable charges >$500 per dose Out-of -Network Bone Growth Stimulators Long Term Support Services (LTSS) – per State benefit Gastrectomy, total; with esophagoenterostomy with Roux-hyphenen-hyphenY reconstruction with formation of intestinal pouch, any type Gastrectomy, partial, distal; with gastroduodenostomy with gastrojejunostomy with formation of intestinal pouch Vagotomy when performed with partial distal gastrectomy (List separately in addition to code(s) for primary procedure) Biopsy of liver, needle; percutaneous [in the absence of signs or symptoms of liver disease (e.g., elevated liver enzymes, enlarged liver)] Biopsy of liver, needle; when done for indicated purpose at tine of other major procedure (list separately in addition to code for primary procedure) [in the absence of signs or symptoms of liver disease (e.g., elevated liver disease, enlarged liver)] Biopsy of liver, wedge [in the absence of signs or symptoms of liver disease (e.g., elevated liver disease, enlarged liver)] Cholecystectomy with exploration of common duct; with transduodenal sphincterotomy or sphincteroplasty, with or without cholangiography Cholecystectomy with exploration of common duct; with choledochoenterostomy Cholecystectomy with exploration of common duct; Cholecystectomy; with cholangiography Cholecystectomy; Laparoscopy, surgical; cholecystoenterostomy Laparoscopy, surgical; cholecystectomy with exploration of common duct Laparoscopy, surgical; cholecystectomy with cholangiography Laparoscopy, surgical; cholecystectomy Adjustment of gastric band diameter via subcutaneous port by injection or aspiration of saline Weight management classes, non-hyphenphysician provider, per session Exercise classes, non-hyphenphysician provider, per session Nutrition classes, non-hyphenphysician provider, per session Per 2019 Auth List Obesity Treatment and Surgery - ALL obesity treatment and surgery must be performed at University Hospital See important Endnotes. STAR

TMHP ie Checked STAR in GOLD- Code not in non covered SG 10.12.18 AR STAR - Codes moved to PA term. AR 10.12.18 Removed in GOLD. AR 10.12.18 Added term date in CPT / Svccode table of 12/31/2015 STAR - Not in STAR non covered SG. AR 10.12.18 This code is configured in STAR beneit term MED ALLERGY IMMUNOTHERAPY ADMIN and set to require PA in GOLD Validated not in Medicaid Non Covered list - GOLD AR 10.17.18 Yes, code in w/PA benefit terms - AR 10.17.18 Validated in w PA term. AR 10.17.18 Validated still listed in TMHP Medicaid Non Covered Per TMH Manual may be reimbursed, verify in QNXT, does not show up in Ben Term Sheet Star Per Amysis not a covered MA , Deny XZ, Verify in QNXT does not show in Noncovered for STAR - add to Medicaid Non Covered List Per Amysis not a covered MA , Deny XZ, Verify in QNXT does not show in Noncovered for STAR Per TMH is a covered service w/ Auth - need to remove from noncovered in QNXT for STAR - COMPLETE Per TMHP Manual is covered w/ auth- Remove from QNXT Noncovered list - COMPLETE QNXT set up under BEN AUTH SURGERY Cosmetic is that okay? Per TMHP Manual maybe covered for injury or trauma - Remove from QNXT Noncovered List - COMPLETE PER TMHP Manual is limited to 2 svc per lifetime (only for breast reconstruction)- Remove from QNXT is noncovered, PA flag set in QNXT for STAR - COMPLETE PER TMHP Manual is limited to 2 svc per lifetime (only for breast reconstruction)- Remove from QNXT noncovered, PA flag set in QNXT for STAR - COMPLETE Per TMHP Manual is covered - Remove from QNXT noncovered - COMPLETE Remove from QNXT noncovered - is set for PA on STAR Term - COMPLETE Noncovered for STAR - Should be added to QNXT noncovered - COMPLETE Remove from QNXT noncovered - is set for PA on STAR Term - COMPLETE. Remove from noncovered list QNXT Need to remove from QNXT non covered Need to removed from QNXT Noncovered - Needs PA Set Need to set PA Flag in QNXT Needs to be added to PA QNXT - is covered per TMHP - is on Noncovered list for QNXT Add to STAR TMHP Non Covered SG - Ann 10.12.18 Removed code form STAR TMHP Non Covered SG Added to CHIP Non Covered SG 10.17.18 AR Code added to PA terms in GOLD 10.17.18 AR Validated STAR TMHP Non Covered SG…. Code is Not listed in GOLD AR 10.17.18 I see it listed as Non Covered for Commercial fg CPT Codes Descriptions PA Set in QNXT Yes or No Oncology drugs when utilized for off label use UFCP UFCP ONLY Video EEG Monitoring Unlisted laparoscopy procedure, biliary tract Unlisted procedure, stomach Anesthesia for intraperitoneal procedures in upper abdomen including laparoscopy; gastric restrictive procedure for morbid obesity Vagus nerve blocking therapy (morbid obesity); laparoscopic implantation of neurostimulator electrode array, anterior and posterior vagal trunks adjacent to esophagogastric junction (EGJ), with implantation of pulse generator, includes programming Vagus nerve blocking therapy (morbid obesity); laparoscopic revision or replacement of vagal trunk neurostimulator electrode array, including connection to existing pulse generator Vagus nerve blocking therapy (morbid obesity); laparoscopic removal of vagal trunk neurostimulator electrode array and pulse generator Vagus nerve blocking therapy (morbid obesity); removal of pulse generator Vagus nerve blocking therapy (morbid obesity); replacement of pulse generator Vagus nerve blocking therapy (morbid obesity); neurostimulator pulse generator electronic analysis, includes reprogramming when performed Face-to-face behavioral counseling for obesity, 15 minutes Face-to-face behavioral counseling for obesity, group (2-10), 30 minutes Cancer Chemotherapy: requires preauthorization for allowable charges >$500 per dose Out-of -Network Bone Growth Stimulators Long Term Support Services (LTSS) – per State benefit Gastrectomy, total; with esophagoenterostomy with Roux-hyphenen-hyphenY reconstruction with formation of intestinal pouch, any type Gastrectomy, partial, distal; with gastroduodenostomy with gastrojejunostomy with formation of intestinal pouch Vagotomy when performed with partial distal gastrectomy (List separately in addition to code(s) for primary procedure) Biopsy of liver, needle; percutaneous [in the absence of signs or symptoms of liver disease (e.g., elevated liver enzymes, enlarged liver)] Biopsy of liver, needle; when done for indicated purpose at tine of other major procedure (list separately in addition to code for primary procedure) [in the absence of signs or symptoms of liver disease (e.g., elevated liver disease, enlarged liver)] Biopsy of liver, wedge [in the absence of signs or symptoms of liver disease (e.g., elevated liver disease, enlarged liver)] Cholecystectomy with exploration of common duct; with transduodenal sphincterotomy or sphincteroplasty, with or without cholangiography Cholecystectomy with exploration of common duct; with choledochoenterostomy Cholecystectomy with exploration of common duct; Cholecystectomy; with cholangiography Cholecystectomy; Laparoscopy, surgical; cholecystoenterostomy Laparoscopy, surgical; cholecystectomy with exploration of common duct Laparoscopy, surgical; cholecystectomy with cholangiography Laparoscopy, surgical; cholecystectomy Adjustment of gastric band diameter via subcutaneous port by injection or aspiration of saline Weight management classes, non-hyphenphysician provider, per session Exercise classes, non-hyphenphysician provider, per session Nutrition classes, non-hyphenphysician provider, per session Per 2019 Auth List Obesity Treatment and Surgery - ALL obesity treatment and surgery must be performed at University Hospital See important Endnotes. STAR

TMHP ie Checked STAR in GOLD- Code not in non covered SG 10.12.18 AR STAR - Codes moved to PA term. AR 10.12.18 Removed in GOLD. AR 10.12.18 Added term date in CPT / Svccode table of 12/31/2015 STAR - Not in STAR non covered SG. AR 10.12.18 This code is configured in STAR beneit term MED ALLERGY IMMUNOTHERAPY ADMIN and set to require PA in GOLD Validated not in Medicaid Non Covered list - GOLD AR 10.17.18 Yes, code in w/PA benefit terms - AR 10.17.18 Validated in w PA term. AR 10.17.18 Validated still listed in TMHP Medicaid Non Covered Per TMH Manual may be reimbursed, verify in QNXT, does not show up in Ben Term Sheet Star Per Amysis not a covered MA , Deny XZ, Verify in QNXT does not show in Noncovered for STAR - add to Medicaid Non Covered List Per Amysis not a covered MA , Deny XZ, Verify in QNXT does not show in Noncovered for STAR Per TMH is a covered service w/ Auth - need to remove from noncovered in QNXT for STAR - COMPLETE Per TMHP Manual is covered w/ auth- Remove from QNXT Noncovered list - COMPLETE QNXT set up under BEN AUTH SURGERY Cosmetic is that okay? Per TMHP Manual maybe covered for injury or trauma - Remove from QNXT Noncovered List - COMPLETE PER TMHP Manual is limited to 2 svc per lifetime (only for breast reconstruction)- Remove from QNXT is noncovered, PA flag set in QNXT for STAR - COMPLETE PER TMHP Manual is limited to 2 svc per lifetime (only for breast reconstruction)- Remove from QNXT noncovered, PA flag set in QNXT for STAR - COMPLETE Per TMHP Manual is covered - Remove from QNXT noncovered - COMPLETE Remove from QNXT noncovered - is set for PA on STAR Term - COMPLETE Noncovered for STAR - Should be added to QNXT noncovered - COMPLETE Remove from QNXT noncovered - is set for PA on STAR Term - COMPLETE. Remove from noncovered list QNXT Need to remove from QNXT non covered Need to removed from QNXT Noncovered - Needs PA Set Need to set PA Flag in QNXT Needs to be added to PA QNXT - is covered per TMHP - is on Noncovered list for QNXT Add to STAR TMHP Non Covered SG - Ann 10.12.18 Removed code form STAR TMHP Non Covered SG Added to CHIP Non Covered SG 10.17.18 AR Code added to PA terms in GOLD 10.17.18 AR Validated STAR TMHP Non Covered SG…. Code is Not listed in GOLD AR 10.17.18 I see it listed as Non Covered for Commercial fg CPT Codes Descriptions PA Set in QNXT Yes or No Oncology drugs when utilized for off label use UFCP UFCP ONLY Video EEG Monitoring Unlisted laparoscopy procedure, biliary tract Unlisted procedure, stomach Anesthesia for intraperitoneal procedures in upper abdomen including laparoscopy; gastric restrictive procedure for morbid obesity Vagus nerve blocking therapy (morbid obesity); laparoscopic implantation of neurostimulator electrode array, anterior and posterior vagal trunks adjacent to esophagogastric junction (EGJ), with implantation of pulse generator, includes programming Vagus nerve blocking therapy (morbid obesity); laparoscopic revision or replacement of vagal trunk neurostimulator electrode array, including connection to existing pulse generator Vagus nerve blocking therapy (morbid obesity); laparoscopic removal of vagal trunk neurostimulator electrode array and pulse generator Vagus nerve blocking therapy (morbid obesity); removal of pulse generator Vagus nerve blocking therapy (morbid obesity); replacement of pulse generator Vagus nerve blocking therapy (morbid obesity); neurostimulator pulse generator electronic analysis, includes reprogramming when performed Face-to-face behavioral counseling for obesity, 15 minutes Face-to-face behavioral counseling for obesity, group (2-10), 30 minutes Cancer Chemotherapy: requires preauthorization for allowable charges >$500 per dose Out-of -Network Bone Growth Stimulators Long Term Support Services (LTSS) – per State benefit Gastrectomy, total; with esophagoenterostomy with Roux-hyphenen-hyphenY reconstruction with formation of intestinal pouch, any type Gastrectomy, partial, distal; with gastroduodenostomy with gastrojejunostomy with formation of intestinal pouch Vagotomy when performed with partial distal gastrectomy (List separately in addition to code(s) for primary procedure) Biopsy of liver, needle; percutaneous [in the absence of signs or symptoms of liver disease (e.g., elevated liver enzymes, enlarged liver)] Biopsy of liver, needle; when done for indicated purpose at tine of other major procedure (list separately in addition to code for primary procedure) [in the absence of signs or symptoms of liver disease (e.g., elevated liver disease, enlarged liver)] Biopsy of liver, wedge [in the absence of signs or symptoms of liver disease (e.g., elevated liver disease, enlarged liver)] Cholecystectomy with exploration of common duct; with transduodenal sphincterotomy or sphincteroplasty, with or without cholangiography Cholecystectomy with exploration of common duct; with choledochoenterostomy Cholecystectomy with exploration of common duct; Cholecystectomy; with cholangiography Cholecystectomy; Laparoscopy, surgical; cholecystoenterostomy Laparoscopy, surgical; cholecystectomy with exploration of common duct Laparoscopy, surgical; cholecystectomy with cholangiography Laparoscopy, surgical; cholecystectomy Adjustment of gastric band diameter via subcutaneous port by injection or aspiration of saline Weight management classes, non-hyphenphysician provider, per session Exercise classes, non-hyphenphysician provider, per session Nutrition classes, non-hyphenphysician provider, per session Per 2019 Auth List Obesity Treatment and Surgery - ALL obesity treatment and surgery must be performed at University Hospital See important Endnotes. STAR

TMHP ie Checked STAR in GOLD- Code not in non covered SG 10.12.18 AR STAR - Codes moved to PA term. AR 10.12.18 Removed in GOLD. AR 10.12.18 Added term date in CPT / Svccode table of 12/31/2015 STAR - Not in STAR non covered SG. AR 10.12.18 This code is configured in STAR beneit term MED ALLERGY IMMUNOTHERAPY ADMIN and set to require PA in GOLD Validated not in Medicaid Non Covered list - GOLD AR 10.17.18 Yes, code in w/PA benefit terms - AR 10.17.18 Validated in w PA term. AR 10.17.18 Validated still listed in TMHP Medicaid Non Covered Per TMH Manual may be reimbursed, verify in QNXT, does not show up in Ben Term Sheet Star Per Amysis not a covered MA , Deny XZ, Verify in QNXT does not show in Noncovered for STAR - add to Medicaid Non Covered List Per Amysis not a covered MA , Deny XZ, Verify in QNXT does not show in Noncovered for STAR Per TMH is a covered service w/ Auth - need to remove from noncovered in QNXT for STAR - COMPLETE Per TMHP Manual is covered w/ auth- Remove from QNXT Noncovered list - COMPLETE QNXT set up under BEN AUTH SURGERY Cosmetic is that okay? Per TMHP Manual maybe covered for injury or trauma - Remove from QNXT Noncovered List - COMPLETE PER TMHP Manual is limited to 2 svc per lifetime (only for breast reconstruction)- Remove from QNXT is noncovered, PA flag set in QNXT for STAR - COMPLETE PER TMHP Manual is limited to 2 svc per lifetime (only for breast reconstruction)- Remove from QNXT noncovered, PA flag set in QNXT for STAR - COMPLETE Per TMHP Manual is covered - Remove from QNXT noncovered - COMPLETE Remove from QNXT noncovered - is set for PA on STAR Term - COMPLETE Noncovered for STAR - Should be added to QNXT noncovered - COMPLETE Remove from QNXT noncovered - is set for PA on STAR Term - COMPLETE. Remove from noncovered list QNXT Need to remove from QNXT non covered Need to removed from QNXT Noncovered - Needs PA Set Need to set PA Flag in QNXT Needs to be added to PA QNXT - is covered per TMHP - is on Noncovered list for QNXT Add to STAR TMHP Non Covered SG - Ann 10.12.18 Removed code form STAR TMHP Non Covered SG Added to CHIP Non Covered SG 10.17.18 AR Code added to PA terms in GOLD 10.17.18 AR Validated STAR TMHP Non Covered SG…. Code is Not listed in GOLD AR 10.17.18 I see it listed as Non Covered for Commercial fg CPT Codes Descriptions PA Set in QNXT Yes or No Oncology drugs when utilized for off label use UFCP UFCP ONLY Video EEG Monitoring Unlisted laparoscopy procedure, biliary tract Unlisted procedure, stomach Anesthesia for intraperitoneal procedures in upper abdomen including laparoscopy; gastric restrictive procedure for morbid obesity Vagus nerve blocking therapy (morbid obesity); laparoscopic implantation of neurostimulator electrode array, anterior and posterior vagal trunks adjacent to esophagogastric junction (EGJ), with implantation of pulse generator, includes programming Vagus nerve blocking therapy (morbid obesity); laparoscopic revision or replacement of vagal trunk neurostimulator electrode array, including connection to existing pulse generator Vagus nerve blocking therapy (morbid obesity); laparoscopic removal of vagal trunk neurostimulator electrode array and pulse generator Vagus nerve blocking therapy (morbid obesity); removal of pulse generator Vagus nerve blocking therapy (morbid obesity); replacement of pulse generator Vagus nerve blocking therapy (morbid obesity); neurostimulator pulse generator electronic analysis, includes reprogramming when performed Face-to-face behavioral counseling for obesity, 15 minutes Face-to-face behavioral counseling for obesity, group (2-10), 30 minutes Cancer Chemotherapy: requires preauthorization for allowable charges >$500 per dose Out-of -Network Bone Growth Stimulators Long Term Support Services (LTSS) – per State benefit Gastrectomy, total; with esophagoenterostomy with Roux-hyphenen-hyphenY reconstruction with formation of intestinal pouch, any type Gastrectomy, partial, distal; with gastroduodenostomy with gastrojejunostomy with formation of intestinal pouch Vagotomy when performed with partial distal gastrectomy (List separately in addition to code(s) for primary procedure) Biopsy of liver, needle; percutaneous [in the absence of signs or symptoms of liver disease (e.g., elevated liver enzymes, enlarged liver)] Biopsy of liver, needle; when done for indicated purpose at tine of other major procedure (list separately in addition to code for primary procedure) [in the absence of signs or symptoms of liver disease (e.g., elevated liver disease, enlarged liver)] Biopsy of liver, wedge [in the absence of signs or symptoms of liver disease (e.g., elevated liver disease, enlarged liver)] Cholecystectomy with exploration of common duct; with transduodenal sphincterotomy or sphincteroplasty, with or without cholangiography Cholecystectomy with exploration of common duct; with choledochoenterostomy Cholecystectomy with exploration of common duct; Cholecystectomy; with cholangiography Cholecystectomy; Laparoscopy, surgical; cholecystoenterostomy Laparoscopy, surgical; cholecystectomy with exploration of common duct Laparoscopy, surgical; cholecystectomy with cholangiography Laparoscopy, surgical; cholecystectomy Adjustment of gastric band diameter via subcutaneous port by injection or aspiration of saline Weight management classes, non-hyphenphysician provider, per session Exercise classes, non-hyphenphysician provider, per session Nutrition classes, non-hyphenphysician provider, per session Per 2019 Auth List Obesity Treatment and Surgery - ALL obesity treatment and surgery must be performed at University Hospital See important Endnotes. STAR

TMHP ie Checked STAR in GOLD- Code not in non covered SG 10.12.18 AR STAR - Codes moved to PA term. AR 10.12.18 Removed in GOLD. AR 10.12.18 Added term date in CPT / Svccode table of 12/31/2015 STAR - Not in STAR non covered SG. AR 10.12.18 This code is configured in STAR beneit term MED ALLERGY IMMUNOTHERAPY ADMIN and set to require PA in GOLD Validated not in Medicaid Non Covered list - GOLD AR 10.17.18 Yes, code in w/PA benefit terms - AR 10.17.18 Validated in w PA term. AR 10.17.18 Validated still listed in TMHP Medicaid Non Covered Per TMH Manual may be reimbursed, verify in QNXT, does not show up in Ben Term Sheet Star Per Amysis not a covered MA , Deny XZ, Verify in QNXT does not show in Noncovered for STAR - add to Medicaid Non Covered List Per Amysis not a covered MA , Deny XZ, Verify in QNXT does not show in Noncovered for STAR Per TMH is a covered service w/ Auth - need to remove from noncovered in QNXT for STAR - COMPLETE Per TMHP Manual is covered w/ auth- Remove from QNXT Noncovered list - COMPLETE QNXT set up under BEN AUTH SURGERY Cosmetic is that okay? Per TMHP Manual maybe covered for injury or trauma - Remove from QNXT Noncovered List - COMPLETE PER TMHP Manual is limited to 2 svc per lifetime (only for breast reconstruction)- Remove from QNXT is noncovered, PA flag set in QNXT for STAR - COMPLETE PER TMHP Manual is limited to 2 svc per lifetime (only for breast reconstruction)- Remove from QNXT noncovered, PA flag set in QNXT for STAR - COMPLETE Per TMHP Manual is covered - Remove from QNXT noncovered - COMPLETE Remove from QNXT noncovered - is set for PA on STAR Term - COMPLETE Noncovered for STAR - Should be added to QNXT noncovered - COMPLETE Remove from QNXT noncovered - is set for PA on STAR Term - COMPLETE. Remove from noncovered list QNXT Need to remove from QNXT non covered Need to removed from QNXT Noncovered - Needs PA Set Need to set PA Flag in QNXT Needs to be added to PA QNXT - is covered per TMHP - is on Noncovered list for QNXT Add to STAR TMHP Non Covered SG - Ann 10.12.18 Removed code form STAR TMHP Non Covered SG Added to CHIP Non Covered SG 10.17.18 AR Code added to PA terms in GOLD 10.17.18 AR Validated STAR TMHP Non Covered SG…. Code is Not listed in GOLD AR 10.17.18 I see it listed as Non Covered for Commercial fg CPT Codes Descriptions PA Set in QNXT Yes or No Oncology drugs when utilized for off label use UFCP UFCP ONLY Video EEG Monitoring Unlisted laparoscopy procedure, biliary tract Unlisted procedure, stomach Anesthesia for intraperitoneal procedures in upper abdomen including laparoscopy; gastric restrictive procedure for morbid obesity Vagus nerve blocking therapy (morbid obesity); laparoscopic implantation of neurostimulator electrode array, anterior and posterior vagal trunks adjacent to esophagogastric junction (EGJ), with implantation of pulse generator, includes programming Vagus nerve blocking therapy (morbid obesity); laparoscopic revision or replacement of vagal trunk neurostimulator electrode array, including connection to existing pulse generator Vagus nerve blocking therapy (morbid obesity); laparoscopic removal of vagal trunk neurostimulator electrode array and pulse generator Vagus nerve blocking therapy (morbid obesity); removal of pulse generator Vagus nerve blocking therapy (morbid obesity); replacement of pulse generator Vagus nerve blocking therapy (morbid obesity); neurostimulator pulse generator electronic analysis, includes reprogramming when performed Face-to-face behavioral counseling for obesity, 15 minutes Face-to-face behavioral counseling for obesity, group (2-10), 30 minutes Cancer Chemotherapy: requires preauthorization for allowable charges >$500 per dose Out-of -Network Bone Growth Stimulators Long Term Support Services (LTSS) – per State benefit Gastrectomy, total; with esophagoenterostomy with Roux-hyphenen-hyphenY reconstruction with formation of intestinal pouch, any type Gastrectomy, partial, distal; with gastroduodenostomy with gastrojejunostomy with formation of intestinal pouch Vagotomy when performed with partial distal gastrectomy (List separately in addition to code(s) for primary procedure) Biopsy of liver, needle; percutaneous [in the absence of signs or symptoms of liver disease (e.g., elevated liver enzymes, enlarged liver)] Biopsy of liver, needle; when done for indicated purpose at tine of other major procedure (list separately in addition to code for primary procedure) [in the absence of signs or symptoms of liver disease (e.g., elevated liver disease, enlarged liver)] Biopsy of liver, wedge [in the absence of signs or symptoms of liver disease (e.g., elevated liver disease, enlarged liver)] Cholecystectomy with exploration of common duct; with transduodenal sphincterotomy or sphincteroplasty, with or without cholangiography Cholecystectomy with exploration of common duct; with choledochoenterostomy Cholecystectomy with exploration of common duct; Cholecystectomy; with cholangiography Cholecystectomy; Laparoscopy, surgical; cholecystoenterostomy Laparoscopy, surgical; cholecystectomy with exploration of common duct Laparoscopy, surgical; cholecystectomy with cholangiography Laparoscopy, surgical; cholecystectomy Adjustment of gastric band diameter via subcutaneous port by injection or aspiration of saline Weight management classes, non-hyphenphysician provider, per session Exercise classes, non-hyphenphysician provider, per session Nutrition classes, non-hyphenphysician provider, per session Per 2019 Auth List Obesity Treatment and Surgery - ALL obesity treatment and surgery must be performed at University Hospital See important Endnotes. STAR

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

6 9 99 139 138 139 138 146 118 51 140 145 147 141 119 51 140 145 147 141 120 51 140 145 147 141 121 51 140 145 147 141 117 51 140 577 147 141 572 5 122 51 140 577 147 141 572 123 51 140 578 147 141 596 124 51 140 578 147 141 596 125 51 140 578 147 141 596 126 51 140 578 147 141 596 127 51 140 578 147 141 596 5 128 51 140 578 147 141 596 129 51 140 443 147 141 596 130 51 140 579 147 141 596 131 51 142 141 147 141 132 51 142 141 147 141 133 51 142 141 147 141 134 51 142 141 147 141 135 51 142 141 147 141 136 51 142 141 147 141 137 51 142 141 147 141 19 139 138 139 138 23 51 140 141 147 141 24 51 140 141 147 141 143 144 140 141 147 141 25 51 140 141 147 141 26 51 140 141 147 141 27 51 140 141 147 141 28 51 140 141 147 141 29 51 140 141 147 141 30 51 140 141 147 141 31 148 140 580 147 141 32 51 140 580 147 141 33 51 140 141 147 141 34 51 140 141 147 141 35 51 140 141 147 141 36 51 140 141 147 141 37 51 140 141 147 141 38 51 140 141 147 141 39 51 140 141 147 141 20 139 138 139 138 40 41 42 43 51 140 581 573 44 45 51 140 581 573 46 47 51 140 582 574 48 49 51 140 582 574 446 544 444 140 453 545 444 140 454 546 444 140 455 547 444 140 456 548 444 140 447 549 444 140 448 550 444 140 449 551 444 140 450 552 444 140 451 553 444 140 452 554 444 140 149 50 444 140 445 5 100 139 138 139 138 323 148 140 583 573 325 148 140 583 573 326 148 140 583 573 327 148 140 583 573 328 148 140 583 573 324 148 140 332 573 329 148 140 330 575 331 148 140 333 575 159 334 51 140 141 575 160 335 51 140 141 575 161 336 51 140 141 575 337 51 140 141 575 338 51 140 141 575 339 51 140 141 575 340 51 140 141 575 341 51 140 141 575 342 51 140 141 575 343 51 140 141 575 344 51 140 141 575 345 51 140 141 575 346 51 140 141 575 347 51 140 141 575 348 51 140 141 575 162 349 51 140 141 575 163 350 51 140 141 575 164 351 51 140 141 575 156 565 51 140 584 573 157 352 51 140 585 573 158 353 51 140 585 573 165 354 51 140 141 575 166 355 51 140 141 575 167 357 51 140 141 575 168 356 51 140 141 575 169 358 51 140 141 575 170 359 51 140 141 575 171 360 51 140 457 576 172 361 51 140 141 575 601 324 51 140 141 575 311 362 51 140 141 575 305 308 51 140 586 573 173 363 51 140 141 575 309 310 51 140 141 575 312 364 51 140 141 575 313 365 51 140 141 575 314 366 51 140 141 575 306 307 51 140 586 573 315 367 51 140 586 573 174 368 51 140 141 175 369 51 140 587 573 176 177 51 140 587 573 178 370 51 140 587 573 179 371 51 140 587 573 180 372 51 140 587 573 181 373 51 140 141 182 375 382 140 588 573 376 382 140 588 573 377 382 140 588 573 378 382 140 588 573 379 382 140 588 573 380 382 140 588 573 381 382 140 588 573 381 51 140 141 183 383 51 140 141 184 384 51 140 141 185 385 51 140 141 186 386 51 140 141 387 331 51 140 589 573 187 388 51 140 588 573 188 389 51 140 588 573 189 390 51 140 588 573 190 391 51 140 141 191 392 374 140 141 192 393 51 140 141 193 394 382 140 141 194 395 51 140 141 195 396 374 140 141 196 397 374 140 141 197 398 374 140 141 198 399 374 140 141 199 400 374 140 141 200 401 374 140 141 201 402 374 140 141 202 403 374 140 141 203 404 374 140 141 204 405 374 140 141 205 406 51 140 141 206 407 51 140 141 207 408 51 140 141 208 409 51 140 141 209 410 51 140 141 210 411 51 140 141 211 412 51 140 141 212 413 51 140 141 213 414 51 140 141 214 415 51 140 141 215 416 51 140 141 216 417 51 140 141 217 418 51 140 419 147 420 597 320 421 51 140 590 566 567 150 113 51 140 141 321 114 382 140 590 147 141 567 322 115 51 140 590 566 567 151 435 51 140 141 152 436 51 140 141 424 429 51 140 141 425 430 51 140 141 426 431 51 140 440 568 439 438 51 140 440 568 427 432 51 140 141 153 428 51 140 141 154 434 51 140 141 155 437 51 140 141 423 433 51 140 441 218 442 51 140 441 219 458 51 140 441 220 459 51 140 441 221 460 51 140 441 222 461 51 140 441 223 462 51 140 441 224 463 51 140 441 225 464 51 140 441 226 465 51 140 441 227 466 51 140 441 316 467 51 140 441 317 468 51 140 441 318 469 51 140 441 319 470 51 140 441 228 471 51 140 441 229 472 51 140 441 230 473 51 140 441 536 540 51 140 441 231 474 51 140 441 232 475 51 140 441 233 476 51 140 441 234 477 51 140 441 235 478 51 140 591 5 569 236 479 51 140 141 237 480 51 140 141 238 101 51 140 141 239 102 51 140 141 240 103 51 140 141 241 104 51 140 141 242 105 51 140 141 243 106 51 140 141 244 107 51 140 141 245 108 51 140 141 246 109 51 140 141 247 481 382 140 141 248 482 382 140 141 249 483 382 140 141 250 484 382 140 141 251 485 382 140 141 252 486 382 140 141 253 487 382 140 141 254 89 382 140 141 255 488 382 140 141 256 90 382 140 141 257 489 382 140 141 258 92 382 140 141 259 490 382 140 141 260 491 382 140 141 261 492 382 140 141 262 493 382 140 141 263 494 382 140 141 264 495 382 140 141 265 496 382 140 141 266 498 497 570 267 499 382 140 141 268 500 382 140 141 269 501 382 140 141 270 502 382 140 141 271 503 382 140 141 272 504 382 140 141 273 505 382 140 141 274 96 382 140 141 275 97 382 140 141 276 506 382 140 141 277 98 382 140 141 278 507 51 140 592 569 279 508 51 140 592 569 280 509 382 140 141 281 510 382 140 141 282 511 382 140 141 283 512 382 140 141 537 541 382 140 141 538 542 382 140 141 539 543 382 140 141 284 513 382 140 141 285 514 382 140 141 286 515 382 140 141 287 516 382 140 141 288 517 382 140 141 289 518 382 140 141 290 519 51 140 141 291 520 51 140 141 292 521 51 140 141 293 522 51 140 141 294 524 51 140 591 571 295 525 51 140 591 571 296 526 51 140 141 297 527 51 140 141 298 528 51 140 141 299 529 51 140 141 300 530 51 140 141 301 531 51 140 141 302 532 51 140 141 303 533 51 140 534 304 110 51 140 535 10 11 12 18 139 138 139 138 52 51 140 141 53 51 140 141 74 51 140 141 54 51 140 141 75 51 140 141 55 51 140 141 556 51 140 141 56 51 140 141 57 51 140 141 58 51 140 141 76 51 140 141 59 51 140 141 60 51 140 141 61 51 140 141 62 51 140 141 63 51 140 141 64 51 140 141 65 51 140 141 77 51 140 141 66 51 140 141 67 51 140 141 78 140 141 68 140 141 79 51 140 141 80 51 140 141 69 51 140 141 81 51 140 141 70 51 140 141 82 51 140 141 71 51 140 141 72 51 140 141 72 51 140 141 73 51 140 141 83 557 140 593 598 84 51 140 593 598 85 51 140 593 598 86 51 140 593 598 87 51 140 593 598 555 51 140 141 88 557 593 598 21 22 139 138 139 138 113 51 140 141 114 51 140 141 115 51 140 141 13 139 138 139 138 110 382 140 141 111 112 14 139 138 139 138 101 382 140 141 102 382 140 141 103 382 140 141 104 382 140 141 105 382 140 141 106 382 140 141 107 382 140 141 108 382 140 141 109 382 140 141 15 5 16 558 51 140 593 598 559 51 140 593 598 560 51 140 593 598 561 564 140 593 598 562 564 140 593 598 563 564 140 593 598 5 17 89 422 90 91 92 93 94 95 374 140 594 598 96 97 98 5 523 595 599 600

6 9 99 139 138 139 138 146 118 51 140 145 147 141 119 51 140 145 147 141 120 51 140 145 147 141 121 51 140 145 147 141 117 51 140 577 147 141 572 5 122 51 140 577 147 141 572 123 51 140 578 147 141 596 124 51 140 578 147 141 596 125 51 140 578 147 141 596 126 51 140 578 147 141 596 127 51 140 578 147 141 596 5 128 51 140 578 147 141 596 129 51 140 443 147 141 596 130 51 140 579 147 141 596 131 51 142 141 147 141 132 51 142 141 147 141 133 51 142 141 147 141 134 51 142 141 147 141 135 51 142 141 147 141 136 51 142 141 147 141 137 51 142 141 147 141 19 139 138 139 138 23 51 140 141 147 141 24 51 140 141 147 141 143 144 140 141 147 141 25 51 140 141 147 141 26 51 140 141 147 141 27 51 140 141 147 141 28 51 140 141 147 141 29 51 140 141 147 141 30 51 140 141 147 141 31 148 140 580 147 141 32 51 140 580 147 141 33 51 140 141 147 141 34 51 140 141 147 141 35 51 140 141 147 141 36 51 140 141 147 141 37 51 140 141 147 141 38 51 140 141 147 141 39 51 140 141 147 141 20 139 138 139 138 40 41 42 43 51 140 581 573 44 45 51 140 581 573 46 47 51 140 582 574 48 49 51 140 582 574 446 544 444 140 453 545 444 140 454 546 444 140 455 547 444 140 456 548 444 140 447 549 444 140 448 550 444 140 449 551 444 140 450 552 444 140 451 553 444 140 452 554 444 140 149 50 444 140 445 5 100 139 138 139 138 323 148 140 583 573 325 148 140 583 573 326 148 140 583 573 327 148 140 583 573 328 148 140 583 573 324 148 140 332 573 329 148 140 330 575 331 148 140 333 575 159 334 51 140 141 575 160 335 51 140 141 575 161 336 51 140 141 575 337 51 140 141 575 338 51 140 141 575 339 51 140 141 575 340 51 140 141 575 341 51 140 141 575 342 51 140 141 575 343 51 140 141 575 344 51 140 141 575 345 51 140 141 575 346 51 140 141 575 347 51 140 141 575 348 51 140 141 575 162 349 51 140 141 575 163 350 51 140 141 575 164 351 51 140 141 575 156 565 51 140 584 573 157 352 51 140 585 573 158 353 51 140 585 573 165 354 51 140 141 575 166 355 51 140 141 575 167 357 51 140 141 575 168 356 51 140 141 575 169 358 51 140 141 575 170 359 51 140 141 575 171 360 51 140 457 576 172 361 51 140 141 575 601 324 51 140 141 575 311 362 51 140 141 575 305 308 51 140 586 573 173 363 51 140 141 575 309 310 51 140 141 575 312 364 51 140 141 575 313 365 51 140 141 575 314 366 51 140 141 575 306 307 51 140 586 573 315 367 51 140 586 573 174 368 51 140 141 175 369 51 140 587 573 176 177 51 140 587 573 178 370 51 140 587 573 179 371 51 140 587 573 180 372 51 140 587 573 181 373 51 140 141 182 375 382 140 588 573 376 382 140 588 573 377 382 140 588 573 378 382 140 588 573 379 382 140 588 573 380 382 140 588 573 381 382 140 588 573 381 51 140 141 183 383 51 140 141 184 384 51 140 141 185 385 51 140 141 186 386 51 140 141 387 331 51 140 589 573 187 388 51 140 588 573 188 389 51 140 588 573 189 390 51 140 588 573 190 391 51 140 141 191 392 374 140 141 192 393 51 140 141 193 394 382 140 141 194 395 51 140 141 195 396 374 140 141 196 397 374 140 141 197 398 374 140 141 198 399 374 140 141 199 400 374 140 141 200 401 374 140 141 201 402 374 140 141 202 403 374 140 141 203 404 374 140 141 204 405 374 140 141 205 406 51 140 141 206 407 51 140 141 207 408 51 140 141 208 409 51 140 141 209 410 51 140 141 210 411 51 140 141 211 412 51 140 141 212 413 51 140 141 213 414 51 140 141 214 415 51 140 141 215 416 51 140 141 216 417 51 140 141 217 418 51 140 419 147 420 597 320 421 51 140 590 566 567 150 113 51 140 141 321 114 382 140 590 147 141 567 322 115 51 140 590 566 567 151 435 51 140 141 152 436 51 140 141 424 429 51 140 141 425 430 51 140 141 426 431 51 140 440 568 439 438 51 140 440 568 427 432 51 140 141 153 428 51 140 141 154 434 51 140 141 155 437 51 140 141 423 433 51 140 441 218 442 51 140 441 219 458 51 140 441 220 459 51 140 441 221 460 51 140 441 222 461 51 140 441 223 462 51 140 441 224 463 51 140 441 225 464 51 140 441 226 465 51 140 441 227 466 51 140 441 316 467 51 140 441 317 468 51 140 441 318 469 51 140 441 319 470 51 140 441 228 471 51 140 441 229 472 51 140 441 230 473 51 140 441 536 540 51 140 441 231 474 51 140 441 232 475 51 140 441 233 476 51 140 441 234 477 51 140 441 235 478 51 140 591 5 569 236 479 51 140 141 237 480 51 140 141 238 101 51 140 141 239 102 51 140 141 240 103 51 140 141 241 104 51 140 141 242 105 51 140 141 243 106 51 140 141 244 107 51 140 141 245 108 51 140 141 246 109 51 140 141 247 481 382 140 141 248 482 382 140 141 249 483 382 140 141 250 484 382 140 141 251 485 382 140 141 252 486 382 140 141 253 487 382 140 141 254 89 382 140 141 255 488 382 140 141 256 90 382 140 141 257 489 382 140 141 258 92 382 140 141 259 490 382 140 141 260 491 382 140 141 261 492 382 140 141 262 493 382 140 141 263 494 382 140 141 264 495 382 140 141 265 496 382 140 141 266 498 497 570 267 499 382 140 141 268 500 382 140 141 269 501 382 140 141 270 502 382 140 141 271 503 382 140 141 272 504 382 140 141 273 505 382 140 141 274 96 382 140 141 275 97 382 140 141 276 506 382 140 141 277 98 382 140 141 278 507 51 140 592 569 279 508 51 140 592 569 280 509 382 140 141 281 510 382 140 141 282 511 382 140 141 283 512 382 140 141 537 541 382 140 141 538 542 382 140 141 539 543 382 140 141 284 513 382 140 141 285 514 382 140 141 286 515 382 140 141 287 516 382 140 141 288 517 382 140 141 289 518 382 140 141 290 519 51 140 141 291 520 51 140 141 292 521 51 140 141 293 522 51 140 141 294 524 51 140 591 571 295 525 51 140 591 571 296 526 51 140 141 297 527 51 140 141 298 528 51 140 141 299 529 51 140 141 300 530 51 140 141 301 531 51 140 141 302 532 51 140 141 303 533 51 140 534 304 110 51 140 535 10 11 12 18 139 138 139 138 52 51 140 141 53 51 140 141 74 51 140 141 54 51 140 141 75 51 140 141 55 51 140 141 556 51 140 141 56 51 140 141 57 51 140 141 58 51 140 141 76 51 140 141 59 51 140 141 60 51 140 141 61 51 140 141 62 51 140 141 63 51 140 141 64 51 140 141 65 51 140 141 77 51 140 141 66 51 140 141 67 51 140 141 78 140 141 68 140 141 79 51 140 141 80 51 140 141 69 51 140 141 81 51 140 141 70 51 140 141 82 51 140 141 71 51 140 141 72 51 140 141 72 51 140 141 73 51 140 141 83 557 140 593 598 84 51 140 593 598 85 51 140 593 598 86 51 140 593 598 87 51 140 593 598 555 51 140 141 88 557 593 598 21 22 139 138 139 138 113 51 140 141 114 51 140 141 115 51 140 141 13 139 138 139 138 110 382 140 141 111 112 14 139 138 139 138 101 382 140 141 102 382 140 141 103 382 140 141 104 382 140 141 105 382 140 141 106 382 140 141 107 382 140 141 108 382 140 141 109 382 140 141 15 5 16 558 51 140 593 598 559 51 140 593 598 560 51 140 593 598 561 564 140 593 598 562 564 140 593 598 563 564 140 593 598 5 17 89 422 90 91 92 93 94 95 374 140 594 598 96 97 98 5 523 595 599 600

6 9 99 139 138 139 138 146 118 51 140 145 147 141 119 51 140 145 147 141 120 51 140 145 147 141 121 51 140 145 147 141 117 51 140 577 147 141 572 5 122 51 140 577 147 141 572 123 51 140 578 147 141 596 124 51 140 578 147 141 596 125 51 140 578 147 141 596 126 51 140 578 147 141 596 127 51 140 578 147 141 596 5 128 51 140 578 147 141 596 129 51 140 443 147 141 596 130 51 140 579 147 141 596 131 51 142 141 147 141 132 51 142 141 147 141 133 51 142 141 147 141 134 51 142 141 147 141 135 51 142 141 147 141 136 51 142 141 147 141 137 51 142 141 147 141 19 139 138 139 138 23 51 140 141 147 141 24 51 140 141 147 141 143 144 140 141 147 141 25 51 140 141 147 141 26 51 140 141 147 141 27 51 140 141 147 141 28 51 140 141 147 141 29 51 140 141 147 141 30 51 140 141 147 141 31 148 140 580 147 141 32 51 140 580 147 141 33 51 140 141 147 141 34 51 140 141 147 141 35 51 140 141 147 141 36 51 140 141 147 141 37 51 140 141 147 141 38 51 140 141 147 141 39 51 140 141 147 141 20 139 138 139 138 40 41 42 43 51 140 581 573 44 45 51 140 581 573 46 47 51 140 582 574 48 49 51 140 582 574 446 544 444 140 453 545 444 140 454 546 444 140 455 547 444 140 456 548 444 140 447 549 444 140 448 550 444 140 449 551 444 140 450 552 444 140 451 553 444 140 452 554 444 140 149 50 444 140 445 5 100 139 138 139 138 323 148 140 583 573 325 148 140 583 573 326 148 140 583 573 327 148 140 583 573 328 148 140 583 573 324 148 140 332 573 329 148 140 330 575 331 148 140 333 575 159 334 51 140 141 575 160 335 51 140 141 575 161 336 51 140 141 575 337 51 140 141 575 338 51 140 141 575 339 51 140 141 575 340 51 140 141 575 341 51 140 141 575 342 51 140 141 575 343 51 140 141 575 344 51 140 141 575 345 51 140 141 575 346 51 140 141 575 347 51 140 141 575 348 51 140 141 575 162 349 51 140 141 575 163 350 51 140 141 575 164 351 51 140 141 575 156 565 51 140 584 573 157 352 51 140 585 573 158 353 51 140 585 573 165 354 51 140 141 575 166 355 51 140 141 575 167 357 51 140 141 575 168 356 51 140 141 575 169 358 51 140 141 575 170 359 51 140 141 575 171 360 51 140 457 576 172 361 51 140 141 575 601 324 51 140 141 575 311 362 51 140 141 575 305 308 51 140 586 573 173 363 51 140 141 575 309 310 51 140 141 575 312 364 51 140 141 575 313 365 51 140 141 575 314 366 51 140 141 575 306 307 51 140 586 573 315 367 51 140 586 573 174 368 51 140 141 175 369 51 140 587 573 176 177 51 140 587 573 178 370 51 140 587 573 179 371 51 140 587 573 180 372 51 140 587 573 181 373 51 140 141 182 375 382 140 588 573 376 382 140 588 573 377 382 140 588 573 378 382 140 588 573 379 382 140 588 573 380 382 140 588 573 381 382 140 588 573 381 51 140 141 183 383 51 140 141 184 384 51 140 141 185 385 51 140 141 186 386 51 140 141 387 331 51 140 589 573 187 388 51 140 588 573 188 389 51 140 588 573 189 390 51 140 588 573 190 391 51 140 141 191 392 374 140 141 192 393 51 140 141 193 394 382 140 141 194 395 51 140 141 195 396 374 140 141 196 397 374 140 141 197 398 374 140 141 198 399 374 140 141 199 400 374 140 141 200 401 374 140 141 201 402 374 140 141 202 403 374 140 141 203 404 374 140 141 204 405 374 140 141 205 406 51 140 141 206 407 51 140 141 207 408 51 140 141 208 409 51 140 141 209 410 51 140 141 210 411 51 140 141 211 412 51 140 141 212 413 51 140 141 213 414 51 140 141 214 415 51 140 141 215 416 51 140 141 216 417 51 140 141 217 418 51 140 419 147 420 597 320 421 51 140 590 566 567 150 113 51 140 141 321 114 382 140 590 147 141 567 322 115 51 140 590 566 567 151 435 51 140 141 152 436 51 140 141 424 429 51 140 141 425 430 51 140 141 426 431 51 140 440 568 439 438 51 140 440 568 427 432 51 140 141 153 428 51 140 141 154 434 51 140 141 155 437 51 140 141 423 433 51 140 441 218 442 51 140 441 219 458 51 140 441 220 459 51 140 441 221 460 51 140 441 222 461 51 140 441 223 462 51 140 441 224 463 51 140 441 225 464 51 140 441 226 465 51 140 441 227 466 51 140 441 316 467 51 140 441 317 468 51 140 441 318 469 51 140 441 319 470 51 140 441 228 471 51 140 441 229 472 51 140 441 230 473 51 140 441 536 540 51 140 441 231 474 51 140 441 232 475 51 140 441 233 476 51 140 441 234 477 51 140 441 235 478 51 140 591 5 569 236 479 51 140 141 237 480 51 140 141 238 101 51 140 141 239 102 51 140 141 240 103 51 140 141 241 104 51 140 141 242 105 51 140 141 243 106 51 140 141 244 107 51 140 141 245 108 51 140 141 246 109 51 140 141 247 481 382 140 141 248 482 382 140 141 249 483 382 140 141 250 484 382 140 141 251 485 382 140 141 252 486 382 140 141 253 487 382 140 141 254 89 382 140 141 255 488 382 140 141 256 90 382 140 141 257 489 382 140 141 258 92 382 140 141 259 490 382 140 141 260 491 382 140 141 261 492 382 140 141 262 493 382 140 141 263 494 382 140 141 264 495 382 140 141 265 496 382 140 141 266 498 497 570 267 499 382 140 141 268 500 382 140 141 269 501 382 140 141 270 502 382 140 141 271 503 382 140 141 272 504 382 140 141 273 505 382 140 141 274 96 382 140 141 275 97 382 140 141 276 506 382 140 141 277 98 382 140 141 278 507 51 140 592 569 279 508 51 140 592 569 280 509 382 140 141 281 510 382 140 141 282 511 382 140 141 283 512 382 140 141 537 541 382 140 141 538 542 382 140 141 539 543 382 140 141 284 513 382 140 141 285 514 382 140 141 286 515 382 140 141 287 516 382 140 141 288 517 382 140 141 289 518 382 140 141 290 519 51 140 141 291 520 51 140 141 292 521 51 140 141 293 522 51 140 141 294 524 51 140 591 571 295 525 51 140 591 571 296 526 51 140 141 297 527 51 140 141 298 528 51 140 141 299 529 51 140 141 300 530 51 140 141 301 531 51 140 141 302 532 51 140 141 303 533 51 140 534 304 110 51 140 535 10 11 12 18 139 138 139 138 52 51 140 141 53 51 140 141 74 51 140 141 54 51 140 141 75 51 140 141 55 51 140 141 556 51 140 141 56 51 140 141 57 51 140 141 58 51 140 141 76 51 140 141 59 51 140 141 60 51 140 141 61 51 140 141 62 51 140 141 63 51 140 141 64 51 140 141 65 51 140 141 77 51 140 141 66 51 140 141 67 51 140 141 78 140 141 68 140 141 79 51 140 141 80 51 140 141 69 51 140 141 81 51 140 141 70 51 140 141 82 51 140 141 71 51 140 141 72 51 140 141 72 51 140 141 73 51 140 141 83 557 140 593 598 84 51 140 593 598 85 51 140 593 598 86 51 140 593 598 87 51 140 593 598 555 51 140 141 88 557 593 598 21 22 139 138 139 138 113 51 140 141 114 51 140 141 115 51 140 141 13 139 138 139 138 110 382 140 141 111 112 14 139 138 139 138 101 382 140 141 102 382 140 141 103 382 140 141 104 382 140 141 105 382 140 141 106 382 140 141 107 382 140 141 108 382 140 141 109 382 140 141 15 5 16 558 51 140 593 598 559 51 140 593 598 560 51 140 593 598 561 564 140 593 598 562 564 140 593 598 563 564 140 593 598 5 17 89 422 90 91 92 93 94 95 374 140 594 598 96 97 98 5 523 595 599 600

6 9 99 139 138 139 138 146 118 51 140 145 147 141 119 51 140 145 147 141 120 51 140 145 147 141 121 51 140 145 147 141 117 51 140 577 147 141 572 5 122 51 140 577 147 141 572 123 51 140 578 147 141 596 124 51 140 578 147 141 596 125 51 140 578 147 141 596 126 51 140 578 147 141 596 127 51 140 578 147 141 596 5 128 51 140 578 147 141 596 129 51 140 443 147 141 596 130 51 140 579 147 141 596 131 51 142 141 147 141 132 51 142 141 147 141 133 51 142 141 147 141 134 51 142 141 147 141 135 51 142 141 147 141 136 51 142 141 147 141 137 51 142 141 147 141 19 139 138 139 138 23 51 140 141 147 141 24 51 140 141 147 141 143 144 140 141 147 141 25 51 140 141 147 141 26 51 140 141 147 141 27 51 140 141 147 141 28 51 140 141 147 141 29 51 140 141 147 141 30 51 140 141 147 141 31 148 140 580 147 141 32 51 140 580 147 141 33 51 140 141 147 141 34 51 140 141 147 141 35 51 140 141 147 141 36 51 140 141 147 141 37 51 140 141 147 141 38 51 140 141 147 141 39 51 140 141 147 141 20 139 138 139 138 40 41 42 43 51 140 581 573 44 45 51 140 581 573 46 47 51 140 582 574 48 49 51 140 582 574 446 544 444 140 453 545 444 140 454 546 444 140 455 547 444 140 456 548 444 140 447 549 444 140 448 550 444 140 449 551 444 140 450 552 444 140 451 553 444 140 452 554 444 140 149 50 444 140 445 5 100 139 138 139 138 323 148 140 583 573 325 148 140 583 573 326 148 140 583 573 327 148 140 583 573 328 148 140 583 573 324 148 140 332 573 329 148 140 330 575 331 148 140 333 575 159 334 51 140 141 575 160 335 51 140 141 575 161 336 51 140 141 575 337 51 140 141 575 338 51 140 141 575 339 51 140 141 575 340 51 140 141 575 341 51 140 141 575 342 51 140 141 575 343 51 140 141 575 344 51 140 141 575 345 51 140 141 575 346 51 140 141 575 347 51 140 141 575 348 51 140 141 575 162 349 51 140 141 575 163 350 51 140 141 575 164 351 51 140 141 575 156 565 51 140 584 573 157 352 51 140 585 573 158 353 51 140 585 573 165 354 51 140 141 575 166 355 51 140 141 575 167 357 51 140 141 575 168 356 51 140 141 575 169 358 51 140 141 575 170 359 51 140 141 575 171 360 51 140 457 576 172 361 51 140 141 575 601 324 51 140 141 575 311 362 51 140 141 575 305 308 51 140 586 573 173 363 51 140 141 575 309 310 51 140 141 575 312 364 51 140 141 575 313 365 51 140 141 575 314 366 51 140 141 575 306 307 51 140 586 573 315 367 51 140 586 573 174 368 51 140 141 175 369 51 140 587 573 176 177 51 140 587 573 178 370 51 140 587 573 179 371 51 140 587 573 180 372 51 140 587 573 181 373 51 140 141 182 375 382 140 588 573 376 382 140 588 573 377 382 140 588 573 378 382 140 588 573 379 382 140 588 573 380 382 140 588 573 381 382 140 588 573 381 51 140 141 183 383 51 140 141 184 384 51 140 141 185 385 51 140 141 186 386 51 140 141 387 331 51 140 589 573 187 388 51 140 588 573 188 389 51 140 588 573 189 390 51 140 588 573 190 391 51 140 141 191 392 374 140 141 192 393 51 140 141 193 394 382 140 141 194 395 51 140 141 195 396 374 140 141 196 397 374 140 141 197 398 374 140 141 198 399 374 140 141 199 400 374 140 141 200 401 374 140 141 201 402 374 140 141 202 403 374 140 141 203 404 374 140 141 204 405 374 140 141 205 406 51 140 141 206 407 51 140 141 207 408 51 140 141 208 409 51 140 141 209 410 51 140 141 210 411 51 140 141 211 412 51 140 141 212 413 51 140 141 213 414 51 140 141 214 415 51 140 141 215 416 51 140 141 216 417 51 140 141 217 418 51 140 419 147 420 597 320 421 51 140 590 566 567 150 113 51 140 141 321 114 382 140 590 147 141 567 322 115 51 140 590 566 567 151 435 51 140 141 152 436 51 140 141 424 429 51 140 141 425 430 51 140 141 426 431 51 140 440 568 439 438 51 140 440 568 427 432 51 140 141 153 428 51 140 141 154 434 51 140 141 155 437 51 140 141 423 433 51 140 441 218 442 51 140 441 219 458 51 140 441 220 459 51 140 441 221 460 51 140 441 222 461 51 140 441 223 462 51 140 441 224 463 51 140 441 225 464 51 140 441 226 465 51 140 441 227 466 51 140 441 316 467 51 140 441 317 468 51 140 441 318 469 51 140 441 319 470 51 140 441 228 471 51 140 441 229 472 51 140 441 230 473 51 140 441 536 540 51 140 441 231 474 51 140 441 232 475 51 140 441 233 476 51 140 441 234 477 51 140 441 235 478 51 140 591 5 569 236 479 51 140 141 237 480 51 140 141 238 101 51 140 141 239 102 51 140 141 240 103 51 140 141 241 104 51 140 141 242 105 51 140 141 243 106 51 140 141 244 107 51 140 141 245 108 51 140 141 246 109 51 140 141 247 481 382 140 141 248 482 382 140 141 249 483 382 140 141 250 484 382 140 141 251 485 382 140 141 252 486 382 140 141 253 487 382 140 141 254 89 382 140 141 255 488 382 140 141 256 90 382 140 141 257 489 382 140 141 258 92 382 140 141 259 490 382 140 141 260 491 382 140 141 261 492 382 140 141 262 493 382 140 141 263 494 382 140 141 264 495 382 140 141 265 496 382 140 141 266 498 497 570 267 499 382 140 141 268 500 382 140 141 269 501 382 140 141 270 502 382 140 141 271 503 382 140 141 272 504 382 140 141 273 505 382 140 141 274 96 382 140 141 275 97 382 140 141 276 506 382 140 141 277 98 382 140 141 278 507 51 140 592 569 279 508 51 140 592 569 280 509 382 140 141 281 510 382 140 141 282 511 382 140 141 283 512 382 140 141 537 541 382 140 141 538 542 382 140 141 539 543 382 140 141 284 513 382 140 141 285 514 382 140 141 286 515 382 140 141 287 516 382 140 141 288 517 382 140 141 289 518 382 140 141 290 519 51 140 141 291 520 51 140 141 292 521 51 140 141 293 522 51 140 141 294 524 51 140 591 571 295 525 51 140 591 571 296 526 51 140 141 297 527 51 140 141 298 528 51 140 141 299 529 51 140 141 300 530 51 140 141 301 531 51 140 141 302 532 51 140 141 303 533 51 140 534 304 110 51 140 535 10 11 12 18 139 138 139 138 52 51 140 141 53 51 140 141 74 51 140 141 54 51 140 141 75 51 140 141 55 51 140 141 556 51 140 141 56 51 140 141 57 51 140 141 58 51 140 141 76 51 140 141 59 51 140 141 60 51 140 141 61 51 140 141 62 51 140 141 63 51 140 141 64 51 140 141 65 51 140 141 77 51 140 141 66 51 140 141 67 51 140 141 78 140 141 68 140 141 79 51 140 141 80 51 140 141 69 51 140 141 81 51 140 141 70 51 140 141 82 51 140 141 71 51 140 141 72 51 140 141 72 51 140 141 73 51 140 141 83 557 140 593 598 84 51 140 593 598 85 51 140 593 598 86 51 140 593 598 87 51 140 593 598 555 51 140 141 88 557 593 598 21 22 139 138 139 138 113 51 140 141 114 51 140 141 115 51 140 141 13 139 138 139 138 110 382 140 141 111 112 14 139 138 139 138 101 382 140 141 102 382 140 141 103 382 140 141 104 382 140 141 105 382 140 141 106 382 140 141 107 382 140 141 108 382 140 141 109 382 140 141 15 5 16 558 51 140 593 598 559 51 140 593 598 560 51 140 593 598 561 564 140 593 598 562 564 140 593 598 563 564 140 593 598 5 17 89 422 90 91 92 93 94 95 374 140 594 598 96 97 98 5 523 595 599 600

6 9 99 139 138 139 138 146 118 51 140 145 147 141 119 51 140 145 147 141 120 51 140 145 147 141 121 51 140 145 147 141 117 51 140 577 147 141 572 5 122 51 140 577 147 141 572 123 51 140 578 147 141 596 124 51 140 578 147 141 596 125 51 140 578 147 141 596 126 51 140 578 147 141 596 127 51 140 578 147 141 596 5 128 51 140 578 147 141 596 129 51 140 443 147 141 596 130 51 140 579 147 141 596 131 51 142 141 147 141 132 51 142 141 147 141 133 51 142 141 147 141 134 51 142 141 147 141 135 51 142 141 147 141 136 51 142 141 147 141 137 51 142 141 147 141 19 139 138 139 138 23 51 140 141 147 141 24 51 140 141 147 141 143 144 140 141 147 141 25 51 140 141 147 141 26 51 140 141 147 141 27 51 140 141 147 141 28 51 140 141 147 141 29 51 140 141 147 141 30 51 140 141 147 141 31 148 140 580 147 141 32 51 140 580 147 141 33 51 140 141 147 141 34 51 140 141 147 141 35 51 140 141 147 141 36 51 140 141 147 141 37 51 140 141 147 141 38 51 140 141 147 141 39 51 140 141 147 141 20 139 138 139 138 40 41 42 43 51 140 581 573 44 45 51 140 581 573 46 47 51 140 582 574 48 49 51 140 582 574 446 544 444 140 453 545 444 140 454 546 444 140 455 547 444 140 456 548 444 140 447 549 444 140 448 550 444 140 449 551 444 140 450 552 444 140 451 553 444 140 452 554 444 140 149 50 444 140 445 5 100 139 138 139 138 323 148 140 583 573 325 148 140 583 573 326 148 140 583 573 327 148 140 583 573 328 148 140 583 573 324 148 140 332 573 329 148 140 330 575 331 148 140 333 575 159 334 51 140 141 575 160 335 51 140 141 575 161 336 51 140 141 575 337 51 140 141 575 338 51 140 141 575 339 51 140 141 575 340 51 140 141 575 341 51 140 141 575 342 51 140 141 575 343 51 140 141 575 344 51 140 141 575 345 51 140 141 575 346 51 140 141 575 347 51 140 141 575 348 51 140 141 575 162 349 51 140 141 575 163 350 51 140 141 575 164 351 51 140 141 575 156 565 51 140 584 573 157 352 51 140 585 573 158 353 51 140 585 573 165 354 51 140 141 575 166 355 51 140 141 575 167 357 51 140 141 575 168 356 51 140 141 575 169 358 51 140 141 575 170 359 51 140 141 575 171 360 51 140 457 576 172 361 51 140 141 575 601 324 51 140 141 575 311 362 51 140 141 575 305 308 51 140 586 573 173 363 51 140 141 575 309 310 51 140 141 575 312 364 51 140 141 575 313 365 51 140 141 575 314 366 51 140 141 575 306 307 51 140 586 573 315 367 51 140 586 573 174 368 51 140 141 175 369 51 140 587 573 176 177 51 140 587 573 178 370 51 140 587 573 179 371 51 140 587 573 180 372 51 140 587 573 181 373 51 140 141 182 375 382 140 588 573 376 382 140 588 573 377 382 140 588 573 378 382 140 588 573 379 382 140 588 573 380 382 140 588 573 381 382 140 588 573 381 51 140 141 183 383 51 140 141 184 384 51 140 141 185 385 51 140 141 186 386 51 140 141 387 331 51 140 589 573 187 388 51 140 588 573 188 389 51 140 588 573 189 390 51 140 588 573 190 391 51 140 141 191 392 374 140 141 192 393 51 140 141 193 394 382 140 141 194 395 51 140 141 195 396 374 140 141 196 397 374 140 141 197 398 374 140 141 198 399 374 140 141 199 400 374 140 141 200 401 374 140 141 201 402 374 140 141 202 403 374 140 141 203 404 374 140 141 204 405 374 140 141 205 406 51 140 141 206 407 51 140 141 207 408 51 140 141 208 409 51 140 141 209 410 51 140 141 210 411 51 140 141 211 412 51 140 141 212 413 51 140 141 213 414 51 140 141 214 415 51 140 141 215 416 51 140 141 216 417 51 140 141 217 418 51 140 419 147 420 597 320 421 51 140 590 566 567 150 113 51 140 141 321 114 382 140 590 147 141 567 322 115 51 140 590 566 567 151 435 51 140 141 152 436 51 140 141 424 429 51 140 141 425 430 51 140 141 426 431 51 140 440 568 439 438 51 140 440 568 427 432 51 140 141 153 428 51 140 141 154 434 51 140 141 155 437 51 140 141 423 433 51 140 441 218 442 51 140 441 219 458 51 140 441 220 459 51 140 441 221 460 51 140 441 222 461 51 140 441 223 462 51 140 441 224 463 51 140 441 225 464 51 140 441 226 465 51 140 441 227 466 51 140 441 316 467 51 140 441 317 468 51 140 441 318 469 51 140 441 319 470 51 140 441 228 471 51 140 441 229 472 51 140 441 230 473 51 140 441 536 540 51 140 441 231 474 51 140 441 232 475 51 140 441 233 476 51 140 441 234 477 51 140 441 235 478 51 140 591 5 569 236 479 51 140 141 237 480 51 140 141 238 101 51 140 141 239 102 51 140 141 240 103 51 140 141 241 104 51 140 141 242 105 51 140 141 243 106 51 140 141 244 107 51 140 141 245 108 51 140 141 246 109 51 140 141 247 481 382 140 141 248 482 382 140 141 249 483 382 140 141 250 484 382 140 141 251 485 382 140 141 252 486 382 140 141 253 487 382 140 141 254 89 382 140 141 255 488 382 140 141 256 90 382 140 141 257 489 382 140 141 258 92 382 140 141 259 490 382 140 141 260 491 382 140 141 261 492 382 140 141 262 493 382 140 141 263 494 382 140 141 264 495 382 140 141 265 496 382 140 141 266 498 497 570 267 499 382 140 141 268 500 382 140 141 269 501 382 140 141 270 502 382 140 141 271 503 382 140 141 272 504 382 140 141 273 505 382 140 141 274 96 382 140 141 275 97 382 140 141 276 506 382 140 141 277 98 382 140 141 278 507 51 140 592 569 279 508 51 140 592 569 280 509 382 140 141 281 510 382 140 141 282 511 382 140 141 283 512 382 140 141 537 541 382 140 141 538 542 382 140 141 539 543 382 140 141 284 513 382 140 141 285 514 382 140 141 286 515 382 140 141 287 516 382 140 141 288 517 382 140 141 289 518 382 140 141 290 519 51 140 141 291 520 51 140 141 292 521 51 140 141 293 522 51 140 141 294 524 51 140 591 571 295 525 51 140 591 571 296 526 51 140 141 297 527 51 140 141 298 528 51 140 141 299 529 51 140 141 300 530 51 140 141 301 531 51 140 141 302 532 51 140 141 303 533 51 140 534 304 110 51 140 535 10 11 12 18 139 138 139 138 52 51 140 141 53 51 140 141 74 51 140 141 54 51 140 141 75 51 140 141 55 51 140 141 556 51 140 141 56 51 140 141 57 51 140 141 58 51 140 141 76 51 140 141 59 51 140 141 60 51 140 141 61 51 140 141 62 51 140 141 63 51 140 141 64 51 140 141 65 51 140 141 77 51 140 141 66 51 140 141 67 51 140 141 78 140 141 68 140 141 79 51 140 141 80 51 140 141 69 51 140 141 81 51 140 141 70 51 140 141 82 51 140 141 71 51 140 141 72 51 140 141 72 51 140 141 73 51 140 141 83 557 140 593 598 84 51 140 593 598 85 51 140 593 598 86 51 140 593 598 87 51 140 593 598 555 51 140 141 88 557 593 598 21 22 139 138 139 138 113 51 140 141 114 51 140 141 115 51 140 141 13 139 138 139 138 110 382 140 141 111 112 14 139 138 139 138 101 382 140 141 102 382 140 141 103 382 140 141 104 382 140 141 105 382 140 141 106 382 140 141 107 382 140 141 108 382 140 141 109 382 140 141 15 5 16 558 51 140 593 598 559 51 140 593 598 560 51 140 593 598 561 564 140 593 598 562 564 140 593 598 563 564 140 593 598 5 17 89 422 90 91 92 93 94 95 374 140 594 598 96 97 98 5 523 595 599 600

6 9 99 139 138 139 138 146 118 51 140 145 147 141 119 51 140 145 147 141 120 51 140 145 147 141 121 51 140 145 147 141 117 51 140 577 147 141 572 5 122 51 140 577 147 141 572 123 51 140 578 147 141 596 124 51 140 578 147 141 596 125 51 140 578 147 141 596 126 51 140 578 147 141 596 127 51 140 578 147 141 596 5 128 51 140 578 147 141 596 129 51 140 443 147 141 596 130 51 140 579 147 141 596 131 51 142 141 147 141 132 51 142 141 147 141 133 51 142 141 147 141 134 51 142 141 147 141 135 51 142 141 147 141 136 51 142 141 147 141 137 51 142 141 147 141 19 139 138 139 138 23 51 140 141 147 141 24 51 140 141 147 141 143 144 140 141 147 141 25 51 140 141 147 141 26 51 140 141 147 141 27 51 140 141 147 141 28 51 140 141 147 141 29 51 140 141 147 141 30 51 140 141 147 141 31 148 140 580 147 141 32 51 140 580 147 141 33 51 140 141 147 141 34 51 140 141 147 141 35 51 140 141 147 141 36 51 140 141 147 141 37 51 140 141 147 141 38 51 140 141 147 141 39 51 140 141 147 141 20 139 138 139 138 40 41 42 43 51 140 581 573 44 45 51 140 581 573 46 47 51 140 582 574 48 49 51 140 582 574 446 544 444 140 453 545 444 140 454 546 444 140 455 547 444 140 456 548 444 140 447 549 444 140 448 550 444 140 449 551 444 140 450 552 444 140 451 553 444 140 452 554 444 140 149 50 444 140 445 5 100 139 138 139 138 323 148 140 583 573 325 148 140 583 573 326 148 140 583 573 327 148 140 583 573 328 148 140 583 573 324 148 140 332 573 329 148 140 330 575 331 148 140 333 575 159 334 51 140 141 575 160 335 51 140 141 575 161 336 51 140 141 575 337 51 140 141 575 338 51 140 141 575 339 51 140 141 575 340 51 140 141 575 341 51 140 141 575 342 51 140 141 575 343 51 140 141 575 344 51 140 141 575 345 51 140 141 575 346 51 140 141 575 347 51 140 141 575 348 51 140 141 575 162 349 51 140 141 575 163 350 51 140 141 575 164 351 51 140 141 575 156 565 51 140 584 573 157 352 51 140 585 573 158 353 51 140 585 573 165 354 51 140 141 575 166 355 51 140 141 575 167 357 51 140 141 575 168 356 51 140 141 575 169 358 51 140 141 575 170 359 51 140 141 575 171 360 51 140 457 576 172 361 51 140 141 575 601 324 51 140 141 575 311 362 51 140 141 575 305 308 51 140 586 573 173 363 51 140 141 575 309 310 51 140 141 575 312 364 51 140 141 575 313 365 51 140 141 575 314 366 51 140 141 575 306 307 51 140 586 573 315 367 51 140 586 573 174 368 51 140 141 175 369 51 140 587 573 176 177 51 140 587 573 178 370 51 140 587 573 179 371 51 140 587 573 180 372 51 140 587 573 181 373 51 140 141 182 375 382 140 588 573 376 382 140 588 573 377 382 140 588 573 378 382 140 588 573 379 382 140 588 573 380 382 140 588 573 381 382 140 588 573 381 51 140 141 183 383 51 140 141 184 384 51 140 141 185 385 51 140 141 186 386 51 140 141 387 331 51 140 589 573 187 388 51 140 588 573 188 389 51 140 588 573 189 390 51 140 588 573 190 391 51 140 141 191 392 374 140 141 192 393 51 140 141 193 394 382 140 141 194 395 51 140 141 195 396 374 140 141 196 397 374 140 141 197 398 374 140 141 198 399 374 140 141 199 400 374 140 141 200 401 374 140 141 201 402 374 140 141 202 403 374 140 141 203 404 374 140 141 204 405 374 140 141 205 406 51 140 141 206 407 51 140 141 207 408 51 140 141 208 409 51 140 141 209 410 51 140 141 210 411 51 140 141 211 412 51 140 141 212 413 51 140 141 213 414 51 140 141 214 415 51 140 141 215 416 51 140 141 216 417 51 140 141 217 418 51 140 419 147 420 597 320 421 51 140 590 566 567 150 113 51 140 141 321 114 382 140 590 147 141 567 322 115 51 140 590 566 567 151 435 51 140 141 152 436 51 140 141 424 429 51 140 141 425 430 51 140 141 426 431 51 140 440 568 439 438 51 140 440 568 427 432 51 140 141 153 428 51 140 141 154 434 51 140 141 155 437 51 140 141 423 433 51 140 441 218 442 51 140 441 219 458 51 140 441 220 459 51 140 441 221 460 51 140 441 222 461 51 140 441 223 462 51 140 441 224 463 51 140 441 225 464 51 140 441 226 465 51 140 441 227 466 51 140 441 316 467 51 140 441 317 468 51 140 441 318 469 51 140 441 319 470 51 140 441 228 471 51 140 441 229 472 51 140 441 230 473 51 140 441 536 540 51 140 441 231 474 51 140 441 232 475 51 140 441 233 476 51 140 441 234 477 51 140 441 235 478 51 140 591 5 569 236 479 51 140 141 237 480 51 140 141 238 101 51 140 141 239 102 51 140 141 240 103 51 140 141 241 104 51 140 141 242 105 51 140 141 243 106 51 140 141 244 107 51 140 141 245 108 51 140 141 246 109 51 140 141 247 481 382 140 141 248 482 382 140 141 249 483 382 140 141 250 484 382 140 141 251 485 382 140 141 252 486 382 140 141 253 487 382 140 141 254 89 382 140 141 255 488 382 140 141 256 90 382 140 141 257 489 382 140 141 258 92 382 140 141 259 490 382 140 141 260 491 382 140 141 261 492 382 140 141 262 493 382 140 141 263 494 382 140 141 264 495 382 140 141 265 496 382 140 141 266 498 497 570 267 499 382 140 141 268 500 382 140 141 269 501 382 140 141 270 502 382 140 141 271 503 382 140 141 272 504 382 140 141 273 505 382 140 141 274 96 382 140 141 275 97 382 140 141 276 506 382 140 141 277 98 382 140 141 278 507 51 140 592 569 279 508 51 140 592 569 280 509 382 140 141 281 510 382 140 141 282 511 382 140 141 283 512 382 140 141 537 541 382 140 141 538 542 382 140 141 539 543 382 140 141 284 513 382 140 141 285 514 382 140 141 286 515 382 140 141 287 516 382 140 141 288 517 382 140 141 289 518 382 140 141 290 519 51 140 141 291 520 51 140 141 292 521 51 140 141 293 522 51 140 141 294 524 51 140 591 571 295 525 51 140 591 571 296 526 51 140 141 297 527 51 140 141 298 528 51 140 141 299 529 51 140 141 300 530 51 140 141 301 531 51 140 141 302 532 51 140 141 303 533 51 140 534 304 110 51 140 535 10 11 12 18 139 138 139 138 52 51 140 141 53 51 140 141 74 51 140 141 54 51 140 141 75 51 140 141 55 51 140 141 556 51 140 141 56 51 140 141 57 51 140 141 58 51 140 141 76 51 140 141 59 51 140 141 60 51 140 141 61 51 140 141 62 51 140 141 63 51 140 141 64 51 140 141 65 51 140 141 77 51 140 141 66 51 140 141 67 51 140 141 78 140 141 68 140 141 79 51 140 141 80 51 140 141 69 51 140 141 81 51 140 141 70 51 140 141 82 51 140 141 71 51 140 141 72 51 140 141 72 51 140 141 73 51 140 141 83 557 140 593 598 84 51 140 593 598 85 51 140 593 598 86 51 140 593 598 87 51 140 593 598 555 51 140 141 88 557 593 598 21 22 139 138 139 138 113 51 140 141 114 51 140 141 115 51 140 141 13 139 138 139 138 110 382 140 141 111 112 14 139 138 139 138 101 382 140 141 102 382 140 141 103 382 140 141 104 382 140 141 105 382 140 141 106 382 140 141 107 382 140 141 108 382 140 141 109 382 140 141 15 5 16 558 51 140 593 598 559 51 140 593 598 560 51 140 593 598 561 564 140 593 598 562 564 140 593 598 563 564 140 593 598 5 17 89 422 90 91 92 93 94 95 374 140 594 598 96 97 98 5 523 595 599 600

6 9 99 139 138 139 138 146 118 51 140 145 147 141 119 51 140 145 147 141 120 51 140 145 147 141 121 51 140 145 147 141 117 51 140 577 147 141 572 5 122 51 140 577 147 141 572 123 51 140 578 147 141 596 124 51 140 578 147 141 596 125 51 140 578 147 141 596 126 51 140 578 147 141 596 127 51 140 578 147 141 596 5 128 51 140 578 147 141 596 129 51 140 443 147 141 596 130 51 140 579 147 141 596 131 51 142 141 147 141 132 51 142 141 147 141 133 51 142 141 147 141 134 51 142 141 147 141 135 51 142 141 147 141 136 51 142 141 147 141 137 51 142 141 147 141 19 139 138 139 138 23 51 140 141 147 141 24 51 140 141 147 141 143 144 140 141 147 141 25 51 140 141 147 141 26 51 140 141 147 141 27 51 140 141 147 141 28 51 140 141 147 141 29 51 140 141 147 141 30 51 140 141 147 141 31 148 140 580 147 141 32 51 140 580 147 141 33 51 140 141 147 141 34 51 140 141 147 141 35 51 140 141 147 141 36 51 140 141 147 141 37 51 140 141 147 141 38 51 140 141 147 141 39 51 140 141 147 141 20 139 138 139 138 40 41 42 43 51 140 581 573 44 45 51 140 581 573 46 47 51 140 582 574 48 49 51 140 582 574 446 544 444 140 453 545 444 140 454 546 444 140 455 547 444 140 456 548 444 140 447 549 444 140 448 550 444 140 449 551 444 140 450 552 444 140 451 553 444 140 452 554 444 140 149 50 444 140 445 5 100 139 138 139 138 323 148 140 583 573 325 148 140 583 573 326 148 140 583 573 327 148 140 583 573 328 148 140 583 573 324 148 140 332 573 329 148 140 330 575 331 148 140 333 575 159 334 51 140 141 575 160 335 51 140 141 575 161 336 51 140 141 575 337 51 140 141 575 338 51 140 141 575 339 51 140 141 575 340 51 140 141 575 341 51 140 141 575 342 51 140 141 575 343 51 140 141 575 344 51 140 141 575 345 51 140 141 575 346 51 140 141 575 347 51 140 141 575 348 51 140 141 575 162 349 51 140 141 575 163 350 51 140 141 575 164 351 51 140 141 575 156 565 51 140 584 573 157 352 51 140 585 573 158 353 51 140 585 573 165 354 51 140 141 575 166 355 51 140 141 575 167 357 51 140 141 575 168 356 51 140 141 575 169 358 51 140 141 575 170 359 51 140 141 575 171 360 51 140 457 576 172 361 51 140 141 575 601 324 51 140 141 575 311 362 51 140 141 575 305 308 51 140 586 573 173 363 51 140 141 575 309 310 51 140 141 575 312 364 51 140 141 575 313 365 51 140 141 575 314 366 51 140 141 575 306 307 51 140 586 573 315 367 51 140 586 573 174 368 51 140 141 175 369 51 140 587 573 176 177 51 140 587 573 178 370 51 140 587 573 179 371 51 140 587 573 180 372 51 140 587 573 181 373 51 140 141 182 375 382 140 588 573 376 382 140 588 573 377 382 140 588 573 378 382 140 588 573 379 382 140 588 573 380 382 140 588 573 381 382 140 588 573 381 51 140 141 183 383 51 140 141 184 384 51 140 141 185 385 51 140 141 186 386 51 140 141 387 331 51 140 589 573 187 388 51 140 588 573 188 389 51 140 588 573 189 390 51 140 588 573 190 391 51 140 141 191 392 374 140 141 192 393 51 140 141 193 394 382 140 141 194 395 51 140 141 195 396 374 140 141 196 397 374 140 141 197 398 374 140 141 198 399 374 140 141 199 400 374 140 141 200 401 374 140 141 201 402 374 140 141 202 403 374 140 141 203 404 374 140 141 204 405 374 140 141 205 406 51 140 141 206 407 51 140 141 207 408 51 140 141 208 409 51 140 141 209 410 51 140 141 210 411 51 140 141 211 412 51 140 141 212 413 51 140 141 213 414 51 140 141 214 415 51 140 141 215 416 51 140 141 216 417 51 140 141 217 418 51 140 419 147 420 597 320 421 51 140 590 566 567 150 113 51 140 141 321 114 382 140 590 147 141 567 322 115 51 140 590 566 567 151 435 51 140 141 152 436 51 140 141 424 429 51 140 141 425 430 51 140 141 426 431 51 140 440 568 439 438 51 140 440 568 427 432 51 140 141 153 428 51 140 141 154 434 51 140 141 155 437 51 140 141 423 433 51 140 441 218 442 51 140 441 219 458 51 140 441 220 459 51 140 441 221 460 51 140 441 222 461 51 140 441 223 462 51 140 441 224 463 51 140 441 225 464 51 140 441 226 465 51 140 441 227 466 51 140 441 316 467 51 140 441 317 468 51 140 441 318 469 51 140 441 319 470 51 140 441 228 471 51 140 441 229 472 51 140 441 230 473 51 140 441 536 540 51 140 441 231 474 51 140 441 232 475 51 140 441 233 476 51 140 441 234 477 51 140 441 235 478 51 140 591 5 569 236 479 51 140 141 237 480 51 140 141 238 101 51 140 141 239 102 51 140 141 240 103 51 140 141 241 104 51 140 141 242 105 51 140 141 243 106 51 140 141 244 107 51 140 141 245 108 51 140 141 246 109 51 140 141 247 481 382 140 141 248 482 382 140 141 249 483 382 140 141 250 484 382 140 141 251 485 382 140 141 252 486 382 140 141 253 487 382 140 141 254 89 382 140 141 255 488 382 140 141 256 90 382 140 141 257 489 382 140 141 258 92 382 140 141 259 490 382 140 141 260 491 382 140 141 261 492 382 140 141 262 493 382 140 141 263 494 382 140 141 264 495 382 140 141 265 496 382 140 141 266 498 497 570 267 499 382 140 141 268 500 382 140 141 269 501 382 140 141 270 502 382 140 141 271 503 382 140 141 272 504 382 140 141 273 505 382 140 141 274 96 382 140 141 275 97 382 140 141 276 506 382 140 141 277 98 382 140 141 278 507 51 140 592 569 279 508 51 140 592 569 280 509 382 140 141 281 510 382 140 141 282 511 382 140 141 283 512 382 140 141 537 541 382 140 141 538 542 382 140 141 539 543 382 140 141 284 513 382 140 141 285 514 382 140 141 286 515 382 140 141 287 516 382 140 141 288 517 382 140 141 289 518 382 140 141 290 519 51 140 141 291 520 51 140 141 292 521 51 140 141 293 522 51 140 141 294 524 51 140 591 571 295 525 51 140 591 571 296 526 51 140 141 297 527 51 140 141 298 528 51 140 141 299 529 51 140 141 300 530 51 140 141 301 531 51 140 141 302 532 51 140 141 303 533 51 140 534 304 110 51 140 535 10 11 12 18 139 138 139 138 52 51 140 141 53 51 140 141 74 51 140 141 54 51 140 141 75 51 140 141 55 51 140 141 556 51 140 141 56 51 140 141 57 51 140 141 58 51 140 141 76 51 140 141 59 51 140 141 60 51 140 141 61 51 140 141 62 51 140 141 63 51 140 141 64 51 140 141 65 51 140 141 77 51 140 141 66 51 140 141 67 51 140 141 78 140 141 68 140 141 79 51 140 141 80 51 140 141 69 51 140 141 81 51 140 141 70 51 140 141 82 51 140 141 71 51 140 141 72 51 140 141 72 51 140 141 73 51 140 141 83 557 140 593 598 84 51 140 593 598 85 51 140 593 598 86 51 140 593 598 87 51 140 593 598 555 51 140 141 88 557 593 598 21 22 139 138 139 138 113 51 140 141 114 51 140 141 115 51 140 141 13 139 138 139 138 110 382 140 141 111 112 14 139 138 139 138 101 382 140 141 102 382 140 141 103 382 140 141 104 382 140 141 105 382 140 141 106 382 140 141 107 382 140 141 108 382 140 141 109 382 140 141 15 5 16 558 51 140 593 598 559 51 140 593 598 560 51 140 593 598 561 564 140 593 598 562 564 140 593 598 563 564 140 593 598 5 17 89 422 90 91 92 93 94 95 374 140 594 598 96 97 98 5 523 595 599 600

6 9 99 139 138 139 138 146 118 51 140 145 147 141 119 51 140 145 147 141 120 51 140 145 147 141 121 51 140 145 147 141 117 51 140 577 147 141 572 5 122 51 140 577 147 141 572 123 51 140 578 147 141 596 124 51 140 578 147 141 596 125 51 140 578 147 141 596 126 51 140 578 147 141 596 127 51 140 578 147 141 596 5 128 51 140 578 147 141 596 129 51 140 443 147 141 596 130 51 140 579 147 141 596 131 51 142 141 147 141 132 51 142 141 147 141 133 51 142 141 147 141 134 51 142 141 147 141 135 51 142 141 147 141 136 51 142 141 147 141 137 51 142 141 147 141 19 139 138 139 138 23 51 140 141 147 141 24 51 140 141 147 141 143 144 140 141 147 141 25 51 140 141 147 141 26 51 140 141 147 141 27 51 140 141 147 141 28 51 140 141 147 141 29 51 140 141 147 141 30 51 140 141 147 141 31 148 140 580 147 141 32 51 140 580 147 141 33 51 140 141 147 141 34 51 140 141 147 141 35 51 140 141 147 141 36 51 140 141 147 141 37 51 140 141 147 141 38 51 140 141 147 141 39 51 140 141 147 141 20 139 138 139 138 40 41 42 43 51 140 581 573 44 45 51 140 581 573 46 47 51 140 582 574 48 49 51 140 582 574 446 544 444 140 453 545 444 140 454 546 444 140 455 547 444 140 456 548 444 140 447 549 444 140 448 550 444 140 449 551 444 140 450 552 444 140 451 553 444 140 452 554 444 140 149 50 444 140 445 5 100 139 138 139 138 323 148 140 583 573 325 148 140 583 573 326 148 140 583 573 327 148 140 583 573 328 148 140 583 573 324 148 140 332 573 329 148 140 330 575 331 148 140 333 575 159 334 51 140 141 575 160 335 51 140 141 575 161 336 51 140 141 575 337 51 140 141 575 338 51 140 141 575 339 51 140 141 575 340 51 140 141 575 341 51 140 141 575 342 51 140 141 575 343 51 140 141 575 344 51 140 141 575 345 51 140 141 575 346 51 140 141 575 347 51 140 141 575 348 51 140 141 575 162 349 51 140 141 575 163 350 51 140 141 575 164 351 51 140 141 575 156 565 51 140 584 573 157 352 51 140 585 573 158 353 51 140 585 573 165 354 51 140 141 575 166 355 51 140 141 575 167 357 51 140 141 575 168 356 51 140 141 575 169 358 51 140 141 575 170 359 51 140 141 575 171 360 51 140 457 576 172 361 51 140 141 575 601 324 51 140 141 575 311 362 51 140 141 575 305 308 51 140 586 573 173 363 51 140 141 575 309 310 51 140 141 575 312 364 51 140 141 575 313 365 51 140 141 575 314 366 51 140 141 575 306 307 51 140 586 573 315 367 51 140 586 573 174 368 51 140 141 175 369 51 140 587 573 176 177 51 140 587 573 178 370 51 140 587 573 179 371 51 140 587 573 180 372 51 140 587 573 181 373 51 140 141 182 375 382 140 588 573 376 382 140 588 573 377 382 140 588 573 378 382 140 588 573 379 382 140 588 573 380 382 140 588 573 381 382 140 588 573 381 51 140 141 183 383 51 140 141 184 384 51 140 141 185 385 51 140 141 186 386 51 140 141 387 331 51 140 589 573 187 388 51 140 588 573 188 389 51 140 588 573 189 390 51 140 588 573 190 391 51 140 141 191 392 374 140 141 192 393 51 140 141 193 394 382 140 141 194 395 51 140 141 195 396 374 140 141 196 397 374 140 141 197 398 374 140 141 198 399 374 140 141 199 400 374 140 141 200 401 374 140 141 201 402 374 140 141 202 403 374 140 141 203 404 374 140 141 204 405 374 140 141 205 406 51 140 141 206 407 51 140 141 207 408 51 140 141 208 409 51 140 141 209 410 51 140 141 210 411 51 140 141 211 412 51 140 141 212 413 51 140 141 213 414 51 140 141 214 415 51 140 141 215 416 51 140 141 216 417 51 140 141 217 418 51 140 419 147 420 597 320 421 51 140 590 566 567 150 113 51 140 141 321 114 382 140 590 147 141 567 322 115 51 140 590 566 567 151 435 51 140 141 152 436 51 140 141 424 429 51 140 141 425 430 51 140 141 426 431 51 140 440 568 439 438 51 140 440 568 427 432 51 140 141 153 428 51 140 141 154 434 51 140 141 155 437 51 140 141 423 433 51 140 441 218 442 51 140 441 219 458 51 140 441 220 459 51 140 441 221 460 51 140 441 222 461 51 140 441 223 462 51 140 441 224 463 51 140 441 225 464 51 140 441 226 465 51 140 441 227 466 51 140 441 316 467 51 140 441 317 468 51 140 441 318 469 51 140 441 319 470 51 140 441 228 471 51 140 441 229 472 51 140 441 230 473 51 140 441 536 540 51 140 441 231 474 51 140 441 232 475 51 140 441 233 476 51 140 441 234 477 51 140 441 235 478 51 140 591 5 569 236 479 51 140 141 237 480 51 140 141 238 101 51 140 141 239 102 51 140 141 240 103 51 140 141 241 104 51 140 141 242 105 51 140 141 243 106 51 140 141 244 107 51 140 141 245 108 51 140 141 246 109 51 140 141 247 481 382 140 141 248 482 382 140 141 249 483 382 140 141 250 484 382 140 141 251 485 382 140 141 252 486 382 140 141 253 487 382 140 141 254 89 382 140 141 255 488 382 140 141 256 90 382 140 141 257 489 382 140 141 258 92 382 140 141 259 490 382 140 141 260 491 382 140 141 261 492 382 140 141 262 493 382 140 141 263 494 382 140 141 264 495 382 140 141 265 496 382 140 141 266 498 497 570 267 499 382 140 141 268 500 382 140 141 269 501 382 140 141 270 502 382 140 141 271 503 382 140 141 272 504 382 140 141 273 505 382 140 141 274 96 382 140 141 275 97 382 140 141 276 506 382 140 141 277 98 382 140 141 278 507 51 140 592 569 279 508 51 140 592 569 280 509 382 140 141 281 510 382 140 141 282 511 382 140 141 283 512 382 140 141 537 541 382 140 141 538 542 382 140 141 539 543 382 140 141 284 513 382 140 141 285 514 382 140 141 286 515 382 140 141 287 516 382 140 141 288 517 382 140 141 289 518 382 140 141 290 519 51 140 141 291 520 51 140 141 292 521 51 140 141 293 522 51 140 141 294 524 51 140 591 571 295 525 51 140 591 571 296 526 51 140 141 297 527 51 140 141 298 528 51 140 141 299 529 51 140 141 300 530 51 140 141 301 531 51 140 141 302 532 51 140 141 303 533 51 140 534 304 110 51 140 535 10 11 12 18 139 138 139 138 52 51 140 141 53 51 140 141 74 51 140 141 54 51 140 141 75 51 140 141 55 51 140 141 556 51 140 141 56 51 140 141 57 51 140 141 58 51 140 141 76 51 140 141 59 51 140 141 60 51 140 141 61 51 140 141 62 51 140 141 63 51 140 141 64 51 140 141 65 51 140 141 77 51 140 141 66 51 140 141 67 51 140 141 78 140 141 68 140 141 79 51 140 141 80 51 140 141 69 51 140 141 81 51 140 141 70 51 140 141 82 51 140 141 71 51 140 141 72 51 140 141 72 51 140 141 73 51 140 141 83 557 140 593 598 84 51 140 593 598 85 51 140 593 598 86 51 140 593 598 87 51 140 593 598 555 51 140 141 88 557 593 598 21 22 139 138 139 138 113 51 140 141 114 51 140 141 115 51 140 141 13 139 138 139 138 110 382 140 141 111 112 14 139 138 139 138 101 382 140 141 102 382 140 141 103 382 140 141 104 382 140 141 105 382 140 141 106 382 140 141 107 382 140 141 108 382 140 141 109 382 140 141 15 5 16 558 51 140 593 598 559 51 140 593 598 560 51 140 593 598 561 564 140 593 598 562 564 140 593 598 563 564 140 593 598 5 17 89 422 90 91 92 93 94 95 374 140 594 598 96 97 98 5 523 595 599 600

6 9 99 139 138 139 138 146 118 51 140 145 147 141 119 51 140 145 147 141 120 51 140 145 147 141 121 51 140 145 147 141 117 51 140 577 147 141 572 5 122 51 140 577 147 141 572 123 51 140 578 147 141 596 124 51 140 578 147 141 596 125 51 140 578 147 141 596 126 51 140 578 147 141 596 127 51 140 578 147 141 596 5 128 51 140 578 147 141 596 129 51 140 443 147 141 596 130 51 140 579 147 141 596 131 51 142 141 147 141 132 51 142 141 147 141 133 51 142 141 147 141 134 51 142 141 147 141 135 51 142 141 147 141 136 51 142 141 147 141 137 51 142 141 147 141 19 139 138 139 138 23 51 140 141 147 141 24 51 140 141 147 141 143 144 140 141 147 141 25 51 140 141 147 141 26 51 140 141 147 141 27 51 140 141 147 141 28 51 140 141 147 141 29 51 140 141 147 141 30 51 140 141 147 141 31 148 140 580 147 141 32 51 140 580 147 141 33 51 140 141 147 141 34 51 140 141 147 141 35 51 140 141 147 141 36 51 140 141 147 141 37 51 140 141 147 141 38 51 140 141 147 141 39 51 140 141 147 141 20 139 138 139 138 40 41 42 43 51 140 581 573 44 45 51 140 581 573 46 47 51 140 582 574 48 49 51 140 582 574 446 544 444 140 453 545 444 140 454 546 444 140 455 547 444 140 456 548 444 140 447 549 444 140 448 550 444 140 449 551 444 140 450 552 444 140 451 553 444 140 452 554 444 140 149 50 444 140 445 5 100 139 138 139 138 323 148 140 583 573 325 148 140 583 573 326 148 140 583 573 327 148 140 583 573 328 148 140 583 573 324 148 140 332 573 329 148 140 330 575 331 148 140 333 575 159 334 51 140 141 575 160 335 51 140 141 575 161 336 51 140 141 575 337 51 140 141 575 338 51 140 141 575 339 51 140 141 575 340 51 140 141 575 341 51 140 141 575 342 51 140 141 575 343 51 140 141 575 344 51 140 141 575 345 51 140 141 575 346 51 140 141 575 347 51 140 141 575 348 51 140 141 575 162 349 51 140 141 575 163 350 51 140 141 575 164 351 51 140 141 575 156 565 51 140 584 573 157 352 51 140 585 573 158 353 51 140 585 573 165 354 51 140 141 575 166 355 51 140 141 575 167 357 51 140 141 575 168 356 51 140 141 575 169 358 51 140 141 575 170 359 51 140 141 575 171 360 51 140 457 576 172 361 51 140 141 575 601 324 51 140 141 575 311 362 51 140 141 575 305 308 51 140 586 573 173 363 51 140 141 575 309 310 51 140 141 575 312 364 51 140 141 575 313 365 51 140 141 575 314 366 51 140 141 575 306 307 51 140 586 573 315 367 51 140 586 573 174 368 51 140 141 175 369 51 140 587 573 176 177 51 140 587 573 178 370 51 140 587 573 179 371 51 140 587 573 180 372 51 140 587 573 181 373 51 140 141 182 375 382 140 588 573 376 382 140 588 573 377 382 140 588 573 378 382 140 588 573 379 382 140 588 573 380 382 140 588 573 381 382 140 588 573 381 51 140 141 183 383 51 140 141 184 384 51 140 141 185 385 51 140 141 186 386 51 140 141 387 331 51 140 589 573 187 388 51 140 588 573 188 389 51 140 588 573 189 390 51 140 588 573 190 391 51 140 141 191 392 374 140 141 192 393 51 140 141 193 394 382 140 141 194 395 51 140 141 195 396 374 140 141 196 397 374 140 141 197 398 374 140 141 198 399 374 140 141 199 400 374 140 141 200 401 374 140 141 201 402 374 140 141 202 403 374 140 141 203 404 374 140 141 204 405 374 140 141 205 406 51 140 141 206 407 51 140 141 207 408 51 140 141 208 409 51 140 141 209 410 51 140 141 210 411 51 140 141 211 412 51 140 141 212 413 51 140 141 213 414 51 140 141 214 415 51 140 141 215 416 51 140 141 216 417 51 140 141 217 418 51 140 419 147 420 597 320 421 51 140 590 566 567 150 113 51 140 141 321 114 382 140 590 147 141 567 322 115 51 140 590 566 567 151 435 51 140 141 152 436 51 140 141 424 429 51 140 141 425 430 51 140 141 426 431 51 140 440 568 439 438 51 140 440 568 427 432 51 140 141 153 428 51 140 141 154 434 51 140 141 155 437 51 140 141 423 433 51 140 441 218 442 51 140 441 219 458 51 140 441 220 459 51 140 441 221 460 51 140 441 222 461 51 140 441 223 462 51 140 441 224 463 51 140 441 225 464 51 140 441 226 465 51 140 441 227 466 51 140 441 316 467 51 140 441 317 468 51 140 441 318 469 51 140 441 319 470 51 140 441 228 471 51 140 441 229 472 51 140 441 230 473 51 140 441 536 540 51 140 441 231 474 51 140 441 232 475 51 140 441 233 476 51 140 441 234 477 51 140 441 235 478 51 140 591 5 569 236 479 51 140 141 237 480 51 140 141 238 101 51 140 141 239 102 51 140 141 240 103 51 140 141 241 104 51 140 141 242 105 51 140 141 243 106 51 140 141 244 107 51 140 141 245 108 51 140 141 246 109 51 140 141 247 481 382 140 141 248 482 382 140 141 249 483 382 140 141 250 484 382 140 141 251 485 382 140 141 252 486 382 140 141 253 487 382 140 141 254 89 382 140 141 255 488 382 140 141 256 90 382 140 141 257 489 382 140 141 258 92 382 140 141 259 490 382 140 141 260 491 382 140 141 261 492 382 140 141 262 493 382 140 141 263 494 382 140 141 264 495 382 140 141 265 496 382 140 141 266 498 497 570 267 499 382 140 141 268 500 382 140 141 269 501 382 140 141 270 502 382 140 141 271 503 382 140 141 272 504 382 140 141 273 505 382 140 141 274 96 382 140 141 275 97 382 140 141 276 506 382 140 141 277 98 382 140 141 278 507 51 140 592 569 279 508 51 140 592 569 280 509 382 140 141 281 510 382 140 141 282 511 382 140 141 283 512 382 140 141 537 541 382 140 141 538 542 382 140 141 539 543 382 140 141 284 513 382 140 141 285 514 382 140 141 286 515 382 140 141 287 516 382 140 141 288 517 382 140 141 289 518 382 140 141 290 519 51 140 141 291 520 51 140 141 292 521 51 140 141 293 522 51 140 141 294 524 51 140 591 571 295 525 51 140 591 571 296 526 51 140 141 297 527 51 140 141 298 528 51 140 141 299 529 51 140 141 300 530 51 140 141 301 531 51 140 141 302 532 51 140 141 303 533 51 140 534 304 110 51 140 535 10 11 12 18 139 138 139 138 52 51 140 141 53 51 140 141 74 51 140 141 54 51 140 141 75 51 140 141 55 51 140 141 556 51 140 141 56 51 140 141 57 51 140 141 58 51 140 141 76 51 140 141 59 51 140 141 60 51 140 141 61 51 140 141 62 51 140 141 63 51 140 141 64 51 140 141 65 51 140 141 77 51 140 141 66 51 140 141 67 51 140 141 78 140 141 68 140 141 79 51 140 141 80 51 140 141 69 51 140 141 81 51 140 141 70 51 140 141 82 51 140 141 71 51 140 141 72 51 140 141 72 51 140 141 73 51 140 141 83 557 140 593 598 84 51 140 593 598 85 51 140 593 598 86 51 140 593 598 87 51 140 593 598 555 51 140 141 88 557 593 598 21 22 139 138 139 138 113 51 140 141 114 51 140 141 115 51 140 141 13 139 138 139 138 110 382 140 141 111 112 14 139 138 139 138 101 382 140 141 102 382 140 141 103 382 140 141 104 382 140 141 105 382 140 141 106 382 140 141 107 382 140 141 108 382 140 141 109 382 140 141 15 5 16 558 51 140 593 598 559 51 140 593 598 560 51 140 593 598 561 564 140 593 598 562 564 140 593 598 563 564 140 593 598 5 17 89 422 90 91 92 93 94 95 374 140 594 598 96 97 98 5 523 595 599 600

6 9 99 139 138 139 138 146 118 51 140 145 147 141 119 51 140 145 147 141 120 51 140 145 147 141 121 51 140 145 147 141 117 51 140 577 147 141 572 5 122 51 140 577 147 141 572 123 51 140 578 147 141 596 124 51 140 578 147 141 596 125 51 140 578 147 141 596 126 51 140 578 147 141 596 127 51 140 578 147 141 596 5 128 51 140 578 147 141 596 129 51 140 443 147 141 596 130 51 140 579 147 141 596 131 51 142 141 147 141 132 51 142 141 147 141 133 51 142 141 147 141 134 51 142 141 147 141 135 51 142 141 147 141 136 51 142 141 147 141 137 51 142 141 147 141 19 139 138 139 138 23 51 140 141 147 141 24 51 140 141 147 141 143 144 140 141 147 141 25 51 140 141 147 141 26 51 140 141 147 141 27 51 140 141 147 141 28 51 140 141 147 141 29 51 140 141 147 141 30 51 140 141 147 141 31 148 140 580 147 141 32 51 140 580 147 141 33 51 140 141 147 141 34 51 140 141 147 141 35 51 140 141 147 141 36 51 140 141 147 141 37 51 140 141 147 141 38 51 140 141 147 141 39 51 140 141 147 141 20 139 138 139 138 40 41 42 43 51 140 581 573 44 45 51 140 581 573 46 47 51 140 582 574 48 49 51 140 582 574 446 544 444 140 453 545 444 140 454 546 444 140 455 547 444 140 456 548 444 140 447 549 444 140 448 550 444 140 449 551 444 140 450 552 444 140 451 553 444 140 452 554 444 140 149 50 444 140 445 5 100 139 138 139 138 323 148 140 583 573 325 148 140 583 573 326 148 140 583 573 327 148 140 583 573 328 148 140 583 573 324 148 140 332 573 329 148 140 330 575 331 148 140 333 575 159 334 51 140 141 575 160 335 51 140 141 575 161 336 51 140 141 575 337 51 140 141 575 338 51 140 141 575 339 51 140 141 575 340 51 140 141 575 341 51 140 141 575 342 51 140 141 575 343 51 140 141 575 344 51 140 141 575 345 51 140 141 575 346 51 140 141 575 347 51 140 141 575 348 51 140 141 575 162 349 51 140 141 575 163 350 51 140 141 575 164 351 51 140 141 575 156 565 51 140 584 573 157 352 51 140 585 573 158 353 51 140 585 573 165 354 51 140 141 575 166 355 51 140 141 575 167 357 51 140 141 575 168 356 51 140 141 575 169 358 51 140 141 575 170 359 51 140 141 575 171 360 51 140 457 576 172 361 51 140 141 575 601 324 51 140 141 575 311 362 51 140 141 575 305 308 51 140 586 573 173 363 51 140 141 575 309 310 51 140 141 575 312 364 51 140 141 575 313 365 51 140 141 575 314 366 51 140 141 575 306 307 51 140 586 573 315 367 51 140 586 573 174 368 51 140 141 175 369 51 140 587 573 176 177 51 140 587 573 178 370 51 140 587 573 179 371 51 140 587 573 180 372 51 140 587 573 181 373 51 140 141 182 375 382 140 588 573 376 382 140 588 573 377 382 140 588 573 378 382 140 588 573 379 382 140 588 573 380 382 140 588 573 381 382 140 588 573 381 51 140 141 183 383 51 140 141 184 384 51 140 141 185 385 51 140 141 186 386 51 140 141 387 331 51 140 589 573 187 388 51 140 588 573 188 389 51 140 588 573 189 390 51 140 588 573 190 391 51 140 141 191 392 374 140 141 192 393 51 140 141 193 394 382 140 141 194 395 51 140 141 195 396 374 140 141 196 397 374 140 141 197 398 374 140 141 198 399 374 140 141 199 400 374 140 141 200 401 374 140 141 201 402 374 140 141 202 403 374 140 141 203 404 374 140 141 204 405 374 140 141 205 406 51 140 141 206 407 51 140 141 207 408 51 140 141 208 409 51 140 141 209 410 51 140 141 210 411 51 140 141 211 412 51 140 141 212 413 51 140 141 213 414 51 140 141 214 415 51 140 141 215 416 51 140 141 216 417 51 140 141 217 418 51 140 419 147 420 597 320 421 51 140 590 566 567 150 113 51 140 141 321 114 382 140 590 147 141 567 322 115 51 140 590 566 567 151 435 51 140 141 152 436 51 140 141 424 429 51 140 141 425 430 51 140 141 426 431 51 140 440 568 439 438 51 140 440 568 427 432 51 140 141 153 428 51 140 141 154 434 51 140 141 155 437 51 140 141 423 433 51 140 441 218 442 51 140 441 219 458 51 140 441 220 459 51 140 441 221 460 51 140 441 222 461 51 140 441 223 462 51 140 441 224 463 51 140 441 225 464 51 140 441 226 465 51 140 441 227 466 51 140 441 316 467 51 140 441 317 468 51 140 441 318 469 51 140 441 319 470 51 140 441 228 471 51 140 441 229 472 51 140 441 230 473 51 140 441 536 540 51 140 441 231 474 51 140 441 232 475 51 140 441 233 476 51 140 441 234 477 51 140 441 235 478 51 140 591 5 569 236 479 51 140 141 237 480 51 140 141 238 101 51 140 141 239 102 51 140 141 240 103 51 140 141 241 104 51 140 141 242 105 51 140 141 243 106 51 140 141 244 107 51 140 141 245 108 51 140 141 246 109 51 140 141 247 481 382 140 141 248 482 382 140 141 249 483 382 140 141 250 484 382 140 141 251 485 382 140 141 252 486 382 140 141 253 487 382 140 141 254 89 382 140 141 255 488 382 140 141 256 90 382 140 141 257 489 382 140 141 258 92 382 140 141 259 490 382 140 141 260 491 382 140 141 261 492 382 140 141 262 493 382 140 141 263 494 382 140 141 264 495 382 140 141 265 496 382 140 141 266 498 497 570 267 499 382 140 141 268 500 382 140 141 269 501 382 140 141 270 502 382 140 141 271 503 382 140 141 272 504 382 140 141 273 505 382 140 141 274 96 382 140 141 275 97 382 140 141 276 506 382 140 141 277 98 382 140 141 278 507 51 140 592 569 279 508 51 140 592 569 280 509 382 140 141 281 510 382 140 141 282 511 382 140 141 283 512 382 140 141 537 541 382 140 141 538 542 382 140 141 539 543 382 140 141 284 513 382 140 141 285 514 382 140 141 286 515 382 140 141 287 516 382 140 141 288 517 382 140 141 289 518 382 140 141 290 519 51 140 141 291 520 51 140 141 292 521 51 140 141 293 522 51 140 141 294 524 51 140 591 571 295 525 51 140 591 571 296 526 51 140 141 297 527 51 140 141 298 528 51 140 141 299 529 51 140 141 300 530 51 140 141 301 531 51 140 141 302 532 51 140 141 303 533 51 140 534 304 110 51 140 535 10 11 12 18 139 138 139 138 52 51 140 141 53 51 140 141 74 51 140 141 54 51 140 141 75 51 140 141 55 51 140 141 556 51 140 141 56 51 140 141 57 51 140 141 58 51 140 141 76 51 140 141 59 51 140 141 60 51 140 141 61 51 140 141 62 51 140 141 63 51 140 141 64 51 140 141 65 51 140 141 77 51 140 141 66 51 140 141 67 51 140 141 78 140 141 68 140 141 79 51 140 141 80 51 140 141 69 51 140 141 81 51 140 141 70 51 140 141 82 51 140 141 71 51 140 141 72 51 140 141 72 51 140 141 73 51 140 141 83 557 140 593 598 84 51 140 593 598 85 51 140 593 598 86 51 140 593 598 87 51 140 593 598 555 51 140 141 88 557 593 598 21 22 139 138 139 138 113 51 140 141 114 51 140 141 115 51 140 141 13 139 138 139 138 110 382 140 141 111 112 14 139 138 139 138 101 382 140 141 102 382 140 141 103 382 140 141 104 382 140 141 105 382 140 141 106 382 140 141 107 382 140 141 108 382 140 141 109 382 140 141 15 5 16 558 51 140 593 598 559 51 140 593 598 560 51 140 593 598 561 564 140 593 598 562 564 140 593 598 563 564 140 593 598 5 17 89 422 90 91 92 93 94 95 374 140 594 598 96 97 98 5 523 595 599 600

6 9 99 139 138 139 138 146 118 51 140 145 147 141 119 51 140 145 147 141 120 51 140 145 147 141 121 51 140 145 147 141 117 51 140 577 147 141 572 5 122 51 140 577 147 141 572 123 51 140 578 147 141 596 124 51 140 578 147 141 596 125 51 140 578 147 141 596 126 51 140 578 147 141 596 127 51 140 578 147 141 596 5 128 51 140 578 147 141 596 129 51 140 443 147 141 596 130 51 140 579 147 141 596 131 51 142 141 147 141 132 51 142 141 147 141 133 51 142 141 147 141 134 51 142 141 147 141 135 51 142 141 147 141 136 51 142 141 147 141 137 51 142 141 147 141 19 139 138 139 138 23 51 140 141 147 141 24 51 140 141 147 141 143 144 140 141 147 141 25 51 140 141 147 141 26 51 140 141 147 141 27 51 140 141 147 141 28 51 140 141 147 141 29 51 140 141 147 141 30 51 140 141 147 141 31 148 140 580 147 141 32 51 140 580 147 141 33 51 140 141 147 141 34 51 140 141 147 141 35 51 140 141 147 141 36 51 140 141 147 141 37 51 140 141 147 141 38 51 140 141 147 141 39 51 140 141 147 141 20 139 138 139 138 40 41 42 43 51 140 581 573 44 45 51 140 581 573 46 47 51 140 582 574 48 49 51 140 582 574 446 544 444 140 453 545 444 140 454 546 444 140 455 547 444 140 456 548 444 140 447 549 444 140 448 550 444 140 449 551 444 140 450 552 444 140 451 553 444 140 452 554 444 140 149 50 444 140 445 5 100 139 138 139 138 323 148 140 583 573 325 148 140 583 573 326 148 140 583 573 327 148 140 583 573 328 148 140 583 573 324 148 140 332 573 329 148 140 330 575 331 148 140 333 575 159 334 51 140 141 575 160 335 51 140 141 575 161 336 51 140 141 575 337 51 140 141 575 338 51 140 141 575 339 51 140 141 575 340 51 140 141 575 341 51 140 141 575 342 51 140 141 575 343 51 140 141 575 344 51 140 141 575 345 51 140 141 575 346 51 140 141 575 347 51 140 141 575 348 51 140 141 575 162 349 51 140 141 575 163 350 51 140 141 575 164 351 51 140 141 575 156 565 51 140 584 573 157 352 51 140 585 573 158 353 51 140 585 573 165 354 51 140 141 575 166 355 51 140 141 575 167 357 51 140 141 575 168 356 51 140 141 575 169 358 51 140 141 575 170 359 51 140 141 575 171 360 51 140 457 576 172 361 51 140 141 575 601 324 51 140 141 575 311 362 51 140 141 575 305 308 51 140 586 573 173 363 51 140 141 575 309 310 51 140 141 575 312 364 51 140 141 575 313 365 51 140 141 575 314 366 51 140 141 575 306 307 51 140 586 573 315 367 51 140 586 573 174 368 51 140 141 175 369 51 140 587 573 176 177 51 140 587 573 178 370 51 140 587 573 179 371 51 140 587 573 180 372 51 140 587 573 181 373 51 140 141 182 375 382 140 588 573 376 382 140 588 573 377 382 140 588 573 378 382 140 588 573 379 382 140 588 573 380 382 140 588 573 381 382 140 588 573 381 51 140 141 183 383 51 140 141 184 384 51 140 141 185 385 51 140 141 186 386 51 140 141 387 331 51 140 589 573 187 388 51 140 588 573 188 389 51 140 588 573 189 390 51 140 588 573 190 391 51 140 141 191 392 374 140 141 192 393 51 140 141 193 394 382 140 141 194 395 51 140 141 195 396 374 140 141 196 397 374 140 141 197 398 374 140 141 198 399 374 140 141 199 400 374 140 141 200 401 374 140 141 201 402 374 140 141 202 403 374 140 141 203 404 374 140 141 204 405 374 140 141 205 406 51 140 141 206 407 51 140 141 207 408 51 140 141 208 409 51 140 141 209 410 51 140 141 210 411 51 140 141 211 412 51 140 141 212 413 51 140 141 213 414 51 140 141 214 415 51 140 141 215 416 51 140 141 216 417 51 140 141 217 418 51 140 419 147 420 597 320 421 51 140 590 566 567 150 113 51 140 141 321 114 382 140 590 147 141 567 322 115 51 140 590 566 567 151 435 51 140 141 152 436 51 140 141 424 429 51 140 141 425 430 51 140 141 426 431 51 140 440 568 439 438 51 140 440 568 427 432 51 140 141 153 428 51 140 141 154 434 51 140 141 155 437 51 140 141 423 433 51 140 441 218 442 51 140 441 219 458 51 140 441 220 459 51 140 441 221 460 51 140 441 222 461 51 140 441 223 462 51 140 441 224 463 51 140 441 225 464 51 140 441 226 465 51 140 441 227 466 51 140 441 316 467 51 140 441 317 468 51 140 441 318 469 51 140 441 319 470 51 140 441 228 471 51 140 441 229 472 51 140 441 230 473 51 140 441 536 540 51 140 441 231 474 51 140 441 232 475 51 140 441 233 476 51 140 441 234 477 51 140 441 235 478 51 140 591 5 569 236 479 51 140 141 237 480 51 140 141 238 101 51 140 141 239 102 51 140 141 240 103 51 140 141 241 104 51 140 141 242 105 51 140 141 243 106 51 140 141 244 107 51 140 141 245 108 51 140 141 246 109 51 140 141 247 481 382 140 141 248 482 382 140 141 249 483 382 140 141 250 484 382 140 141 251 485 382 140 141 252 486 382 140 141 253 487 382 140 141 254 89 382 140 141 255 488 382 140 141 256 90 382 140 141 257 489 382 140 141 258 92 382 140 141 259 490 382 140 141 260 491 382 140 141 261 492 382 140 141 262 493 382 140 141 263 494 382 140 141 264 495 382 140 141 265 496 382 140 141 266 498 497 570 267 499 382 140 141 268 500 382 140 141 269 501 382 140 141 270 502 382 140 141 271 503 382 140 141 272 504 382 140 141 273 505 382 140 141 274 96 382 140 141 275 97 382 140 141 276 506 382 140 141 277 98 382 140 141 278 507 51 140 592 569 279 508 51 140 592 569 280 509 382 140 141 281 510 382 140 141 282 511 382 140 141 283 512 382 140 141 537 541 382 140 141 538 542 382 140 141 539 543 382 140 141 284 513 382 140 141 285 514 382 140 141 286 515 382 140 141 287 516 382 140 141 288 517 382 140 141 289 518 382 140 141 290 519 51 140 141 291 520 51 140 141 292 521 51 140 141 293 522 51 140 141 294 524 51 140 591 571 295 525 51 140 591 571 296 526 51 140 141 297 527 51 140 141 298 528 51 140 141 299 529 51 140 141 300 530 51 140 141 301 531 51 140 141 302 532 51 140 141 303 533 51 140 534 304 110 51 140 535 10 11 12 18 139 138 139 138 52 51 140 141 53 51 140 141 74 51 140 141 54 51 140 141 75 51 140 141 55 51 140 141 556 51 140 141 56 51 140 141 57 51 140 141 58 51 140 141 76 51 140 141 59 51 140 141 60 51 140 141 61 51 140 141 62 51 140 141 63 51 140 141 64 51 140 141 65 51 140 141 77 51 140 141 66 51 140 141 67 51 140 141 78 140 141 68 140 141 79 51 140 141 80 51 140 141 69 51 140 141 81 51 140 141 70 51 140 141 82 51 140 141 71 51 140 141 72 51 140 141 72 51 140 141 73 51 140 141 83 557 140 593 598 84 51 140 593 598 85 51 140 593 598 86 51 140 593 598 87 51 140 593 598 555 51 140 141 88 557 593 598 21 22 139 138 139 138 113 51 140 141 114 51 140 141 115 51 140 141 13 139 138 139 138 110 382 140 141 111 112 14 139 138 139 138 101 382 140 141 102 382 140 141 103 382 140 141 104 382 140 141 105 382 140 141 106 382 140 141 107 382 140 141 108 382 140 141 109 382 140 141 15 5 16 558 51 140 593 598 559 51 140 593 598 560 51 140 593 598 561 564 140 593 598 562 564 140 593 598 563 564 140 593 598 5 17 89 422 90 91 92 93 94 95 374 140 594 598 96 97 98 5 523 595 599 600

6 9 99 139 138 139 138 146 118 51 140 145 147 141 119 51 140 145 147 141 120 51 140 145 147 141 121 51 140 145 147 141 117 51 140 577 147 141 572 5 122 51 140 577 147 141 572 123 51 140 578 147 141 596 124 51 140 578 147 141 596 125 51 140 578 147 141 596 126 51 140 578 147 141 596 127 51 140 578 147 141 596 5 128 51 140 578 147 141 596 129 51 140 443 147 141 596 130 51 140 579 147 141 596 131 51 142 141 147 141 132 51 142 141 147 141 133 51 142 141 147 141 134 51 142 141 147 141 135 51 142 141 147 141 136 51 142 141 147 141 137 51 142 141 147 141 19 139 138 139 138 23 51 140 141 147 141 24 51 140 141 147 141 143 144 140 141 147 141 25 51 140 141 147 141 26 51 140 141 147 141 27 51 140 141 147 141 28 51 140 141 147 141 29 51 140 141 147 141 30 51 140 141 147 141 31 148 140 580 147 141 32 51 140 580 147 141 33 51 140 141 147 141 34 51 140 141 147 141 35 51 140 141 147 141 36 51 140 141 147 141 37 51 140 141 147 141 38 51 140 141 147 141 39 51 140 141 147 141 20 139 138 139 138 40 41 42 43 51 140 581 573 44 45 51 140 581 573 46 47 51 140 582 574 48 49 51 140 582 574 446 544 444 140 453 545 444 140 454 546 444 140 455 547 444 140 456 548 444 140 447 549 444 140 448 550 444 140 449 551 444 140 450 552 444 140 451 553 444 140 452 554 444 140 149 50 444 140 445 5 100 139 138 139 138 323 148 140 583 573 325 148 140 583 573 326 148 140 583 573 327 148 140 583 573 328 148 140 583 573 324 148 140 332 573 329 148 140 330 575 331 148 140 333 575 159 334 51 140 141 575 160 335 51 140 141 575 161 336 51 140 141 575 337 51 140 141 575 338 51 140 141 575 339 51 140 141 575 340 51 140 141 575 341 51 140 141 575 342 51 140 141 575 343 51 140 141 575 344 51 140 141 575 345 51 140 141 575 346 51 140 141 575 347 51 140 141 575 348 51 140 141 575 162 349 51 140 141 575 163 350 51 140 141 575 164 351 51 140 141 575 156 565 51 140 584 573 157 352 51 140 585 573 158 353 51 140 585 573 165 354 51 140 141 575 166 355 51 140 141 575 167 357 51 140 141 575 168 356 51 140 141 575 169 358 51 140 141 575 170 359 51 140 141 575 171 360 51 140 457 576 172 361 51 140 141 575 601 324 51 140 141 575 311 362 51 140 141 575 305 308 51 140 586 573 173 363 51 140 141 575 309 310 51 140 141 575 312 364 51 140 141 575 313 365 51 140 141 575 314 366 51 140 141 575 306 307 51 140 586 573 315 367 51 140 586 573 174 368 51 140 141 175 369 51 140 587 573 176 177 51 140 587 573 178 370 51 140 587 573 179 371 51 140 587 573 180 372 51 140 587 573 181 373 51 140 141 182 375 382 140 588 573 376 382 140 588 573 377 382 140 588 573 378 382 140 588 573 379 382 140 588 573 380 382 140 588 573 381 382 140 588 573 381 51 140 141 183 383 51 140 141 184 384 51 140 141 185 385 51 140 141 186 386 51 140 141 387 331 51 140 589 573 187 388 51 140 588 573 188 389 51 140 588 573 189 390 51 140 588 573 190 391 51 140 141 191 392 374 140 141 192 393 51 140 141 193 394 382 140 141 194 395 51 140 141 195 396 374 140 141 196 397 374 140 141 197 398 374 140 141 198 399 374 140 141 199 400 374 140 141 200 401 374 140 141 201 402 374 140 141 202 403 374 140 141 203 404 374 140 141 204 405 374 140 141 205 406 51 140 141 206 407 51 140 141 207 408 51 140 141 208 409 51 140 141 209 410 51 140 141 210 411 51 140 141 211 412 51 140 141 212 413 51 140 141 213 414 51 140 141 214 415 51 140 141 215 416 51 140 141 216 417 51 140 141 217 418 51 140 419 147 420 597 320 421 51 140 590 566 567 150 113 51 140 141 321 114 382 140 590 147 141 567 322 115 51 140 590 566 567 151 435 51 140 141 152 436 51 140 141 424 429 51 140 141 425 430 51 140 141 426 431 51 140 440 568 439 438 51 140 440 568 427 432 51 140 141 153 428 51 140 141 154 434 51 140 141 155 437 51 140 141 423 433 51 140 441 218 442 51 140 441 219 458 51 140 441 220 459 51 140 441 221 460 51 140 441 222 461 51 140 441 223 462 51 140 441 224 463 51 140 441 225 464 51 140 441 226 465 51 140 441 227 466 51 140 441 316 467 51 140 441 317 468 51 140 441 318 469 51 140 441 319 470 51 140 441 228 471 51 140 441 229 472 51 140 441 230 473 51 140 441 536 540 51 140 441 231 474 51 140 441 232 475 51 140 441 233 476 51 140 441 234 477 51 140 441 235 478 51 140 591 5 569 236 479 51 140 141 237 480 51 140 141 238 101 51 140 141 239 102 51 140 141 240 103 51 140 141 241 104 51 140 141 242 105 51 140 141 243 106 51 140 141 244 107 51 140 141 245 108 51 140 141 246 109 51 140 141 247 481 382 140 141 248 482 382 140 141 249 483 382 140 141 250 484 382 140 141 251 485 382 140 141 252 486 382 140 141 253 487 382 140 141 254 89 382 140 141 255 488 382 140 141 256 90 382 140 141 257 489 382 140 141 258 92 382 140 141 259 490 382 140 141 260 491 382 140 141 261 492 382 140 141 262 493 382 140 141 263 494 382 140 141 264 495 382 140 141 265 496 382 140 141 266 498 497 570 267 499 382 140 141 268 500 382 140 141 269 501 382 140 141 270 502 382 140 141 271 503 382 140 141 272 504 382 140 141 273 505 382 140 141 274 96 382 140 141 275 97 382 140 141 276 506 382 140 141 277 98 382 140 141 278 507 51 140 592 569 279 508 51 140 592 569 280 509 382 140 141 281 510 382 140 141 282 511 382 140 141 283 512 382 140 141 537 541 382 140 141 538 542 382 140 141 539 543 382 140 141 284 513 382 140 141 285 514 382 140 141 286 515 382 140 141 287 516 382 140 141 288 517 382 140 141 289 518 382 140 141 290 519 51 140 141 291 520 51 140 141 292 521 51 140 141 293 522 51 140 141 294 524 51 140 591 571 295 525 51 140 591 571 296 526 51 140 141 297 527 51 140 141 298 528 51 140 141 299 529 51 140 141 300 530 51 140 141 301 531 51 140 141 302 532 51 140 141 303 533 51 140 534 304 110 51 140 535 10 11 12 18 139 138 139 138 52 51 140 141 53 51 140 141 74 51 140 141 54 51 140 141 75 51 140 141 55 51 140 141 556 51 140 141 56 51 140 141 57 51 140 141 58 51 140 141 76 51 140 141 59 51 140 141 60 51 140 141 61 51 140 141 62 51 140 141 63 51 140 141 64 51 140 141 65 51 140 141 77 51 140 141 66 51 140 141 67 51 140 141 78 140 141 68 140 141 79 51 140 141 80 51 140 141 69 51 140 141 81 51 140 141 70 51 140 141 82 51 140 141 71 51 140 141 72 51 140 141 72 51 140 141 73 51 140 141 83 557 140 593 598 84 51 140 593 598 85 51 140 593 598 86 51 140 593 598 87 51 140 593 598 555 51 140 141 88 557 593 598 21 22 139 138 139 138 113 51 140 141 114 51 140 141 115 51 140 141 13 139 138 139 138 110 382 140 141 111 112 14 139 138 139 138 101 382 140 141 102 382 140 141 103 382 140 141 104 382 140 141 105 382 140 141 106 382 140 141 107 382 140 141 108 382 140 141 109 382 140 141 15 5 16 558 51 140 593 598 559 51 140 593 598 560 51 140 593 598 561 564 140 593 598 562 564 140 593 598 563 564 140 593 598 5 17 89 422 90 91 92 93 94 95 374 140 594 598 96 97 98 5 523 595 599 600

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

6 9 99 139 138 139 138 146 118 51 140 145 147 141 119 51 140 145 147 141 120 51 140 145 147 141 121 51 140 145 147 141 117 51 140 577 147 141 572 5 122 51 140 577 147 141 572 123 51 140 578 147 141 596 124 51 140 578 147 141 596 125 51 140 578 147 141 596 126 51 140 578 147 141 596 127 51 140 578 147 141 596 5 128 51 140 578 147 141 596 129 51 140 443 147 141 596 130 51 140 579 147 141 596 131 51 142 141 147 141 132 51 142 141 147 141 133 51 142 141 147 141 134 51 142 141 147 141 135 51 142 141 147 141 136 51 142 141 147 141 137 51 142 141 147 141 19 139 138 139 138 23 51 140 141 147 141 24 51 140 141 147 141 143 144 140 141 147 141 25 51 140 141 147 141 26 51 140 141 147 141 27 51 140 141 147 141 28 51 140 141 147 141 29 51 140 141 147 141 30 51 140 141 147 141 31 148 140 580 147 141 32 51 140 580 147 141 33 51 140 141 147 141 34 51 140 141 147 141 35 51 140 141 147 141 36 51 140 141 147 141 37 51 140 141 147 141 38 51 140 141 147 141 39 51 140 141 147 141 20 139 138 139 138 40 41 42 43 51 140 581 573 44 45 51 140 581 573 46 47 51 140 582 574 48 49 51 140 582 574 446 544 444 140 453 545 444 140 454 546 444 140 455 547 444 140 456 548 444 140 447 549 444 140 448 550 444 140 449 551 444 140 450 552 444 140 451 553 444 140 452 554 444 140 149 50 444 140 445 5 100 139 138 139 138 323 148 140 583 573 325 148 140 583 573 326 148 140 583 573 327 148 140 583 573 328 148 140 583 573 324 148 140 332 573 329 148 140 330 575 331 148 140 333 575 159 334 51 140 141 575 160 335 51 140 141 575 161 336 51 140 141 575 337 51 140 141 575 338 51 140 141 575 339 51 140 141 575 340 51 140 141 575 341 51 140 141 575 342 51 140 141 575 343 51 140 141 575 344 51 140 141 575 345 51 140 141 575 346 51 140 141 575 347 51 140 141 575 348 51 140 141 575 162 349 51 140 141 575 163 350 51 140 141 575 164 351 51 140 141 575 156 565 51 140 584 573 157 352 51 140 585 573 158 353 51 140 585 573 165 354 51 140 141 575 166 355 51 140 141 575 167 357 51 140 141 575 168 356 51 140 141 575 169 358 51 140 141 575 170 359 51 140 141 575 171 360 51 140 457 576 172 361 51 140 141 575 601 324 51 140 141 575 311 362 51 140 141 575 305 308 51 140 586 573 173 363 51 140 141 575 309 310 51 140 141 575 312 364 51 140 141 575 313 365 51 140 141 575 314 366 51 140 141 575 306 307 51 140 586 573 315 367 51 140 586 573 174 368 51 140 141 175 369 51 140 587 573 176 177 51 140 587 573 178 370 51 140 587 573 179 371 51 140 587 573 180 372 51 140 587 573 181 373 51 140 141 182 375 382 140 588 573 376 382 140 588 573 377 382 140 588 573 378 382 140 588 573 379 382 140 588 573 380 382 140 588 573 381 382 140 588 573 381 51 140 141 183 383 51 140 141 184 384 51 140 141 185 385 51 140 141 186 386 51 140 141 387 331 51 140 589 573 187 388 51 140 588 573 188 389 51 140 588 573 189 390 51 140 588 573 190 391 51 140 141 191 392 374 140 141 192 393 51 140 141 193 394 382 140 141 194 395 51 140 141 195 396 374 140 141 196 397 374 140 141 197 398 374 140 141 198 399 374 140 141 199 400 374 140 141 200 401 374 140 141 201 402 374 140 141 202 403 374 140 141 203 404 374 140 141 204 405 374 140 141 205 406 51 140 141 206 407 51 140 141 207 408 51 140 141 208 409 51 140 141 209 410 51 140 141 210 411 51 140 141 211 412 51 140 141 212 413 51 140 141 213 414 51 140 141 214 415 51 140 141 215 416 51 140 141 216 417 51 140 141 217 418 51 140 419 147 420 597 320 421 51 140 590 566 567 150 113 51 140 141 321 114 382 140 590 147 141 567 322 115 51 140 590 566 567 151 435 51 140 141 152 436 51 140 141 424 429 51 140 141 425 430 51 140 141 426 431 51 140 440 568 439 438 51 140 440 568 427 432 51 140 141 153 428 51 140 141 154 434 51 140 141 155 437 51 140 141 423 433 51 140 441 218 442 51 140 441 219 458 51 140 441 220 459 51 140 441 221 460 51 140 441 222 461 51 140 441 223 462 51 140 441 224 463 51 140 441 225 464 51 140 441 226 465 51 140 441 227 466 51 140 441 316 467 51 140 441 317 468 51 140 441 318 469 51 140 441 319 470 51 140 441 228 471 51 140 441 229 472 51 140 441 230 473 51 140 441 536 540 51 140 441 231 474 51 140 441 232 475 51 140 441 233 476 51 140 441 234 477 51 140 441 235 478 51 140 591 5 569 236 479 51 140 141 237 480 51 140 141 238 101 51 140 141 239 102 51 140 141 240 103 51 140 141 241 104 51 140 141 242 105 51 140 141 243 106 51 140 141 244 107 51 140 141 245 108 51 140 141 246 109 51 140 141 247 481 382 140 141 248 482 382 140 141 249 483 382 140 141 250 484 382 140 141 251 485 382 140 141 252 486 382 140 141 253 487 382 140 141 254 89 382 140 141 255 488 382 140 141 256 90 382 140 141 257 489 382 140 141 258 92 382 140 141 259 490 382 140 141 260 491 382 140 141 261 492 382 140 141 262 493 382 140 141 263 494 382 140 141 264 495 382 140 141 265 496 382 140 141 266 498 497 570 267 499 382 140 141 268 500 382 140 141 269 501 382 140 141 270 502 382 140 141 271 503 382 140 141 272 504 382 140 141 273 505 382 140 141 274 96 382 140 141 275 97 382 140 141 276 506 382 140 141 277 98 382 140 141 278 507 51 140 592 569 279 508 51 140 592 569 280 509 382 140 141 281 510 382 140 141 282 511 382 140 141 283 512 382 140 141 537 541 382 140 141 538 542 382 140 141 539 543 382 140 141 284 513 382 140 141 285 514 382 140 141 286 515 382 140 141 287 516 382 140 141 288 517 382 140 141 289 518 382 140 141 290 519 51 140 141 291 520 51 140 141 292 521 51 140 141 293 522 51 140 141 294 524 51 140 591 571 295 525 51 140 591 571 296 526 51 140 141 297 527 51 140 141 298 528 51 140 141 299 529 51 140 141 300 530 51 140 141 301 531 51 140 141 302 532 51 140 141 303 533 51 140 534 304 110 51 140 535 10 11 12 18 139 138 139 138 52 51 140 141 53 51 140 141 74 51 140 141 54 51 140 141 75 51 140 141 55 51 140 141 556 51 140 141 56 51 140 141 57 51 140 141 58 51 140 141 76 51 140 141 59 51 140 141 60 51 140 141 61 51 140 141 62 51 140 141 63 51 140 141 64 51 140 141 65 51 140 141 77 51 140 141 66 51 140 141 67 51 140 141 78 140 141 68 140 141 79 51 140 141 80 51 140 141 69 51 140 141 81 51 140 141 70 51 140 141 82 51 140 141 71 51 140 141 72 51 140 141 72 51 140 141 73 51 140 141 83 557 140 593 598 84 51 140 593 598 85 51 140 593 598 86 51 140 593 598 87 51 140 593 598 555 51 140 141 88 557 593 598 21 22 139 138 139 138 113 51 140 141 114 51 140 141 115 51 140 141 13 139 138 139 138 110 382 140 141 111 112 14 139 138 139 138 101 382 140 141 102 382 140 141 103 382 140 141 104 382 140 141 105 382 140 141 106 382 140 141 107 382 140 141 108 382 140 141 109 382 140 141 15 5 16 558 51 140 593 598 559 51 140 593 598 560 51 140 593 598 561 564 140 593 598 562 564 140 593 598 563 564 140 593 598 5 17 89 422 90 91 92 93 94 95 374 140 594 598 96 97 98 5 523 595 599 600

6 9 99 139 138 139 138 146 118 51 140 145 147 141 119 51 140 145 147 141 120 51 140 145 147 141 121 51 140 145 147 141 117 51 140 577 147 141 572 5 122 51 140 577 147 141 572 123 51 140 578 147 141 596 124 51 140 578 147 141 596 125 51 140 578 147 141 596 126 51 140 578 147 141 596 127 51 140 578 147 141 596 5 128 51 140 578 147 141 596 129 51 140 443 147 141 596 130 51 140 579 147 141 596 131 51 142 141 147 141 132 51 142 141 147 141 133 51 142 141 147 141 134 51 142 141 147 141 135 51 142 141 147 141 136 51 142 141 147 141 137 51 142 141 147 141 19 139 138 139 138 23 51 140 141 147 141 24 51 140 141 147 141 143 144 140 141 147 141 25 51 140 141 147 141 26 51 140 141 147 141 27 51 140 141 147 141 28 51 140 141 147 141 29 51 140 141 147 141 30 51 140 141 147 141 31 148 140 580 147 141 32 51 140 580 147 141 33 51 140 141 147 141 34 51 140 141 147 141 35 51 140 141 147 141 36 51 140 141 147 141 37 51 140 141 147 141 38 51 140 141 147 141 39 51 140 141 147 141 20 139 138 139 138 40 41 42 43 51 140 581 573 44 45 51 140 581 573 46 47 51 140 582 574 48 49 51 140 582 574 446 544 444 140 453 545 444 140 454 546 444 140 455 547 444 140 456 548 444 140 447 549 444 140 448 550 444 140 449 551 444 140 450 552 444 140 451 553 444 140 452 554 444 140 149 50 444 140 445 5 100 139 138 139 138 323 148 140 583 573 325 148 140 583 573 326 148 140 583 573 327 148 140 583 573 328 148 140 583 573 324 148 140 332 573 329 148 140 330 575 331 148 140 333 575 159 334 51 140 141 575 160 335 51 140 141 575 161 336 51 140 141 575 337 51 140 141 575 338 51 140 141 575 339 51 140 141 575 340 51 140 141 575 341 51 140 141 575 342 51 140 141 575 343 51 140 141 575 344 51 140 141 575 345 51 140 141 575 346 51 140 141 575 347 51 140 141 575 348 51 140 141 575 162 349 51 140 141 575 163 350 51 140 141 575 164 351 51 140 141 575 156 565 51 140 584 573 157 352 51 140 585 573 158 353 51 140 585 573 165 354 51 140 141 575 166 355 51 140 141 575 167 357 51 140 141 575 168 356 51 140 141 575 169 358 51 140 141 575 170 359 51 140 141 575 171 360 51 140 457 576 172 361 51 140 141 575 601 324 51 140 141 575 311 362 51 140 141 575 305 308 51 140 586 573 173 363 51 140 141 575 309 310 51 140 141 575 312 364 51 140 141 575 313 365 51 140 141 575 314 366 51 140 141 575 306 307 51 140 586 573 315 367 51 140 586 573 174 368 51 140 141 175 369 51 140 587 573 176 177 51 140 587 573 178 370 51 140 587 573 179 371 51 140 587 573 180 372 51 140 587 573 181 373 51 140 141 182 375 382 140 588 573 376 382 140 588 573 377 382 140 588 573 378 382 140 588 573 379 382 140 588 573 380 382 140 588 573 381 382 140 588 573 381 51 140 141 183 383 51 140 141 184 384 51 140 141 185 385 51 140 141 186 386 51 140 141 387 331 51 140 589 573 187 388 51 140 588 573 188 389 51 140 588 573 189 390 51 140 588 573 190 391 51 140 141 191 392 374 140 141 192 393 51 140 141 193 394 382 140 141 194 395 51 140 141 195 396 374 140 141 196 397 374 140 141 197 398 374 140 141 198 399 374 140 141 199 400 374 140 141 200 401 374 140 141 201 402 374 140 141 202 403 374 140 141 203 404 374 140 141 204 405 374 140 141 205 406 51 140 141 206 407 51 140 141 207 408 51 140 141 208 409 51 140 141 209 410 51 140 141 210 411 51 140 141 211 412 51 140 141 212 413 51 140 141 213 414 51 140 141 214 415 51 140 141 215 416 51 140 141 216 417 51 140 141 217 418 51 140 419 147 420 597 320 421 51 140 590 566 567 150 113 51 140 141 321 114 382 140 590 147 141 567 322 115 51 140 590 566 567 151 435 51 140 141 152 436 51 140 141 424 429 51 140 141 425 430 51 140 141 426 431 51 140 440 568 439 438 51 140 440 568 427 432 51 140 141 153 428 51 140 141 154 434 51 140 141 155 437 51 140 141 423 433 51 140 441 218 442 51 140 441 219 458 51 140 441 220 459 51 140 441 221 460 51 140 441 222 461 51 140 441 223 462 51 140 441 224 463 51 140 441 225 464 51 140 441 226 465 51 140 441 227 466 51 140 441 316 467 51 140 441 317 468 51 140 441 318 469 51 140 441 319 470 51 140 441 228 471 51 140 441 229 472 51 140 441 230 473 51 140 441 536 540 51 140 441 231 474 51 140 441 232 475 51 140 441 233 476 51 140 441 234 477 51 140 441 235 478 51 140 591 5 569 236 479 51 140 141 237 480 51 140 141 238 101 51 140 141 239 102 51 140 141 240 103 51 140 141 241 104 51 140 141 242 105 51 140 141 243 106 51 140 141 244 107 51 140 141 245 108 51 140 141 246 109 51 140 141 247 481 382 140 141 248 482 382 140 141 249 483 382 140 141 250 484 382 140 141 251 485 382 140 141 252 486 382 140 141 253 487 382 140 141 254 89 382 140 141 255 488 382 140 141 256 90 382 140 141 257 489 382 140 141 258 92 382 140 141 259 490 382 140 141 260 491 382 140 141 261 492 382 140 141 262 493 382 140 141 263 494 382 140 141 264 495 382 140 141 265 496 382 140 141 266 498 497 570 267 499 382 140 141 268 500 382 140 141 269 501 382 140 141 270 502 382 140 141 271 503 382 140 141 272 504 382 140 141 273 505 382 140 141 274 96 382 140 141 275 97 382 140 141 276 506 382 140 141 277 98 382 140 141 278 507 51 140 592 569 279 508 51 140 592 569 280 509 382 140 141 281 510 382 140 141 282 511 382 140 141 283 512 382 140 141 537 541 382 140 141 538 542 382 140 141 539 543 382 140 141 284 513 382 140 141 285 514 382 140 141 286 515 382 140 141 287 516 382 140 141 288 517 382 140 141 289 518 382 140 141 290 519 51 140 141 291 520 51 140 141 292 521 51 140 141 293 522 51 140 141 294 524 51 140 591 571 295 525 51 140 591 571 296 526 51 140 141 297 527 51 140 141 298 528 51 140 141 299 529 51 140 141 300 530 51 140 141 301 531 51 140 141 302 532 51 140 141 303 533 51 140 534 304 110 51 140 535 10 11 12 18 139 138 139 138 52 51 140 141 53 51 140 141 74 51 140 141 54 51 140 141 75 51 140 141 55 51 140 141 556 51 140 141 56 51 140 141 57 51 140 141 58 51 140 141 76 51 140 141 59 51 140 141 60 51 140 141 61 51 140 141 62 51 140 141 63 51 140 141 64 51 140 141 65 51 140 141 77 51 140 141 66 51 140 141 67 51 140 141 78 140 141 68 140 141 79 51 140 141 80 51 140 141 69 51 140 141 81 51 140 141 70 51 140 141 82 51 140 141 71 51 140 141 72 51 140 141 72 51 140 141 73 51 140 141 83 557 140 593 598 84 51 140 593 598 85 51 140 593 598 86 51 140 593 598 87 51 140 593 598 555 51 140 141 88 557 593 598 21 22 139 138 139 138 113 51 140 141 114 51 140 141 115 51 140 141 13 139 138 139 138 110 382 140 141 111 112 14 139 138 139 138 101 382 140 141 102 382 140 141 103 382 140 141 104 382 140 141 105 382 140 141 106 382 140 141 107 382 140 141 108 382 140 141 109 382 140 141 15 5 16 558 51 140 593 598 559 51 140 593 598 560 51 140 593 598 561 564 140 593 598 562 564 140 593 598 563 564 140 593 598 5 17 89 422 90 91 92 93 94 95 374 140 594 598 96 97 98 5 523 595 599 600

6 9 99 139 138 139 138 146 118 51 140 145 147 141 119 51 140 145 147 141 120 51 140 145 147 141 121 51 140 145 147 141 117 51 140 577 147 141 572 5 122 51 140 577 147 141 572 123 51 140 578 147 141 596 124 51 140 578 147 141 596 125 51 140 578 147 141 596 126 51 140 578 147 141 596 127 51 140 578 147 141 596 5 128 51 140 578 147 141 596 129 51 140 443 147 141 596 130 51 140 579 147 141 596 131 51 142 141 147 141 132 51 142 141 147 141 133 51 142 141 147 141 134 51 142 141 147 141 135 51 142 141 147 141 136 51 142 141 147 141 137 51 142 141 147 141 19 139 138 139 138 23 51 140 141 147 141 24 51 140 141 147 141 143 144 140 141 147 141 25 51 140 141 147 141 26 51 140 141 147 141 27 51 140 141 147 141 28 51 140 141 147 141 29 51 140 141 147 141 30 51 140 141 147 141 31 148 140 580 147 141 32 51 140 580 147 141 33 51 140 141 147 141 34 51 140 141 147 141 35 51 140 141 147 141 36 51 140 141 147 141 37 51 140 141 147 141 38 51 140 141 147 141 39 51 140 141 147 141 20 139 138 139 138 40 41 42 43 51 140 581 573 44 45 51 140 581 573 46 47 51 140 582 574 48 49 51 140 582 574 446 544 444 140 453 545 444 140 454 546 444 140 455 547 444 140 456 548 444 140 447 549 444 140 448 550 444 140 449 551 444 140 450 552 444 140 451 553 444 140 452 554 444 140 149 50 444 140 445 5 100 139 138 139 138 323 148 140 583 573 325 148 140 583 573 326 148 140 583 573 327 148 140 583 573 328 148 140 583 573 324 148 140 332 573 329 148 140 330 575 331 148 140 333 575 159 334 51 140 141 575 160 335 51 140 141 575 161 336 51 140 141 575 337 51 140 141 575 338 51 140 141 575 339 51 140 141 575 340 51 140 141 575 341 51 140 141 575 342 51 140 141 575 343 51 140 141 575 344 51 140 141 575 345 51 140 141 575 346 51 140 141 575 347 51 140 141 575 348 51 140 141 575 162 349 51 140 141 575 163 350 51 140 141 575 164 351 51 140 141 575 156 565 51 140 584 573 157 352 51 140 585 573 158 353 51 140 585 573 165 354 51 140 141 575 166 355 51 140 141 575 167 357 51 140 141 575 168 356 51 140 141 575 169 358 51 140 141 575 170 359 51 140 141 575 171 360 51 140 457 576 172 361 51 140 141 575 601 324 51 140 141 575 311 362 51 140 141 575 305 308 51 140 586 573 173 363 51 140 141 575 309 310 51 140 141 575 312 364 51 140 141 575 313 365 51 140 141 575 314 366 51 140 141 575 306 307 51 140 586 573 315 367 51 140 586 573 174 368 51 140 141 175 369 51 140 587 573 176 177 51 140 587 573 178 370 51 140 587 573 179 371 51 140 587 573 180 372 51 140 587 573 181 373 51 140 141 182 375 382 140 588 573 376 382 140 588 573 377 382 140 588 573 378 382 140 588 573 379 382 140 588 573 380 382 140 588 573 381 382 140 588 573 381 51 140 141 183 383 51 140 141 184 384 51 140 141 185 385 51 140 141 186 386 51 140 141 387 331 51 140 589 573 187 388 51 140 588 573 188 389 51 140 588 573 189 390 51 140 588 573 190 391 51 140 141 191 392 374 140 141 192 393 51 140 141 193 394 382 140 141 194 395 51 140 141 195 396 374 140 141 196 397 374 140 141 197 398 374 140 141 198 399 374 140 141 199 400 374 140 141 200 401 374 140 141 201 402 374 140 141 202 403 374 140 141 203 404 374 140 141 204 405 374 140 141 205 406 51 140 141 206 407 51 140 141 207 408 51 140 141 208 409 51 140 141 209 410 51 140 141 210 411 51 140 141 211 412 51 140 141 212 413 51 140 141 213 414 51 140 141 214 415 51 140 141 215 416 51 140 141 216 417 51 140 141 217 418 51 140 419 147 420 597 320 421 51 140 590 566 567 150 113 51 140 141 321 114 382 140 590 147 141 567 322 115 51 140 590 566 567 151 435 51 140 141 152 436 51 140 141 424 429 51 140 141 425 430 51 140 141 426 431 51 140 440 568 439 438 51 140 440 568 427 432 51 140 141 153 428 51 140 141 154 434 51 140 141 155 437 51 140 141 423 433 51 140 441 218 442 51 140 441 219 458 51 140 441 220 459 51 140 441 221 460 51 140 441 222 461 51 140 441 223 462 51 140 441 224 463 51 140 441 225 464 51 140 441 226 465 51 140 441 227 466 51 140 441 316 467 51 140 441 317 468 51 140 441 318 469 51 140 441 319 470 51 140 441 228 471 51 140 441 229 472 51 140 441 230 473 51 140 441 536 540 51 140 441 231 474 51 140 441 232 475 51 140 441 233 476 51 140 441 234 477 51 140 441 235 478 51 140 591 5 569 236 479 51 140 141 237 480 51 140 141 238 101 51 140 141 239 102 51 140 141 240 103 51 140 141 241 104 51 140 141 242 105 51 140 141 243 106 51 140 141 244 107 51 140 141 245 108 51 140 141 246 109 51 140 141 247 481 382 140 141 248 482 382 140 141 249 483 382 140 141 250 484 382 140 141 251 485 382 140 141 252 486 382 140 141 253 487 382 140 141 254 89 382 140 141 255 488 382 140 141 256 90 382 140 141 257 489 382 140 141 258 92 382 140 141 259 490 382 140 141 260 491 382 140 141 261 492 382 140 141 262 493 382 140 141 263 494 382 140 141 264 495 382 140 141 265 496 382 140 141 266 498 497 570 267 499 382 140 141 268 500 382 140 141 269 501 382 140 141 270 502 382 140 141 271 503 382 140 141 272 504 382 140 141 273 505 382 140 141 274 96 382 140 141 275 97 382 140 141 276 506 382 140 141 277 98 382 140 141 278 507 51 140 592 569 279 508 51 140 592 569 280 509 382 140 141 281 510 382 140 141 282 511 382 140 141 283 512 382 140 141 537 541 382 140 141 538 542 382 140 141 539 543 382 140 141 284 513 382 140 141 285 514 382 140 141 286 515 382 140 141 287 516 382 140 141 288 517 382 140 141 289 518 382 140 141 290 519 51 140 141 291 520 51 140 141 292 521 51 140 141 293 522 51 140 141 294 524 51 140 591 571 295 525 51 140 591 571 296 526 51 140 141 297 527 51 140 141 298 528 51 140 141 299 529 51 140 141 300 530 51 140 141 301 531 51 140 141 302 532 51 140 141 303 533 51 140 534 304 110 51 140 535 10 11 12 18 139 138 139 138 52 51 140 141 53 51 140 141 74 51 140 141 54 51 140 141 75 51 140 141 55 51 140 141 556 51 140 141 56 51 140 141 57 51 140 141 58 51 140 141 76 51 140 141 59 51 140 141 60 51 140 141 61 51 140 141 62 51 140 141 63 51 140 141 64 51 140 141 65 51 140 141 77 51 140 141 66 51 140 141 67 51 140 141 78 140 141 68 140 141 79 51 140 141 80 51 140 141 69 51 140 141 81 51 140 141 70 51 140 141 82 51 140 141 71 51 140 141 72 51 140 141 72 51 140 141 73 51 140 141 83 557 140 593 598 84 51 140 593 598 85 51 140 593 598 86 51 140 593 598 87 51 140 593 598 555 51 140 141 88 557 593 598 21 22 139 138 139 138 113 51 140 141 114 51 140 141 115 51 140 141 13 139 138 139 138 110 382 140 141 111 112 14 139 138 139 138 101 382 140 141 102 382 140 141 103 382 140 141 104 382 140 141 105 382 140 141 106 382 140 141 107 382 140 141 108 382 140 141 109 382 140 141 15 5 16 558 51 140 593 598 559 51 140 593 598 560 51 140 593 598 561 564 140 593 598 562 564 140 593 598 563 564 140 593 598 5 17 89 422 90 91 92 93 94 95 374 140 594 598 96 97 98 5 523 595 599 600

6 9 99 139 138 139 138 146 118 51 140 145 147 141 119 51 140 145 147 141 120 51 140 145 147 141 121 51 140 145 147 141 117 51 140 577 147 141 572 5 122 51 140 577 147 141 572 123 51 140 578 147 141 596 124 51 140 578 147 141 596 125 51 140 578 147 141 596 126 51 140 578 147 141 596 127 51 140 578 147 141 596 5 128 51 140 578 147 141 596 129 51 140 443 147 141 596 130 51 140 579 147 141 596 131 51 142 141 147 141 132 51 142 141 147 141 133 51 142 141 147 141 134 51 142 141 147 141 135 51 142 141 147 141 136 51 142 141 147 141 137 51 142 141 147 141 19 139 138 139 138 23 51 140 141 147 141 24 51 140 141 147 141 143 144 140 141 147 141 25 51 140 141 147 141 26 51 140 141 147 141 27 51 140 141 147 141 28 51 140 141 147 141 29 51 140 141 147 141 30 51 140 141 147 141 31 148 140 580 147 141 32 51 140 580 147 141 33 51 140 141 147 141 34 51 140 141 147 141 35 51 140 141 147 141 36 51 140 141 147 141 37 51 140 141 147 141 38 51 140 141 147 141 39 51 140 141 147 141 20 139 138 139 138 40 41 42 43 51 140 581 573 44 45 51 140 581 573 46 47 51 140 582 574 48 49 51 140 582 574 446 544 444 140 453 545 444 140 454 546 444 140 455 547 444 140 456 548 444 140 447 549 444 140 448 550 444 140 449 551 444 140 450 552 444 140 451 553 444 140 452 554 444 140 149 50 444 140 445 5 100 139 138 139 138 323 148 140 583 573 325 148 140 583 573 326 148 140 583 573 327 148 140 583 573 328 148 140 583 573 324 148 140 332 573 329 148 140 330 575 331 148 140 333 575 159 334 51 140 141 575 160 335 51 140 141 575 161 336 51 140 141 575 337 51 140 141 575 338 51 140 141 575 339 51 140 141 575 340 51 140 141 575 341 51 140 141 575 342 51 140 141 575 343 51 140 141 575 344 51 140 141 575 345 51 140 141 575 346 51 140 141 575 347 51 140 141 575 348 51 140 141 575 162 349 51 140 141 575 163 350 51 140 141 575 164 351 51 140 141 575 156 565 51 140 584 573 157 352 51 140 585 573 158 353 51 140 585 573 165 354 51 140 141 575 166 355 51 140 141 575 167 357 51 140 141 575 168 356 51 140 141 575 169 358 51 140 141 575 170 359 51 140 141 575 171 360 51 140 457 576 172 361 51 140 141 575 601 324 51 140 141 575 311 362 51 140 141 575 305 308 51 140 586 573 173 363 51 140 141 575 309 310 51 140 141 575 312 364 51 140 141 575 313 365 51 140 141 575 314 366 51 140 141 575 306 307 51 140 586 573 315 367 51 140 586 573 174 368 51 140 141 175 369 51 140 587 573 176 177 51 140 587 573 178 370 51 140 587 573 179 371 51 140 587 573 180 372 51 140 587 573 181 373 51 140 141 182 375 382 140 588 573 376 382 140 588 573 377 382 140 588 573 378 382 140 588 573 379 382 140 588 573 380 382 140 588 573 381 382 140 588 573 381 51 140 141 183 383 51 140 141 184 384 51 140 141 185 385 51 140 141 186 386 51 140 141 387 331 51 140 589 573 187 388 51 140 588 573 188 389 51 140 588 573 189 390 51 140 588 573 190 391 51 140 141 191 392 374 140 141 192 393 51 140 141 193 394 382 140 141 194 395 51 140 141 195 396 374 140 141 196 397 374 140 141 197 398 374 140 141 198 399 374 140 141 199 400 374 140 141 200 401 374 140 141 201 402 374 140 141 202 403 374 140 141 203 404 374 140 141 204 405 374 140 141 205 406 51 140 141 206 407 51 140 141 207 408 51 140 141 208 409 51 140 141 209 410 51 140 141 210 411 51 140 141 211 412 51 140 141 212 413 51 140 141 213 414 51 140 141 214 415 51 140 141 215 416 51 140 141 216 417 51 140 141 217 418 51 140 419 147 420 597 320 421 51 140 590 566 567 150 113 51 140 141 321 114 382 140 590 147 141 567 322 115 51 140 590 566 567 151 435 51 140 141 152 436 51 140 141 424 429 51 140 141 425 430 51 140 141 426 431 51 140 440 568 439 438 51 140 440 568 427 432 51 140 141 153 428 51 140 141 154 434 51 140 141 155 437 51 140 141 423 433 51 140 441 218 442 51 140 441 219 458 51 140 441 220 459 51 140 441 221 460 51 140 441 222 461 51 140 441 223 462 51 140 441 224 463 51 140 441 225 464 51 140 441 226 465 51 140 441 227 466 51 140 441 316 467 51 140 441 317 468 51 140 441 318 469 51 140 441 319 470 51 140 441 228 471 51 140 441 229 472 51 140 441 230 473 51 140 441 536 540 51 140 441 231 474 51 140 441 232 475 51 140 441 233 476 51 140 441 234 477 51 140 441 235 478 51 140 591 5 569 236 479 51 140 141 237 480 51 140 141 238 101 51 140 141 239 102 51 140 141 240 103 51 140 141 241 104 51 140 141 242 105 51 140 141 243 106 51 140 141 244 107 51 140 141 245 108 51 140 141 246 109 51 140 141 247 481 382 140 141 248 482 382 140 141 249 483 382 140 141 250 484 382 140 141 251 485 382 140 141 252 486 382 140 141 253 487 382 140 141 254 89 382 140 141 255 488 382 140 141 256 90 382 140 141 257 489 382 140 141 258 92 382 140 141 259 490 382 140 141 260 491 382 140 141 261 492 382 140 141 262 493 382 140 141 263 494 382 140 141 264 495 382 140 141 265 496 382 140 141 266 498 497 570 267 499 382 140 141 268 500 382 140 141 269 501 382 140 141 270 502 382 140 141 271 503 382 140 141 272 504 382 140 141 273 505 382 140 141 274 96 382 140 141 275 97 382 140 141 276 506 382 140 141 277 98 382 140 141 278 507 51 140 592 569 279 508 51 140 592 569 280 509 382 140 141 281 510 382 140 141 282 511 382 140 141 283 512 382 140 141 537 541 382 140 141 538 542 382 140 141 539 543 382 140 141 284 513 382 140 141 285 514 382 140 141 286 515 382 140 141 287 516 382 140 141 288 517 382 140 141 289 518 382 140 141 290 519 51 140 141 291 520 51 140 141 292 521 51 140 141 293 522 51 140 141 294 524 51 140 591 571 295 525 51 140 591 571 296 526 51 140 141 297 527 51 140 141 298 528 51 140 141 299 529 51 140 141 300 530 51 140 141 301 531 51 140 141 302 532 51 140 141 303 533 51 140 534 304 110 51 140 535 10 11 12 18 139 138 139 138 52 51 140 141 53 51 140 141 74 51 140 141 54 51 140 141 75 51 140 141 55 51 140 141 556 51 140 141 56 51 140 141 57 51 140 141 58 51 140 141 76 51 140 141 59 51 140 141 60 51 140 141 61 51 140 141 62 51 140 141 63 51 140 141 64 51 140 141 65 51 140 141 77 51 140 141 66 51 140 141 67 51 140 141 78 140 141 68 140 141 79 51 140 141 80 51 140 141 69 51 140 141 81 51 140 141 70 51 140 141 82 51 140 141 71 51 140 141 72 51 140 141 72 51 140 141 73 51 140 141 83 557 140 593 598 84 51 140 593 598 85 51 140 593 598 86 51 140 593 598 87 51 140 593 598 555 51 140 141 88 557 593 598 21 22 139 138 139 138 113 51 140 141 114 51 140 141 115 51 140 141 13 139 138 139 138 110 382 140 141 111 112 14 139 138 139 138 101 382 140 141 102 382 140 141 103 382 140 141 104 382 140 141 105 382 140 141 106 382 140 141 107 382 140 141 108 382 140 141 109 382 140 141 15 5 16 558 51 140 593 598 559 51 140 593 598 560 51 140 593 598 561 564 140 593 598 562 564 140 593 598 563 564 140 593 598 5 17 89 422 90 91 92 93 94 95 374 140 594 598 96 97 98 5 523 595 599 600

6 9 99 139 138 139 138 146 118 51 140 145 147 141 119 51 140 145 147 141 120 51 140 145 147 141 121 51 140 145 147 141 117 51 140 577 147 141 572 5 122 51 140 577 147 141 572 123 51 140 578 147 141 596 124 51 140 578 147 141 596 125 51 140 578 147 141 596 126 51 140 578 147 141 596 127 51 140 578 147 141 596 5 128 51 140 578 147 141 596 129 51 140 443 147 141 596 130 51 140 579 147 141 596 131 51 142 141 147 141 132 51 142 141 147 141 133 51 142 141 147 141 134 51 142 141 147 141 135 51 142 141 147 141 136 51 142 141 147 141 137 51 142 141 147 141 19 139 138 139 138 23 51 140 141 147 141 24 51 140 141 147 141 143 144 140 141 147 141 25 51 140 141 147 141 26 51 140 141 147 141 27 51 140 141 147 141 28 51 140 141 147 141 29 51 140 141 147 141 30 51 140 141 147 141 31 148 140 580 147 141 32 51 140 580 147 141 33 51 140 141 147 141 34 51 140 141 147 141 35 51 140 141 147 141 36 51 140 141 147 141 37 51 140 141 147 141 38 51 140 141 147 141 39 51 140 141 147 141 20 139 138 139 138 40 41 42 43 51 140 581 573 44 45 51 140 581 573 46 47 51 140 582 574 48 49 51 140 582 574 446 544 444 140 453 545 444 140 454 546 444 140 455 547 444 140 456 548 444 140 447 549 444 140 448 550 444 140 449 551 444 140 450 552 444 140 451 553 444 140 452 554 444 140 149 50 444 140 445 5 100 139 138 139 138 323 148 140 583 573 325 148 140 583 573 326 148 140 583 573 327 148 140 583 573 328 148 140 583 573 324 148 140 332 573 329 148 140 330 575 331 148 140 333 575 159 334 51 140 141 575 160 335 51 140 141 575 161 336 51 140 141 575 337 51 140 141 575 338 51 140 141 575 339 51 140 141 575 340 51 140 141 575 341 51 140 141 575 342 51 140 141 575 343 51 140 141 575 344 51 140 141 575 345 51 140 141 575 346 51 140 141 575 347 51 140 141 575 348 51 140 141 575 162 349 51 140 141 575 163 350 51 140 141 575 164 351 51 140 141 575 156 565 51 140 584 573 157 352 51 140 585 573 158 353 51 140 585 573 165 354 51 140 141 575 166 355 51 140 141 575 167 357 51 140 141 575 168 356 51 140 141 575 169 358 51 140 141 575 170 359 51 140 141 575 171 360 51 140 457 576 172 361 51 140 141 575 601 324 51 140 141 575 311 362 51 140 141 575 305 308 51 140 586 573 173 363 51 140 141 575 309 310 51 140 141 575 312 364 51 140 141 575 313 365 51 140 141 575 314 366 51 140 141 575 306 307 51 140 586 573 315 367 51 140 586 573 174 368 51 140 141 175 369 51 140 587 573 176 177 51 140 587 573 178 370 51 140 587 573 179 371 51 140 587 573 180 372 51 140 587 573 181 373 51 140 141 182 375 382 140 588 573 376 382 140 588 573 377 382 140 588 573 378 382 140 588 573 379 382 140 588 573 380 382 140 588 573 381 382 140 588 573 381 51 140 141 183 383 51 140 141 184 384 51 140 141 185 385 51 140 141 186 386 51 140 141 387 331 51 140 589 573 187 388 51 140 588 573 188 389 51 140 588 573 189 390 51 140 588 573 190 391 51 140 141 191 392 374 140 141 192 393 51 140 141 193 394 382 140 141 194 395 51 140 141 195 396 374 140 141 196 397 374 140 141 197 398 374 140 141 198 399 374 140 141 199 400 374 140 141 200 401 374 140 141 201 402 374 140 141 202 403 374 140 141 203 404 374 140 141 204 405 374 140 141 205 406 51 140 141 206 407 51 140 141 207 408 51 140 141 208 409 51 140 141 209 410 51 140 141 210 411 51 140 141 211 412 51 140 141 212 413 51 140 141 213 414 51 140 141 214 415 51 140 141 215 416 51 140 141 216 417 51 140 141 217 418 51 140 419 147 420 597 320 421 51 140 590 566 567 150 113 51 140 141 321 114 382 140 590 147 141 567 322 115 51 140 590 566 567 151 435 51 140 141 152 436 51 140 141 424 429 51 140 141 425 430 51 140 141 426 431 51 140 440 568 439 438 51 140 440 568 427 432 51 140 141 153 428 51 140 141 154 434 51 140 141 155 437 51 140 141 423 433 51 140 441 218 442 51 140 441 219 458 51 140 441 220 459 51 140 441 221 460 51 140 441 222 461 51 140 441 223 462 51 140 441 224 463 51 140 441 225 464 51 140 441 226 465 51 140 441 227 466 51 140 441 316 467 51 140 441 317 468 51 140 441 318 469 51 140 441 319 470 51 140 441 228 471 51 140 441 229 472 51 140 441 230 473 51 140 441 536 540 51 140 441 231 474 51 140 441 232 475 51 140 441 233 476 51 140 441 234 477 51 140 441 235 478 51 140 591 5 569 236 479 51 140 141 237 480 51 140 141 238 101 51 140 141 239 102 51 140 141 240 103 51 140 141 241 104 51 140 141 242 105 51 140 141 243 106 51 140 141 244 107 51 140 141 245 108 51 140 141 246 109 51 140 141 247 481 382 140 141 248 482 382 140 141 249 483 382 140 141 250 484 382 140 141 251 485 382 140 141 252 486 382 140 141 253 487 382 140 141 254 89 382 140 141 255 488 382 140 141 256 90 382 140 141 257 489 382 140 141 258 92 382 140 141 259 490 382 140 141 260 491 382 140 141 261 492 382 140 141 262 493 382 140 141 263 494 382 140 141 264 495 382 140 141 265 496 382 140 141 266 498 497 570 267 499 382 140 141 268 500 382 140 141 269 501 382 140 141 270 502 382 140 141 271 503 382 140 141 272 504 382 140 141 273 505 382 140 141 274 96 382 140 141 275 97 382 140 141 276 506 382 140 141 277 98 382 140 141 278 507 51 140 592 569 279 508 51 140 592 569 280 509 382 140 141 281 510 382 140 141 282 511 382 140 141 283 512 382 140 141 537 541 382 140 141 538 542 382 140 141 539 543 382 140 141 284 513 382 140 141 285 514 382 140 141 286 515 382 140 141 287 516 382 140 141 288 517 382 140 141 289 518 382 140 141 290 519 51 140 141 291 520 51 140 141 292 521 51 140 141 293 522 51 140 141 294 524 51 140 591 571 295 525 51 140 591 571 296 526 51 140 141 297 527 51 140 141 298 528 51 140 141 299 529 51 140 141 300 530 51 140 141 301 531 51 140 141 302 532 51 140 141 303 533 51 140 534 304 110 51 140 535 10 11 12 18 139 138 139 138 52 51 140 141 53 51 140 141 74 51 140 141 54 51 140 141 75 51 140 141 55 51 140 141 556 51 140 141 56 51 140 141 57 51 140 141 58 51 140 141 76 51 140 141 59 51 140 141 60 51 140 141 61 51 140 141 62 51 140 141 63 51 140 141 64 51 140 141 65 51 140 141 77 51 140 141 66 51 140 141 67 51 140 141 78 140 141 68 140 141 79 51 140 141 80 51 140 141 69 51 140 141 81 51 140 141 70 51 140 141 82 51 140 141 71 51 140 141 72 51 140 141 72 51 140 141 73 51 140 141 83 557 140 593 598 84 51 140 593 598 85 51 140 593 598 86 51 140 593 598 87 51 140 593 598 555 51 140 141 88 557 593 598 21 22 139 138 139 138 113 51 140 141 114 51 140 141 115 51 140 141 13 139 138 139 138 110 382 140 141 111 112 14 139 138 139 138 101 382 140 141 102 382 140 141 103 382 140 141 104 382 140 141 105 382 140 141 106 382 140 141 107 382 140 141 108 382 140 141 109 382 140 141 15 5 16 558 51 140 593 598 559 51 140 593 598 560 51 140 593 598 561 564 140 593 598 562 564 140 593 598 563 564 140 593 598 5 17 89 422 90 91 92 93 94 95 374 140 594 598 96 97 98 5 523 595 599 600

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

6 9 99 139 138 139 138 146 118 51 140 145 147 141 119 51 140 145 147 141 120 51 140 145 147 141 121 51 140 145 147 141 117 51 140 577 147 141 572 5 122 51 140 577 147 141 572 123 51 140 578 147 141 596 124 51 140 578 147 141 596 125 51 140 578 147 141 596 126 51 140 578 147 141 596 127 51 140 578 147 141 596 5 128 51 140 578 147 141 596 129 51 140 443 147 141 596 130 51 140 579 147 141 596 131 51 142 141 147 141 132 51 142 141 147 141 133 51 142 141 147 141 134 51 142 141 147 141 135 51 142 141 147 141 136 51 142 141 147 141 137 51 142 141 147 141 19 139 138 139 138 23 51 140 141 147 141 24 51 140 141 147 141 143 144 140 141 147 141 25 51 140 141 147 141 26 51 140 141 147 141 27 51 140 141 147 141 28 51 140 141 147 141 29 51 140 141 147 141 30 51 140 141 147 141 31 148 140 580 147 141 32 51 140 580 147 141 33 51 140 141 147 141 34 51 140 141 147 141 35 51 140 141 147 141 36 51 140 141 147 141 37 51 140 141 147 141 38 51 140 141 147 141 39 51 140 141 147 141 20 139 138 139 138 40 41 42 43 51 140 581 573 44 45 51 140 581 573 46 47 51 140 582 574 48 49 51 140 582 574 446 544 444 140 453 545 444 140 454 546 444 140 455 547 444 140 456 548 444 140 447 549 444 140 448 550 444 140 449 551 444 140 450 552 444 140 451 553 444 140 452 554 444 140 149 50 444 140 445 5 100 139 138 139 138 323 148 140 583 573 325 148 140 583 573 326 148 140 583 573 327 148 140 583 573 328 148 140 583 573 324 148 140 332 573 329 148 140 330 575 331 148 140 333 575 159 334 51 140 141 575 160 335 51 140 141 575 161 336 51 140 141 575 337 51 140 141 575 338 51 140 141 575 339 51 140 141 575 340 51 140 141 575 341 51 140 141 575 342 51 140 141 575 343 51 140 141 575 344 51 140 141 575 345 51 140 141 575 346 51 140 141 575 347 51 140 141 575 348 51 140 141 575 162 349 51 140 141 575 163 350 51 140 141 575 164 351 51 140 141 575 156 565 51 140 584 573 157 352 51 140 585 573 158 353 51 140 585 573 165 354 51 140 141 575 166 355 51 140 141 575 167 357 51 140 141 575 168 356 51 140 141 575 169 358 51 140 141 575 170 359 51 140 141 575 171 360 51 140 457 576 172 361 51 140 141 575 601 324 51 140 141 575 311 362 51 140 141 575 305 308 51 140 586 573 173 363 51 140 141 575 309 310 51 140 141 575 312 364 51 140 141 575 313 365 51 140 141 575 314 366 51 140 141 575 306 307 51 140 586 573 315 367 51 140 586 573 174 368 51 140 141 175 369 51 140 587 573 176 177 51 140 587 573 178 370 51 140 587 573 179 371 51 140 587 573 180 372 51 140 587 573 181 373 51 140 141 182 375 382 140 588 573 376 382 140 588 573 377 382 140 588 573 378 382 140 588 573 379 382 140 588 573 380 382 140 588 573 381 382 140 588 573 381 51 140 141 183 383 51 140 141 184 384 51 140 141 185 385 51 140 141 186 386 51 140 141 387 331 51 140 589 573 187 388 51 140 588 573 188 389 51 140 588 573 189 390 51 140 588 573 190 391 51 140 141 191 392 374 140 141 192 393 51 140 141 193 394 382 140 141 194 395 51 140 141 195 396 374 140 141 196 397 374 140 141 197 398 374 140 141 198 399 374 140 141 199 400 374 140 141 200 401 374 140 141 201 402 374 140 141 202 403 374 140 141 203 404 374 140 141 204 405 374 140 141 205 406 51 140 141 206 407 51 140 141 207 408 51 140 141 208 409 51 140 141 209 410 51 140 141 210 411 51 140 141 211 412 51 140 141 212 413 51 140 141 213 414 51 140 141 214 415 51 140 141 215 416 51 140 141 216 417 51 140 141 217 418 51 140 419 147 420 597 320 421 51 140 590 566 567 150 113 51 140 141 321 114 382 140 590 147 141 567 322 115 51 140 590 566 567 151 435 51 140 141 152 436 51 140 141 424 429 51 140 141 425 430 51 140 141 426 431 51 140 440 568 439 438 51 140 440 568 427 432 51 140 141 153 428 51 140 141 154 434 51 140 141 155 437 51 140 141 423 433 51 140 441 218 442 51 140 441 219 458 51 140 441 220 459 51 140 441 221 460 51 140 441 222 461 51 140 441 223 462 51 140 441 224 463 51 140 441 225 464 51 140 441 226 465 51 140 441 227 466 51 140 441 316 467 51 140 441 317 468 51 140 441 318 469 51 140 441 319 470 51 140 441 228 471 51 140 441 229 472 51 140 441 230 473 51 140 441 536 540 51 140 441 231 474 51 140 441 232 475 51 140 441 233 476 51 140 441 234 477 51 140 441 235 478 51 140 591 5 569 236 479 51 140 141 237 480 51 140 141 238 101 51 140 141 239 102 51 140 141 240 103 51 140 141 241 104 51 140 141 242 105 51 140 141 243 106 51 140 141 244 107 51 140 141 245 108 51 140 141 246 109 51 140 141 247 481 382 140 141 248 482 382 140 141 249 483 382 140 141 250 484 382 140 141 251 485 382 140 141 252 486 382 140 141 253 487 382 140 141 254 89 382 140 141 255 488 382 140 141 256 90 382 140 141 257 489 382 140 141 258 92 382 140 141 259 490 382 140 141 260 491 382 140 141 261 492 382 140 141 262 493 382 140 141 263 494 382 140 141 264 495 382 140 141 265 496 382 140 141 266 498 497 570 267 499 382 140 141 268 500 382 140 141 269 501 382 140 141 270 502 382 140 141 271 503 382 140 141 272 504 382 140 141 273 505 382 140 141 274 96 382 140 141 275 97 382 140 141 276 506 382 140 141 277 98 382 140 141 278 507 51 140 592 569 279 508 51 140 592 569 280 509 382 140 141 281 510 382 140 141 282 511 382 140 141 283 512 382 140 141 537 541 382 140 141 538 542 382 140 141 539 543 382 140 141 284 513 382 140 141 285 514 382 140 141 286 515 382 140 141 287 516 382 140 141 288 517 382 140 141 289 518 382 140 141 290 519 51 140 141 291 520 51 140 141 292 521 51 140 141 293 522 51 140 141 294 524 51 140 591 571 295 525 51 140 591 571 296 526 51 140 141 297 527 51 140 141 298 528 51 140 141 299 529 51 140 141 300 530 51 140 141 301 531 51 140 141 302 532 51 140 141 303 533 51 140 534 304 110 51 140 535 10 11 12 18 139 138 139 138 52 51 140 141 53 51 140 141 74 51 140 141 54 51 140 141 75 51 140 141 55 51 140 141 556 51 140 141 56 51 140 141 57 51 140 141 58 51 140 141 76 51 140 141 59 51 140 141 60 51 140 141 61 51 140 141 62 51 140 141 63 51 140 141 64 51 140 141 65 51 140 141 77 51 140 141 66 51 140 141 67 51 140 141 78 140 141 68 140 141 79 51 140 141 80 51 140 141 69 51 140 141 81 51 140 141 70 51 140 141 82 51 140 141 71 51 140 141 72 51 140 141 72 51 140 141 73 51 140 141 83 557 140 593 598 84 51 140 593 598 85 51 140 593 598 86 51 140 593 598 87 51 140 593 598 555 51 140 141 88 557 593 598 21 22 139 138 139 138 113 51 140 141 114 51 140 141 115 51 140 141 13 139 138 139 138 110 382 140 141 111 112 14 139 138 139 138 101 382 140 141 102 382 140 141 103 382 140 141 104 382 140 141 105 382 140 141 106 382 140 141 107 382 140 141 108 382 140 141 109 382 140 141 15 5 16 558 51 140 593 598 559 51 140 593 598 560 51 140 593 598 561 564 140 593 598 562 564 140 593 598 563 564 140 593 598 5 17 89 422 90 91 92 93 94 95 374 140 594 598 96 97 98 5 523 595 599 600

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

Experimental/Investigational Services Pain Management Therapy/Rehabilitation Transplant Wound Care Ambulatory / Surgical Procedures Imaging Services/ Diagnostic Procedures Nursing Services (including initial evaluations) Abortion (According to HHSC guidelines) Dental Oral maxillofacial surgery (including orthognathic surgery) Dental extractions/rehabilitation in members 0-6 years old and children > 13 years and above and all third molars (general anesthesia and facility) – For all other members that do not fall in these age ranges, follow HHSC guidelines. Otoplasty (including Microtia repair) Rhinoplasty/Septoplasty Scar Revision Vagus Nerve Stimulation Varicose Vein Treatment Hysterectomy Bariatric Surgery - Codes Blepharoplasty Implantable devices (e.g. Interspinous Process Decompressors) – includes trials Mammoplasty (Male, Female) Laparoscopy, surgical, gastric restrictive procedure; with gastric bypass and Roux-en-Y gastroenterostomy (roux limb 150 cm or less) Laparoscopy, surgical, gastric restrictive procedure; with gastric bypass and small intestine reconstruction to limit absorption Laparoscopy, surgical, gastric restrictive procedure; placement of adjustable gastric restrictive device (eg, gastric band and subcutaneous port components) Laparoscopy, surgical, gastric restrictive procedure; revision of adjustable gastric restrictive device component only Laparoscopy, surgical, gastric restrictive procedure; removal of adjustable gastric restrictive device component only Laparoscopy, surgical, gastric restrictive procedure; removal and replacement of adjustable gastric restrictive device component only Laparoscopy, surgical, gastric restrictive procedure; removal of adjustable gastric restrictive device and subcutaneous port components Laparoscopy, surgical, gastric restrictive procedure; longitudinal gastrectomy (ie, sleeve gastrectomy) Gastric restrictive procedure, without gastric bypass, for morbid obesity; vertical-banded gastroplasty Gastric restrictive procedure, without gastric bypass, for morbid obesity; other than vertical-banded gastroplasty Gastric restrictive procedure with partial gastrectomy, pylorus-preserving duodenoileostomy and ileoileostomy (50 to 100 cm common channel) to limit absorption (biliopancreatic diversion with duodenal switch) Gastric restrictive procedure, with gastric bypass for morbid obesity; with short limb (150 cm or less) Roux-en-Y gastroenterostomy Gastric restrictive procedure, with gastric bypass for morbid obesity; with small intestine reconstruction to limit absorption Revision, open, of gastric restrictive procedure for morbid obesity, other than adjustable gastric restrictive device (separate procedure) Gastric restrictive procedure, open; revision of subcutaneous port component only Gastric restrictive procedure, open; removal of subcutaneous port component only Gastric restrictive procedure, open; removal and replacement of subcutaneous port component only Anesthesia for reconstructive procedures of eyelid (eg, blepharoplasty, ptosis surgery) Blepharoplasty, lower eyelid; Blepharoplasty, lower eyelid; with extensive herniated fat pad Blepharoplasty, upper eyelid; Blepharoplasty, upper eyelid; with excessive skin weighting down lid Canthoplasty (reconstruction of canthus) CPT Book Closure of vesicouterine fistula; with hysterectomy Total abdominal hysterectomy (corpus and cervix), with or without removal of tube(s), with or without removal of ovary(s Supracervical abdominal hysterectomy (subtotal hysterectomy), with or without removal of tube(s), with or without removal of ovary(s) Radical abdominal hysterectomy, with bilateral total pelvic lymphadenectomy and para-aortic lymph node sampling (biopsy), with or without removal of tube(s), with or without removal of ovary(s) Vaginal hysterectomy, for uterus 250 g or less; Vaginal hysterectomy, for uterus 250 g or less; with removal of tube(s), and/or ovary(s) Vaginal hysterectomy, for uterus 250 g or less; with removal of tube(s), and/or ovary(s), with repair of enterocele Vaginal hysterectomy, for uterus 250 g or less; with repair of enterocele Vaginal hysterectomy, with total or partial vaginectomy; Vaginal hysterectomy, with total or partial vaginectomy; with repair of enterocele Vaginal hysterectomy, radical (Schauta type operation) Vaginal hysterectomy, for uterus greater than 250 g; Vaginal hysterectomy, for uterus greater than 250 g; with removal of tube(s) and/or ovary(s) Vaginal hysterectomy, for uterus greater than 250 g; with removal of tube(s) and/or ovary(s), with repair of enterocele Vaginal hysterectomy, for uterus greater than 250 g; with repair of enterocele Laparoscopy, surgical, supracervical hysterectomy, for uterus 250 g or less; Laparoscopy, surgical, supracervical hysterectomy, for uterus greater than 250 g; Laparoscopy, surgical, with vaginal hysterectomy, for uterus 250 g or less; Laparoscopy, surgical, with vaginal hysterectomy, for uterus greater than 250 g; Laparoscopy, surgical, with total hysterectomy, for uterus 250 g or less; Laparoscopy, surgical, with total hysterectomy, for uterus 250 g or less; with removal of tube(s) and/or ovary(s) Laparoscopy, surgical, with total hysterectomy, for uterus greater than 250 g; with removal of tube(s) and/or ovary(s) Total abdominal hysterectomy (corpus and cervix), with or without removal of tube(s), with or without removal of ovary(s); with colpo-urethrocystopexy (eg, Marshall-Marchetti-Krantz, Burch) Total abdominal hysterectomy, including partial vaginectomy, with para-aortic and pelvic lymph node sampling, with or without removal of tube(s), with or without removal of ovary(s) Vaginal hysterectomy, for uterus 250 g or less; with colpo-urethrocystopexy (Marshall-Marchetti-Krantz type, Pereyra type) with or without endoscopic control Vaginal hysterectomy, for uterus greater than 250 g; with colpo-urethrocystopexy (Marshall-Marchetti-Krantz type, Pereyra type) with or without endoscopic control Laparoscopy, surgical, supracervical hysterectomy, for uterus 250 g or less; with removal of tube(s) and/or ovary(s) Laparoscopy, surgical, supracervical hysterectomy, for uterus greater than 250 g; with removal of tube(s) and/or ovary(s) 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 Laparoscopy, surgical, with vaginal hysterectomy, for uterus 250 g or less; with removal of tube(s) and/or ovary(s) Laparoscopy, surgical, with vaginal hysterectomy, for uterus greater than 250 g; with removal of tube(s) and/or ovary(s) Laparoscopy, surgical, total hysterectomy for resection of malignancy (tumor debulking), with omentectomy including salpingo-oophorectomy, unilateral or bilateral, when performed Resection (initial) of ovarian, tubal or primary peritoneal malignancy with bilateral salpingo-oophorectomy and omentectomy; with total abdominal hysterectomy, pelvic and limited para-aortic lymphadenectomy Bilateral salpingo-oophorectomy with omentectomy, total abdominal hysterectomy and radical dissection for debulking; Bilateral salpingo-oophorectomy with omentectomy, total abdominal hysterectomy and radical dissection for debulking; with pelvic lymphadenectomy and limited para-aortic lymphadenectomy Bilateral salpingo-oophorectomy with total omentectomy, total abdominal hysterectomy for malignancy Subtotal or total hysterectomy after cesarean delivery (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; first vein treated Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; first vein treated Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition t Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; first vein treated Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code fo Endovenous ablation therapy of incompetent vein, extremity, by transcatheter delivery of a chemical adhesive (eg, cyanoacrylate) remote from the access site, inclusive of all imaging guidance and monitoring, percutaneous; first vein treated Endovenous ablation therapy of incompetent vein, extremity, by transcatheter delivery of a chemical adhesive (eg, cyanoacrylate) remote from the access site, inclusive of all imaging guidance and monitoring, percutaneous; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Stab phlebectomy of varicose veins, 1 extremity; 10-20 stab incisions Stab phlebectomy of varicose veins, 1 extremity; more than 20 incisions Ligation, division, and/or excision of varicose vein cluster(s), 1 leg Allergen Immunotherapy Services

Experimental/Investigational Services Pain Management Therapy/Rehabilitation Transplant Wound Care Ambulatory / Surgical Procedures Imaging Services/ Diagnostic Procedures Nursing Services (including initial evaluations) Abortion (According to HHSC guidelines) Dental Oral maxillofacial surgery (including orthognathic surgery) Dental extractions/rehabilitation in members 0-6 years old and children > 13 years and above and all third molars (general anesthesia and facility) – For all other members that do not fall in these age ranges, follow HHSC guidelines. Otoplasty (including Microtia repair) Rhinoplasty/Septoplasty Scar Revision Vagus Nerve Stimulation Varicose Vein Treatment Hysterectomy Bariatric Surgery - Codes Blepharoplasty Implantable devices (e.g. Interspinous Process Decompressors) – includes trials Mammoplasty (Male, Female) Laparoscopy, surgical, gastric restrictive procedure; with gastric bypass and Roux-en-Y gastroenterostomy (roux limb 150 cm or less) Laparoscopy, surgical, gastric restrictive procedure; with gastric bypass and small intestine reconstruction to limit absorption Laparoscopy, surgical, gastric restrictive procedure; placement of adjustable gastric restrictive device (eg, gastric band and subcutaneous port components) Laparoscopy, surgical, gastric restrictive procedure; revision of adjustable gastric restrictive device component only Laparoscopy, surgical, gastric restrictive procedure; removal of adjustable gastric restrictive device component only Laparoscopy, surgical, gastric restrictive procedure; removal and replacement of adjustable gastric restrictive device component only Laparoscopy, surgical, gastric restrictive procedure; removal of adjustable gastric restrictive device and subcutaneous port components Laparoscopy, surgical, gastric restrictive procedure; longitudinal gastrectomy (ie, sleeve gastrectomy) Gastric restrictive procedure, without gastric bypass, for morbid obesity; vertical-banded gastroplasty Gastric restrictive procedure, without gastric bypass, for morbid obesity; other than vertical-banded gastroplasty Gastric restrictive procedure with partial gastrectomy, pylorus-preserving duodenoileostomy and ileoileostomy (50 to 100 cm common channel) to limit absorption (biliopancreatic diversion with duodenal switch) Gastric restrictive procedure, with gastric bypass for morbid obesity; with short limb (150 cm or less) Roux-en-Y gastroenterostomy Gastric restrictive procedure, with gastric bypass for morbid obesity; with small intestine reconstruction to limit absorption Revision, open, of gastric restrictive procedure for morbid obesity, other than adjustable gastric restrictive device (separate procedure) Gastric restrictive procedure, open; revision of subcutaneous port component only Gastric restrictive procedure, open; removal of subcutaneous port component only Gastric restrictive procedure, open; removal and replacement of subcutaneous port component only Anesthesia for reconstructive procedures of eyelid (eg, blepharoplasty, ptosis surgery) Blepharoplasty, lower eyelid; Blepharoplasty, lower eyelid; with extensive herniated fat pad Blepharoplasty, upper eyelid; Blepharoplasty, upper eyelid; with excessive skin weighting down lid Canthoplasty (reconstruction of canthus) CPT Book Closure of vesicouterine fistula; with hysterectomy Total abdominal hysterectomy (corpus and cervix), with or without removal of tube(s), with or without removal of ovary(s Supracervical abdominal hysterectomy (subtotal hysterectomy), with or without removal of tube(s), with or without removal of ovary(s) Radical abdominal hysterectomy, with bilateral total pelvic lymphadenectomy and para-aortic lymph node sampling (biopsy), with or without removal of tube(s), with or without removal of ovary(s) Vaginal hysterectomy, for uterus 250 g or less; Vaginal hysterectomy, for uterus 250 g or less; with removal of tube(s), and/or ovary(s) Vaginal hysterectomy, for uterus 250 g or less; with removal of tube(s), and/or ovary(s), with repair of enterocele Vaginal hysterectomy, for uterus 250 g or less; with repair of enterocele Vaginal hysterectomy, with total or partial vaginectomy; Vaginal hysterectomy, with total or partial vaginectomy; with repair of enterocele Vaginal hysterectomy, radical (Schauta type operation) Vaginal hysterectomy, for uterus greater than 250 g; Vaginal hysterectomy, for uterus greater than 250 g; with removal of tube(s) and/or ovary(s) Vaginal hysterectomy, for uterus greater than 250 g; with removal of tube(s) and/or ovary(s), with repair of enterocele Vaginal hysterectomy, for uterus greater than 250 g; with repair of enterocele Laparoscopy, surgical, supracervical hysterectomy, for uterus 250 g or less; Laparoscopy, surgical, supracervical hysterectomy, for uterus greater than 250 g; Laparoscopy, surgical, with vaginal hysterectomy, for uterus 250 g or less; Laparoscopy, surgical, with vaginal hysterectomy, for uterus greater than 250 g; Laparoscopy, surgical, with total hysterectomy, for uterus 250 g or less; Laparoscopy, surgical, with total hysterectomy, for uterus 250 g or less; with removal of tube(s) and/or ovary(s) Laparoscopy, surgical, with total hysterectomy, for uterus greater than 250 g; with removal of tube(s) and/or ovary(s) Total abdominal hysterectomy (corpus and cervix), with or without removal of tube(s), with or without removal of ovary(s); with colpo-urethrocystopexy (eg, Marshall-Marchetti-Krantz, Burch) Total abdominal hysterectomy, including partial vaginectomy, with para-aortic and pelvic lymph node sampling, with or without removal of tube(s), with or without removal of ovary(s) Vaginal hysterectomy, for uterus 250 g or less; with colpo-urethrocystopexy (Marshall-Marchetti-Krantz type, Pereyra type) with or without endoscopic control Vaginal hysterectomy, for uterus greater than 250 g; with colpo-urethrocystopexy (Marshall-Marchetti-Krantz type, Pereyra type) with or without endoscopic control Laparoscopy, surgical, supracervical hysterectomy, for uterus 250 g or less; with removal of tube(s) and/or ovary(s) Laparoscopy, surgical, supracervical hysterectomy, for uterus greater than 250 g; with removal of tube(s) and/or ovary(s) 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 Laparoscopy, surgical, with vaginal hysterectomy, for uterus 250 g or less; with removal of tube(s) and/or ovary(s) Laparoscopy, surgical, with vaginal hysterectomy, for uterus greater than 250 g; with removal of tube(s) and/or ovary(s) Laparoscopy, surgical, total hysterectomy for resection of malignancy (tumor debulking), with omentectomy including salpingo-oophorectomy, unilateral or bilateral, when performed Resection (initial) of ovarian, tubal or primary peritoneal malignancy with bilateral salpingo-oophorectomy and omentectomy; with total abdominal hysterectomy, pelvic and limited para-aortic lymphadenectomy Bilateral salpingo-oophorectomy with omentectomy, total abdominal hysterectomy and radical dissection for debulking; Bilateral salpingo-oophorectomy with omentectomy, total abdominal hysterectomy and radical dissection for debulking; with pelvic lymphadenectomy and limited para-aortic lymphadenectomy Bilateral salpingo-oophorectomy with total omentectomy, total abdominal hysterectomy for malignancy Subtotal or total hysterectomy after cesarean delivery (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; first vein treated Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; first vein treated Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition t Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; first vein treated Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code fo Endovenous ablation therapy of incompetent vein, extremity, by transcatheter delivery of a chemical adhesive (eg, cyanoacrylate) remote from the access site, inclusive of all imaging guidance and monitoring, percutaneous; first vein treated Endovenous ablation therapy of incompetent vein, extremity, by transcatheter delivery of a chemical adhesive (eg, cyanoacrylate) remote from the access site, inclusive of all imaging guidance and monitoring, percutaneous; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Stab phlebectomy of varicose veins, 1 extremity; 10-20 stab incisions Stab phlebectomy of varicose veins, 1 extremity; more than 20 incisions Ligation, division, and/or excision of varicose vein cluster(s), 1 leg Allergen Immunotherapy Services

Experimental/Investigational Services Pain Management Therapy/Rehabilitation Transplant Wound Care Ambulatory / Surgical Procedures Imaging Services/ Diagnostic Procedures Nursing Services (including initial evaluations) Abortion (According to HHSC guidelines) Dental Oral maxillofacial surgery (including orthognathic surgery) Dental extractions/rehabilitation in members 0-6 years old and children > 13 years and above and all third molars (general anesthesia and facility) – For all other members that do not fall in these age ranges, follow HHSC guidelines. Otoplasty (including Microtia repair) Rhinoplasty/Septoplasty Scar Revision Vagus Nerve Stimulation Varicose Vein Treatment Hysterectomy Bariatric Surgery - Codes Blepharoplasty Implantable devices (e.g. Interspinous Process Decompressors) – includes trials Mammoplasty (Male, Female) Laparoscopy, surgical, gastric restrictive procedure; with gastric bypass and Roux-en-Y gastroenterostomy (roux limb 150 cm or less) Laparoscopy, surgical, gastric restrictive procedure; with gastric bypass and small intestine reconstruction to limit absorption Laparoscopy, surgical, gastric restrictive procedure; placement of adjustable gastric restrictive device (eg, gastric band and subcutaneous port components) Laparoscopy, surgical, gastric restrictive procedure; revision of adjustable gastric restrictive device component only Laparoscopy, surgical, gastric restrictive procedure; removal of adjustable gastric restrictive device component only Laparoscopy, surgical, gastric restrictive procedure; removal and replacement of adjustable gastric restrictive device component only Laparoscopy, surgical, gastric restrictive procedure; removal of adjustable gastric restrictive device and subcutaneous port components Laparoscopy, surgical, gastric restrictive procedure; longitudinal gastrectomy (ie, sleeve gastrectomy) Gastric restrictive procedure, without gastric bypass, for morbid obesity; vertical-banded gastroplasty Gastric restrictive procedure, without gastric bypass, for morbid obesity; other than vertical-banded gastroplasty Gastric restrictive procedure with partial gastrectomy, pylorus-preserving duodenoileostomy and ileoileostomy (50 to 100 cm common channel) to limit absorption (biliopancreatic diversion with duodenal switch) Gastric restrictive procedure, with gastric bypass for morbid obesity; with short limb (150 cm or less) Roux-en-Y gastroenterostomy Gastric restrictive procedure, with gastric bypass for morbid obesity; with small intestine reconstruction to limit absorption Revision, open, of gastric restrictive procedure for morbid obesity, other than adjustable gastric restrictive device (separate procedure) Gastric restrictive procedure, open; revision of subcutaneous port component only Gastric restrictive procedure, open; removal of subcutaneous port component only Gastric restrictive procedure, open; removal and replacement of subcutaneous port component only Anesthesia for reconstructive procedures of eyelid (eg, blepharoplasty, ptosis surgery) Blepharoplasty, lower eyelid; Blepharoplasty, lower eyelid; with extensive herniated fat pad Blepharoplasty, upper eyelid; Blepharoplasty, upper eyelid; with excessive skin weighting down lid Canthoplasty (reconstruction of canthus) CPT Book Closure of vesicouterine fistula; with hysterectomy Total abdominal hysterectomy (corpus and cervix), with or without removal of tube(s), with or without removal of ovary(s Supracervical abdominal hysterectomy (subtotal hysterectomy), with or without removal of tube(s), with or without removal of ovary(s) Radical abdominal hysterectomy, with bilateral total pelvic lymphadenectomy and para-aortic lymph node sampling (biopsy), with or without removal of tube(s), with or without removal of ovary(s) Vaginal hysterectomy, for uterus 250 g or less; Vaginal hysterectomy, for uterus 250 g or less; with removal of tube(s), and/or ovary(s) Vaginal hysterectomy, for uterus 250 g or less; with removal of tube(s), and/or ovary(s), with repair of enterocele Vaginal hysterectomy, for uterus 250 g or less; with repair of enterocele Vaginal hysterectomy, with total or partial vaginectomy; Vaginal hysterectomy, with total or partial vaginectomy; with repair of enterocele Vaginal hysterectomy, radical (Schauta type operation) Vaginal hysterectomy, for uterus greater than 250 g; Vaginal hysterectomy, for uterus greater than 250 g; with removal of tube(s) and/or ovary(s) Vaginal hysterectomy, for uterus greater than 250 g; with removal of tube(s) and/or ovary(s), with repair of enterocele Vaginal hysterectomy, for uterus greater than 250 g; with repair of enterocele Laparoscopy, surgical, supracervical hysterectomy, for uterus 250 g or less; Laparoscopy, surgical, supracervical hysterectomy, for uterus greater than 250 g; Laparoscopy, surgical, with vaginal hysterectomy, for uterus 250 g or less; Laparoscopy, surgical, with vaginal hysterectomy, for uterus greater than 250 g; Laparoscopy, surgical, with total hysterectomy, for uterus 250 g or less; Laparoscopy, surgical, with total hysterectomy, for uterus 250 g or less; with removal of tube(s) and/or ovary(s) Laparoscopy, surgical, with total hysterectomy, for uterus greater than 250 g; with removal of tube(s) and/or ovary(s) Total abdominal hysterectomy (corpus and cervix), with or without removal of tube(s), with or without removal of ovary(s); with colpo-urethrocystopexy (eg, Marshall-Marchetti-Krantz, Burch) Total abdominal hysterectomy, including partial vaginectomy, with para-aortic and pelvic lymph node sampling, with or without removal of tube(s), with or without removal of ovary(s) Vaginal hysterectomy, for uterus 250 g or less; with colpo-urethrocystopexy (Marshall-Marchetti-Krantz type, Pereyra type) with or without endoscopic control Vaginal hysterectomy, for uterus greater than 250 g; with colpo-urethrocystopexy (Marshall-Marchetti-Krantz type, Pereyra type) with or without endoscopic control Laparoscopy, surgical, supracervical hysterectomy, for uterus 250 g or less; with removal of tube(s) and/or ovary(s) Laparoscopy, surgical, supracervical hysterectomy, for uterus greater than 250 g; with removal of tube(s) and/or ovary(s) 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 Laparoscopy, surgical, with vaginal hysterectomy, for uterus 250 g or less; with removal of tube(s) and/or ovary(s) Laparoscopy, surgical, with vaginal hysterectomy, for uterus greater than 250 g; with removal of tube(s) and/or ovary(s) Laparoscopy, surgical, total hysterectomy for resection of malignancy (tumor debulking), with omentectomy including salpingo-oophorectomy, unilateral or bilateral, when performed Resection (initial) of ovarian, tubal or primary peritoneal malignancy with bilateral salpingo-oophorectomy and omentectomy; with total abdominal hysterectomy, pelvic and limited para-aortic lymphadenectomy Bilateral salpingo-oophorectomy with omentectomy, total abdominal hysterectomy and radical dissection for debulking; Bilateral salpingo-oophorectomy with omentectomy, total abdominal hysterectomy and radical dissection for debulking; with pelvic lymphadenectomy and limited para-aortic lymphadenectomy Bilateral salpingo-oophorectomy with total omentectomy, total abdominal hysterectomy for malignancy Subtotal or total hysterectomy after cesarean delivery (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; first vein treated Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; first vein treated Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition t Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; first vein treated Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code fo Endovenous ablation therapy of incompetent vein, extremity, by transcatheter delivery of a chemical adhesive (eg, cyanoacrylate) remote from the access site, inclusive of all imaging guidance and monitoring, percutaneous; first vein treated Endovenous ablation therapy of incompetent vein, extremity, by transcatheter delivery of a chemical adhesive (eg, cyanoacrylate) remote from the access site, inclusive of all imaging guidance and monitoring, percutaneous; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Stab phlebectomy of varicose veins, 1 extremity; 10-20 stab incisions Stab phlebectomy of varicose veins, 1 extremity; more than 20 incisions Ligation, division, and/or excision of varicose vein cluster(s), 1 leg Allergen Immunotherapy Services

Experimental/Investigational Services Pain Management Therapy/Rehabilitation Transplant Wound Care Ambulatory / Surgical Procedures Imaging Services/ Diagnostic Procedures Nursing Services (including initial evaluations) Abortion (According to HHSC guidelines) Dental Oral maxillofacial surgery (including orthognathic surgery) Dental extractions/rehabilitation in members 0-6 years old and children > 13 years and above and all third molars (general anesthesia and facility) – For all other members that do not fall in these age ranges, follow HHSC guidelines. Otoplasty (including Microtia repair) Rhinoplasty/Septoplasty Scar Revision Vagus Nerve Stimulation Varicose Vein Treatment Hysterectomy Bariatric Surgery - Codes Blepharoplasty Implantable devices (e.g. Interspinous Process Decompressors) – includes trials Mammoplasty (Male, Female) Laparoscopy, surgical, gastric restrictive procedure; with gastric bypass and Roux-en-Y gastroenterostomy (roux limb 150 cm or less) Laparoscopy, surgical, gastric restrictive procedure; with gastric bypass and small intestine reconstruction to limit absorption Laparoscopy, surgical, gastric restrictive procedure; placement of adjustable gastric restrictive device (eg, gastric band and subcutaneous port components) Laparoscopy, surgical, gastric restrictive procedure; revision of adjustable gastric restrictive device component only Laparoscopy, surgical, gastric restrictive procedure; removal of adjustable gastric restrictive device component only Laparoscopy, surgical, gastric restrictive procedure; removal and replacement of adjustable gastric restrictive device component only Laparoscopy, surgical, gastric restrictive procedure; removal of adjustable gastric restrictive device and subcutaneous port components Laparoscopy, surgical, gastric restrictive procedure; longitudinal gastrectomy (ie, sleeve gastrectomy) Gastric restrictive procedure, without gastric bypass, for morbid obesity; vertical-banded gastroplasty Gastric restrictive procedure, without gastric bypass, for morbid obesity; other than vertical-banded gastroplasty Gastric restrictive procedure with partial gastrectomy, pylorus-preserving duodenoileostomy and ileoileostomy (50 to 100 cm common channel) to limit absorption (biliopancreatic diversion with duodenal switch) Gastric restrictive procedure, with gastric bypass for morbid obesity; with short limb (150 cm or less) Roux-en-Y gastroenterostomy Gastric restrictive procedure, with gastric bypass for morbid obesity; with small intestine reconstruction to limit absorption Revision, open, of gastric restrictive procedure for morbid obesity, other than adjustable gastric restrictive device (separate procedure) Gastric restrictive procedure, open; revision of subcutaneous port component only Gastric restrictive procedure, open; removal of subcutaneous port component only Gastric restrictive procedure, open; removal and replacement of subcutaneous port component only Anesthesia for reconstructive procedures of eyelid (eg, blepharoplasty, ptosis surgery) Blepharoplasty, lower eyelid; Blepharoplasty, lower eyelid; with extensive herniated fat pad Blepharoplasty, upper eyelid; Blepharoplasty, upper eyelid; with excessive skin weighting down lid Canthoplasty (reconstruction of canthus) CPT Book Closure of vesicouterine fistula; with hysterectomy Total abdominal hysterectomy (corpus and cervix), with or without removal of tube(s), with or without removal of ovary(s Supracervical abdominal hysterectomy (subtotal hysterectomy), with or without removal of tube(s), with or without removal of ovary(s) Radical abdominal hysterectomy, with bilateral total pelvic lymphadenectomy and para-aortic lymph node sampling (biopsy), with or without removal of tube(s), with or without removal of ovary(s) Vaginal hysterectomy, for uterus 250 g or less; Vaginal hysterectomy, for uterus 250 g or less; with removal of tube(s), and/or ovary(s) Vaginal hysterectomy, for uterus 250 g or less; with removal of tube(s), and/or ovary(s), with repair of enterocele Vaginal hysterectomy, for uterus 250 g or less; with repair of enterocele Vaginal hysterectomy, with total or partial vaginectomy; Vaginal hysterectomy, with total or partial vaginectomy; with repair of enterocele Vaginal hysterectomy, radical (Schauta type operation) Vaginal hysterectomy, for uterus greater than 250 g; Vaginal hysterectomy, for uterus greater than 250 g; with removal of tube(s) and/or ovary(s) Vaginal hysterectomy, for uterus greater than 250 g; with removal of tube(s) and/or ovary(s), with repair of enterocele Vaginal hysterectomy, for uterus greater than 250 g; with repair of enterocele Laparoscopy, surgical, supracervical hysterectomy, for uterus 250 g or less; Laparoscopy, surgical, supracervical hysterectomy, for uterus greater than 250 g; Laparoscopy, surgical, with vaginal hysterectomy, for uterus 250 g or less; Laparoscopy, surgical, with vaginal hysterectomy, for uterus greater than 250 g; Laparoscopy, surgical, with total hysterectomy, for uterus 250 g or less; Laparoscopy, surgical, with total hysterectomy, for uterus 250 g or less; with removal of tube(s) and/or ovary(s) Laparoscopy, surgical, with total hysterectomy, for uterus greater than 250 g; with removal of tube(s) and/or ovary(s) Total abdominal hysterectomy (corpus and cervix), with or without removal of tube(s), with or without removal of ovary(s); with colpo-urethrocystopexy (eg, Marshall-Marchetti-Krantz, Burch) Total abdominal hysterectomy, including partial vaginectomy, with para-aortic and pelvic lymph node sampling, with or without removal of tube(s), with or without removal of ovary(s) Vaginal hysterectomy, for uterus 250 g or less; with colpo-urethrocystopexy (Marshall-Marchetti-Krantz type, Pereyra type) with or without endoscopic control Vaginal hysterectomy, for uterus greater than 250 g; with colpo-urethrocystopexy (Marshall-Marchetti-Krantz type, Pereyra type) with or without endoscopic control Laparoscopy, surgical, supracervical hysterectomy, for uterus 250 g or less; with removal of tube(s) and/or ovary(s) Laparoscopy, surgical, supracervical hysterectomy, for uterus greater than 250 g; with removal of tube(s) and/or ovary(s) 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 Laparoscopy, surgical, with vaginal hysterectomy, for uterus 250 g or less; with removal of tube(s) and/or ovary(s) Laparoscopy, surgical, with vaginal hysterectomy, for uterus greater than 250 g; with removal of tube(s) and/or ovary(s) Laparoscopy, surgical, total hysterectomy for resection of malignancy (tumor debulking), with omentectomy including salpingo-oophorectomy, unilateral or bilateral, when performed Resection (initial) of ovarian, tubal or primary peritoneal malignancy with bilateral salpingo-oophorectomy and omentectomy; with total abdominal hysterectomy, pelvic and limited para-aortic lymphadenectomy Bilateral salpingo-oophorectomy with omentectomy, total abdominal hysterectomy and radical dissection for debulking; Bilateral salpingo-oophorectomy with omentectomy, total abdominal hysterectomy and radical dissection for debulking; with pelvic lymphadenectomy and limited para-aortic lymphadenectomy Bilateral salpingo-oophorectomy with total omentectomy, total abdominal hysterectomy for malignancy Subtotal or total hysterectomy after cesarean delivery (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; first vein treated Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; first vein treated Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition t Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; first vein treated Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code fo Endovenous ablation therapy of incompetent vein, extremity, by transcatheter delivery of a chemical adhesive (eg, cyanoacrylate) remote from the access site, inclusive of all imaging guidance and monitoring, percutaneous; first vein treated Endovenous ablation therapy of incompetent vein, extremity, by transcatheter delivery of a chemical adhesive (eg, cyanoacrylate) remote from the access site, inclusive of all imaging guidance and monitoring, percutaneous; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Stab phlebectomy of varicose veins, 1 extremity; 10-20 stab incisions Stab phlebectomy of varicose veins, 1 extremity; more than 20 incisions Ligation, division, and/or excision of varicose vein cluster(s), 1 leg Allergen Immunotherapy Services

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

6 9 99 139 138 139 138 146 118 51 140 145 147 141 119 51 140 145 147 141 120 51 140 145 147 141 121 51 140 145 147 141 117 51 140 577 147 141 572 5 122 51 140 577 147 141 572 123 51 140 578 147 141 596 124 51 140 578 147 141 596 125 51 140 578 147 141 596 126 51 140 578 147 141 596 127 51 140 578 147 141 596 5 128 51 140 578 147 141 596 129 51 140 443 147 141 596 130 51 140 579 147 141 596 131 51 142 141 147 141 132 51 142 141 147 141 133 51 142 141 147 141 134 51 142 141 147 141 135 51 142 141 147 141 136 51 142 141 147 141 137 51 142 141 147 141 19 139 138 139 138 23 51 140 141 147 141 24 51 140 141 147 141 143 144 140 141 147 141 25 51 140 141 147 141 26 51 140 141 147 141 27 51 140 141 147 141 28 51 140 141 147 141 29 51 140 141 147 141 30 51 140 141 147 141 31 148 140 580 147 141 32 51 140 580 147 141 33 51 140 141 147 141 34 51 140 141 147 141 35 51 140 141 147 141 36 51 140 141 147 141 37 51 140 141 147 141 38 51 140 141 147 141 39 51 140 141 147 141 20 139 138 139 138 40 41 42 43 51 140 581 573 44 45 51 140 581 573 46 47 51 140 582 574 48 49 51 140 582 574 446 544 444 140 453 545 444 140 454 546 444 140 455 547 444 140 456 548 444 140 447 549 444 140 448 550 444 140 449 551 444 140 450 552 444 140 451 553 444 140 452 554 444 140 149 50 444 140 445 5 100 139 138 139 138 323 148 140 583 573 325 148 140 583 573 326 148 140 583 573 327 148 140 583 573 328 148 140 583 573 324 148 140 332 573 329 148 140 330 575 331 148 140 333 575 159 334 51 140 141 575 160 335 51 140 141 575 161 336 51 140 141 575 337 51 140 141 575 338 51 140 141 575 339 51 140 141 575 340 51 140 141 575 341 51 140 141 575 342 51 140 141 575 343 51 140 141 575 344 51 140 141 575 345 51 140 141 575 346 51 140 141 575 347 51 140 141 575 348 51 140 141 575 162 349 51 140 141 575 163 350 51 140 141 575 164 351 51 140 141 575 156 565 51 140 584 573 157 352 51 140 585 573 158 353 51 140 585 573 165 354 51 140 141 575 166 355 51 140 141 575 167 357 51 140 141 575 168 356 51 140 141 575 169 358 51 140 141 575 170 359 51 140 141 575 171 360 51 140 457 576 172 361 51 140 141 575 601 324 51 140 141 575 311 362 51 140 141 575 305 308 51 140 586 573 173 363 51 140 141 575 309 310 51 140 141 575 312 364 51 140 141 575 313 365 51 140 141 575 314 366 51 140 141 575 306 307 51 140 586 573 315 367 51 140 586 573 174 368 51 140 141 175 369 51 140 587 573 176 177 51 140 587 573 178 370 51 140 587 573 179 371 51 140 587 573 180 372 51 140 587 573 181 373 51 140 141 182 375 382 140 588 573 376 382 140 588 573 377 382 140 588 573 378 382 140 588 573 379 382 140 588 573 380 382 140 588 573 381 382 140 588 573 381 51 140 141 183 383 51 140 141 184 384 51 140 141 185 385 51 140 141 186 386 51 140 141 387 331 51 140 589 573 187 388 51 140 588 573 188 389 51 140 588 573 189 390 51 140 588 573 190 391 51 140 141 191 392 374 140 141 192 393 51 140 141 193 394 382 140 141 194 395 51 140 141 195 396 374 140 141 196 397 374 140 141 197 398 374 140 141 198 399 374 140 141 199 400 374 140 141 200 401 374 140 141 201 402 374 140 141 202 403 374 140 141 203 404 374 140 141 204 405 374 140 141 205 406 51 140 141 206 407 51 140 141 207 408 51 140 141 208 409 51 140 141 209 410 51 140 141 210 411 51 140 141 211 412 51 140 141 212 413 51 140 141 213 414 51 140 141 214 415 51 140 141 215 416 51 140 141 216 417 51 140 141 217 418 51 140 419 147 420 597 320 421 51 140 590 566 567 150 113 51 140 141 321 114 382 140 590 147 141 567 322 115 51 140 590 566 567 151 435 51 140 141 152 436 51 140 141 424 429 51 140 141 425 430 51 140 141 426 431 51 140 440 568 439 438 51 140 440 568 427 432 51 140 141 153 428 51 140 141 154 434 51 140 141 155 437 51 140 141 423 433 51 140 441 218 442 51 140 441 219 458 51 140 441 220 459 51 140 441 221 460 51 140 441 222 461 51 140 441 223 462 51 140 441 224 463 51 140 441 225 464 51 140 441 226 465 51 140 441 227 466 51 140 441 316 467 51 140 441 317 468 51 140 441 318 469 51 140 441 319 470 51 140 441 228 471 51 140 441 229 472 51 140 441 230 473 51 140 441 536 540 51 140 441 231 474 51 140 441 232 475 51 140 441 233 476 51 140 441 234 477 51 140 441 235 478 51 140 591 5 569 236 479 51 140 141 237 480 51 140 141 238 101 51 140 141 239 102 51 140 141 240 103 51 140 141 241 104 51 140 141 242 105 51 140 141 243 106 51 140 141 244 107 51 140 141 245 108 51 140 141 246 109 51 140 141 247 481 382 140 141 248 482 382 140 141 249 483 382 140 141 250 484 382 140 141 251 485 382 140 141 252 486 382 140 141 253 487 382 140 141 254 89 382 140 141 255 488 382 140 141 256 90 382 140 141 257 489 382 140 141 258 92 382 140 141 259 490 382 140 141 260 491 382 140 141 261 492 382 140 141 262 493 382 140 141 263 494 382 140 141 264 495 382 140 141 265 496 382 140 141 266 498 497 570 267 499 382 140 141 268 500 382 140 141 269 501 382 140 141 270 502 382 140 141 271 503 382 140 141 272 504 382 140 141 273 505 382 140 141 274 96 382 140 141 275 97 382 140 141 276 506 382 140 141 277 98 382 140 141 278 507 51 140 592 569 279 508 51 140 592 569 280 509 382 140 141 281 510 382 140 141 282 511 382 140 141 283 512 382 140 141 537 541 382 140 141 538 542 382 140 141 539 543 382 140 141 284 513 382 140 141 285 514 382 140 141 286 515 382 140 141 287 516 382 140 141 288 517 382 140 141 289 518 382 140 141 290 519 51 140 141 291 520 51 140 141 292 521 51 140 141 293 522 51 140 141 294 524 51 140 591 571 295 525 51 140 591 571 296 526 51 140 141 297 527 51 140 141 298 528 51 140 141 299 529 51 140 141 300 530 51 140 141 301 531 51 140 141 302 532 51 140 141 303 533 51 140 534 304 110 51 140 535 10 11 12 18 139 138 139 138 52 51 140 141 53 51 140 141 74 51 140 141 54 51 140 141 75 51 140 141 55 51 140 141 556 51 140 141 56 51 140 141 57 51 140 141 58 51 140 141 76 51 140 141 59 51 140 141 60 51 140 141 61 51 140 141 62 51 140 141 63 51 140 141 64 51 140 141 65 51 140 141 77 51 140 141 66 51 140 141 67 51 140 141 78 140 141 68 140 141 79 51 140 141 80 51 140 141 69 51 140 141 81 51 140 141 70 51 140 141 82 51 140 141 71 51 140 141 72 51 140 141 72 51 140 141 73 51 140 141 83 557 140 593 598 84 51 140 593 598 85 51 140 593 598 86 51 140 593 598 87 51 140 593 598 555 51 140 141 88 557 593 598 21 22 139 138 139 138 113 51 140 141 114 51 140 141 115 51 140 141 13 139 138 139 138 110 382 140 141 111 112 14 139 138 139 138 101 382 140 141 102 382 140 141 103 382 140 141 104 382 140 141 105 382 140 141 106 382 140 141 107 382 140 141 108 382 140 141 109 382 140 141 15 5 16 558 51 140 593 598 559 51 140 593 598 560 51 140 593 598 561 564 140 593 598 562 564 140 593 598 563 564 140 593 598 5 17 89 422 90 91 92 93 94 95 374 140 594 598 96 97 98 5 523 595 599 600

6 9 99 139 138 139 138 146 118 51 140 145 147 141 119 51 140 145 147 141 120 51 140 145 147 141 121 51 140 145 147 141 117 51 140 577 147 141 572 5 122 51 140 577 147 141 572 123 51 140 578 147 141 596 124 51 140 578 147 141 596 125 51 140 578 147 141 596 126 51 140 578 147 141 596 127 51 140 578 147 141 596 5 128 51 140 578 147 141 596 129 51 140 443 147 141 596 130 51 140 579 147 141 596 131 51 142 141 147 141 132 51 142 141 147 141 133 51 142 141 147 141 134 51 142 141 147 141 135 51 142 141 147 141 136 51 142 141 147 141 137 51 142 141 147 141 19 139 138 139 138 23 51 140 141 147 141 24 51 140 141 147 141 143 144 140 141 147 141 25 51 140 141 147 141 26 51 140 141 147 141 27 51 140 141 147 141 28 51 140 141 147 141 29 51 140 141 147 141 30 51 140 141 147 141 31 148 140 580 147 141 32 51 140 580 147 141 33 51 140 141 147 141 34 51 140 141 147 141 35 51 140 141 147 141 36 51 140 141 147 141 37 51 140 141 147 141 38 51 140 141 147 141 39 51 140 141 147 141 20 139 138 139 138 40 41 42 43 51 140 581 573 44 45 51 140 581 573 46 47 51 140 582 574 48 49 51 140 582 574 446 544 444 140 453 545 444 140 454 546 444 140 455 547 444 140 456 548 444 140 447 549 444 140 448 550 444 140 449 551 444 140 450 552 444 140 451 553 444 140 452 554 444 140 149 50 444 140 445 5 100 139 138 139 138 323 148 140 583 573 325 148 140 583 573 326 148 140 583 573 327 148 140 583 573 328 148 140 583 573 324 148 140 332 573 329 148 140 330 575 331 148 140 333 575 159 334 51 140 141 575 160 335 51 140 141 575 161 336 51 140 141 575 337 51 140 141 575 338 51 140 141 575 339 51 140 141 575 340 51 140 141 575 341 51 140 141 575 342 51 140 141 575 343 51 140 141 575 344 51 140 141 575 345 51 140 141 575 346 51 140 141 575 347 51 140 141 575 348 51 140 141 575 162 349 51 140 141 575 163 350 51 140 141 575 164 351 51 140 141 575 156 565 51 140 584 573 157 352 51 140 585 573 158 353 51 140 585 573 165 354 51 140 141 575 166 355 51 140 141 575 167 357 51 140 141 575 168 356 51 140 141 575 169 358 51 140 141 575 170 359 51 140 141 575 171 360 51 140 457 576 172 361 51 140 141 575 601 324 51 140 141 575 311 362 51 140 141 575 305 308 51 140 586 573 173 363 51 140 141 575 309 310 51 140 141 575 312 364 51 140 141 575 313 365 51 140 141 575 314 366 51 140 141 575 306 307 51 140 586 573 315 367 51 140 586 573 174 368 51 140 141 175 369 51 140 587 573 176 177 51 140 587 573 178 370 51 140 587 573 179 371 51 140 587 573 180 372 51 140 587 573 181 373 51 140 141 182 375 382 140 588 573 376 382 140 588 573 377 382 140 588 573 378 382 140 588 573 379 382 140 588 573 380 382 140 588 573 381 382 140 588 573 381 51 140 141 183 383 51 140 141 184 384 51 140 141 185 385 51 140 141 186 386 51 140 141 387 331 51 140 589 573 187 388 51 140 588 573 188 389 51 140 588 573 189 390 51 140 588 573 190 391 51 140 141 191 392 374 140 141 192 393 51 140 141 193 394 382 140 141 194 395 51 140 141 195 396 374 140 141 196 397 374 140 141 197 398 374 140 141 198 399 374 140 141 199 400 374 140 141 200 401 374 140 141 201 402 374 140 141 202 403 374 140 141 203 404 374 140 141 204 405 374 140 141 205 406 51 140 141 206 407 51 140 141 207 408 51 140 141 208 409 51 140 141 209 410 51 140 141 210 411 51 140 141 211 412 51 140 141 212 413 51 140 141 213 414 51 140 141 214 415 51 140 141 215 416 51 140 141 216 417 51 140 141 217 418 51 140 419 147 420 597 320 421 51 140 590 566 567 150 113 51 140 141 321 114 382 140 590 147 141 567 322 115 51 140 590 566 567 151 435 51 140 141 152 436 51 140 141 424 429 51 140 141 425 430 51 140 141 426 431 51 140 440 568 439 438 51 140 440 568 427 432 51 140 141 153 428 51 140 141 154 434 51 140 141 155 437 51 140 141 423 433 51 140 441 218 442 51 140 441 219 458 51 140 441 220 459 51 140 441 221 460 51 140 441 222 461 51 140 441 223 462 51 140 441 224 463 51 140 441 225 464 51 140 441 226 465 51 140 441 227 466 51 140 441 316 467 51 140 441 317 468 51 140 441 318 469 51 140 441 319 470 51 140 441 228 471 51 140 441 229 472 51 140 441 230 473 51 140 441 536 540 51 140 441 231 474 51 140 441 232 475 51 140 441 233 476 51 140 441 234 477 51 140 441 235 478 51 140 591 5 569 236 479 51 140 141 237 480 51 140 141 238 101 51 140 141 239 102 51 140 141 240 103 51 140 141 241 104 51 140 141 242 105 51 140 141 243 106 51 140 141 244 107 51 140 141 245 108 51 140 141 246 109 51 140 141 247 481 382 140 141 248 482 382 140 141 249 483 382 140 141 250 484 382 140 141 251 485 382 140 141 252 486 382 140 141 253 487 382 140 141 254 89 382 140 141 255 488 382 140 141 256 90 382 140 141 257 489 382 140 141 258 92 382 140 141 259 490 382 140 141 260 491 382 140 141 261 492 382 140 141 262 493 382 140 141 263 494 382 140 141 264 495 382 140 141 265 496 382 140 141 266 498 497 570 267 499 382 140 141 268 500 382 140 141 269 501 382 140 141 270 502 382 140 141 271 503 382 140 141 272 504 382 140 141 273 505 382 140 141 274 96 382 140 141 275 97 382 140 141 276 506 382 140 141 277 98 382 140 141 278 507 51 140 592 569 279 508 51 140 592 569 280 509 382 140 141 281 510 382 140 141 282 511 382 140 141 283 512 382 140 141 537 541 382 140 141 538 542 382 140 141 539 543 382 140 141 284 513 382 140 141 285 514 382 140 141 286 515 382 140 141 287 516 382 140 141 288 517 382 140 141 289 518 382 140 141 290 519 51 140 141 291 520 51 140 141 292 521 51 140 141 293 522 51 140 141 294 524 51 140 591 571 295 525 51 140 591 571 296 526 51 140 141 297 527 51 140 141 298 528 51 140 141 299 529 51 140 141 300 530 51 140 141 301 531 51 140 141 302 532 51 140 141 303 533 51 140 534 304 110 51 140 535 10 11 12 18 139 138 139 138 52 51 140 141 53 51 140 141 74 51 140 141 54 51 140 141 75 51 140 141 55 51 140 141 556 51 140 141 56 51 140 141 57 51 140 141 58 51 140 141 76 51 140 141 59 51 140 141 60 51 140 141 61 51 140 141 62 51 140 141 63 51 140 141 64 51 140 141 65 51 140 141 77 51 140 141 66 51 140 141 67 51 140 141 78 140 141 68 140 141 79 51 140 141 80 51 140 141 69 51 140 141 81 51 140 141 70 51 140 141 82 51 140 141 71 51 140 141 72 51 140 141 72 51 140 141 73 51 140 141 83 557 140 593 598 84 51 140 593 598 85 51 140 593 598 86 51 140 593 598 87 51 140 593 598 555 51 140 141 88 557 593 598 21 22 139 138 139 138 113 51 140 141 114 51 140 141 115 51 140 141 13 139 138 139 138 110 382 140 141 111 112 14 139 138 139 138 101 382 140 141 102 382 140 141 103 382 140 141 104 382 140 141 105 382 140 141 106 382 140 141 107 382 140 141 108 382 140 141 109 382 140 141 15 5 16 558 51 140 593 598 559 51 140 593 598 560 51 140 593 598 561 564 140 593 598 562 564 140 593 598 563 564 140 593 598 5 17 89 422 90 91 92 93 94 95 374 140 594 598 96 97 98 5 523 595 599 600

6 9 99 139 138 139 138 146 118 51 140 145 147 141 119 51 140 145 147 141 120 51 140 145 147 141 121 51 140 145 147 141 117 51 140 577 147 141 572 5 122 51 140 577 147 141 572 123 51 140 578 147 141 596 124 51 140 578 147 141 596 125 51 140 578 147 141 596 126 51 140 578 147 141 596 127 51 140 578 147 141 596 5 128 51 140 578 147 141 596 129 51 140 443 147 141 596 130 51 140 579 147 141 596 131 51 142 141 147 141 132 51 142 141 147 141 133 51 142 141 147 141 134 51 142 141 147 141 135 51 142 141 147 141 136 51 142 141 147 141 137 51 142 141 147 141 19 139 138 139 138 23 51 140 141 147 141 24 51 140 141 147 141 143 144 140 141 147 141 25 51 140 141 147 141 26 51 140 141 147 141 27 51 140 141 147 141 28 51 140 141 147 141 29 51 140 141 147 141 30 51 140 141 147 141 31 148 140 580 147 141 32 51 140 580 147 141 33 51 140 141 147 141 34 51 140 141 147 141 35 51 140 141 147 141 36 51 140 141 147 141 37 51 140 141 147 141 38 51 140 141 147 141 39 51 140 141 147 141 20 139 138 139 138 40 41 42 43 51 140 581 573 44 45 51 140 581 573 46 47 51 140 582 574 48 49 51 140 582 574 446 544 444 140 453 545 444 140 454 546 444 140 455 547 444 140 456 548 444 140 447 549 444 140 448 550 444 140 449 551 444 140 450 552 444 140 451 553 444 140 452 554 444 140 149 50 444 140 445 5 100 139 138 139 138 323 148 140 583 573 325 148 140 583 573 326 148 140 583 573 327 148 140 583 573 328 148 140 583 573 324 148 140 332 573 329 148 140 330 575 331 148 140 333 575 159 334 51 140 141 575 160 335 51 140 141 575 161 336 51 140 141 575 337 51 140 141 575 338 51 140 141 575 339 51 140 141 575 340 51 140 141 575 341 51 140 141 575 342 51 140 141 575 343 51 140 141 575 344 51 140 141 575 345 51 140 141 575 346 51 140 141 575 347 51 140 141 575 348 51 140 141 575 162 349 51 140 141 575 163 350 51 140 141 575 164 351 51 140 141 575 156 565 51 140 584 573 157 352 51 140 585 573 158 353 51 140 585 573 165 354 51 140 141 575 166 355 51 140 141 575 167 357 51 140 141 575 168 356 51 140 141 575 169 358 51 140 141 575 170 359 51 140 141 575 171 360 51 140 457 576 172 361 51 140 141 575 601 324 51 140 141 575 311 362 51 140 141 575 305 308 51 140 586 573 173 363 51 140 141 575 309 310 51 140 141 575 312 364 51 140 141 575 313 365 51 140 141 575 314 366 51 140 141 575 306 307 51 140 586 573 315 367 51 140 586 573 174 368 51 140 141 175 369 51 140 587 573 176 177 51 140 587 573 178 370 51 140 587 573 179 371 51 140 587 573 180 372 51 140 587 573 181 373 51 140 141 182 375 382 140 588 573 376 382 140 588 573 377 382 140 588 573 378 382 140 588 573 379 382 140 588 573 380 382 140 588 573 381 382 140 588 573 381 51 140 141 183 383 51 140 141 184 384 51 140 141 185 385 51 140 141 186 386 51 140 141 387 331 51 140 589 573 187 388 51 140 588 573 188 389 51 140 588 573 189 390 51 140 588 573 190 391 51 140 141 191 392 374 140 141 192 393 51 140 141 193 394 382 140 141 194 395 51 140 141 195 396 374 140 141 196 397 374 140 141 197 398 374 140 141 198 399 374 140 141 199 400 374 140 141 200 401 374 140 141 201 402 374 140 141 202 403 374 140 141 203 404 374 140 141 204 405 374 140 141 205 406 51 140 141 206 407 51 140 141 207 408 51 140 141 208 409 51 140 141 209 410 51 140 141 210 411 51 140 141 211 412 51 140 141 212 413 51 140 141 213 414 51 140 141 214 415 51 140 141 215 416 51 140 141 216 417 51 140 141 217 418 51 140 419 147 420 597 320 421 51 140 590 566 567 150 113 51 140 141 321 114 382 140 590 147 141 567 322 115 51 140 590 566 567 151 435 51 140 141 152 436 51 140 141 424 429 51 140 141 425 430 51 140 141 426 431 51 140 440 568 439 438 51 140 440 568 427 432 51 140 141 153 428 51 140 141 154 434 51 140 141 155 437 51 140 141 423 433 51 140 441 218 442 51 140 441 219 458 51 140 441 220 459 51 140 441 221 460 51 140 441 222 461 51 140 441 223 462 51 140 441 224 463 51 140 441 225 464 51 140 441 226 465 51 140 441 227 466 51 140 441 316 467 51 140 441 317 468 51 140 441 318 469 51 140 441 319 470 51 140 441 228 471 51 140 441 229 472 51 140 441 230 473 51 140 441 536 540 51 140 441 231 474 51 140 441 232 475 51 140 441 233 476 51 140 441 234 477 51 140 441 235 478 51 140 591 5 569 236 479 51 140 141 237 480 51 140 141 238 101 51 140 141 239 102 51 140 141 240 103 51 140 141 241 104 51 140 141 242 105 51 140 141 243 106 51 140 141 244 107 51 140 141 245 108 51 140 141 246 109 51 140 141 247 481 382 140 141 248 482 382 140 141 249 483 382 140 141 250 484 382 140 141 251 485 382 140 141 252 486 382 140 141 253 487 382 140 141 254 89 382 140 141 255 488 382 140 141 256 90 382 140 141 257 489 382 140 141 258 92 382 140 141 259 490 382 140 141 260 491 382 140 141 261 492 382 140 141 262 493 382 140 141 263 494 382 140 141 264 495 382 140 141 265 496 382 140 141 266 498 497 570 267 499 382 140 141 268 500 382 140 141 269 501 382 140 141 270 502 382 140 141 271 503 382 140 141 272 504 382 140 141 273 505 382 140 141 274 96 382 140 141 275 97 382 140 141 276 506 382 140 141 277 98 382 140 141 278 507 51 140 592 569 279 508 51 140 592 569 280 509 382 140 141 281 510 382 140 141 282 511 382 140 141 283 512 382 140 141 537 541 382 140 141 538 542 382 140 141 539 543 382 140 141 284 513 382 140 141 285 514 382 140 141 286 515 382 140 141 287 516 382 140 141 288 517 382 140 141 289 518 382 140 141 290 519 51 140 141 291 520 51 140 141 292 521 51 140 141 293 522 51 140 141 294 524 51 140 591 571 295 525 51 140 591 571 296 526 51 140 141 297 527 51 140 141 298 528 51 140 141 299 529 51 140 141 300 530 51 140 141 301 531 51 140 141 302 532 51 140 141 303 533 51 140 534 304 110 51 140 535 10 11 12 18 139 138 139 138 52 51 140 141 53 51 140 141 74 51 140 141 54 51 140 141 75 51 140 141 55 51 140 141 556 51 140 141 56 51 140 141 57 51 140 141 58 51 140 141 76 51 140 141 59 51 140 141 60 51 140 141 61 51 140 141 62 51 140 141 63 51 140 141 64 51 140 141 65 51 140 141 77 51 140 141 66 51 140 141 67 51 140 141 78 140 141 68 140 141 79 51 140 141 80 51 140 141 69 51 140 141 81 51 140 141 70 51 140 141 82 51 140 141 71 51 140 141 72 51 140 141 72 51 140 141 73 51 140 141 83 557 140 593 598 84 51 140 593 598 85 51 140 593 598 86 51 140 593 598 87 51 140 593 598 555 51 140 141 88 557 593 598 21 22 139 138 139 138 113 51 140 141 114 51 140 141 115 51 140 141 13 139 138 139 138 110 382 140 141 111 112 14 139 138 139 138 101 382 140 141 102 382 140 141 103 382 140 141 104 382 140 141 105 382 140 141 106 382 140 141 107 382 140 141 108 382 140 141 109 382 140 141 15 5 16 558 51 140 593 598 559 51 140 593 598 560 51 140 593 598 561 564 140 593 598 562 564 140 593 598 563 564 140 593 598 5 17 89 422 90 91 92 93 94 95 374 140 594 598 96 97 98 5 523 595 599 600

6 9 99 139 138 139 138 146 118 51 140 145 147 141 119 51 140 145 147 141 120 51 140 145 147 141 121 51 140 145 147 141 117 51 140 577 147 141 572 5 122 51 140 577 147 141 572 123 51 140 578 147 141 596 124 51 140 578 147 141 596 125 51 140 578 147 141 596 126 51 140 578 147 141 596 127 51 140 578 147 141 596 5 128 51 140 578 147 141 596 129 51 140 443 147 141 596 130 51 140 579 147 141 596 131 51 142 141 147 141 132 51 142 141 147 141 133 51 142 141 147 141 134 51 142 141 147 141 135 51 142 141 147 141 136 51 142 141 147 141 137 51 142 141 147 141 19 139 138 139 138 23 51 140 141 147 141 24 51 140 141 147 141 143 144 140 141 147 141 25 51 140 141 147 141 26 51 140 141 147 141 27 51 140 141 147 141 28 51 140 141 147 141 29 51 140 141 147 141 30 51 140 141 147 141 31 148 140 580 147 141 32 51 140 580 147 141 33 51 140 141 147 141 34 51 140 141 147 141 35 51 140 141 147 141 36 51 140 141 147 141 37 51 140 141 147 141 38 51 140 141 147 141 39 51 140 141 147 141 20 139 138 139 138 40 41 42 43 51 140 581 573 44 45 51 140 581 573 46 47 51 140 582 574 48 49 51 140 582 574 446 544 444 140 453 545 444 140 454 546 444 140 455 547 444 140 456 548 444 140 447 549 444 140 448 550 444 140 449 551 444 140 450 552 444 140 451 553 444 140 452 554 444 140 149 50 444 140 445 5 100 139 138 139 138 323 148 140 583 573 325 148 140 583 573 326 148 140 583 573 327 148 140 583 573 328 148 140 583 573 324 148 140 332 573 329 148 140 330 575 331 148 140 333 575 159 334 51 140 141 575 160 335 51 140 141 575 161 336 51 140 141 575 337 51 140 141 575 338 51 140 141 575 339 51 140 141 575 340 51 140 141 575 341 51 140 141 575 342 51 140 141 575 343 51 140 141 575 344 51 140 141 575 345 51 140 141 575 346 51 140 141 575 347 51 140 141 575 348 51 140 141 575 162 349 51 140 141 575 163 350 51 140 141 575 164 351 51 140 141 575 156 565 51 140 584 573 157 352 51 140 585 573 158 353 51 140 585 573 165 354 51 140 141 575 166 355 51 140 141 575 167 357 51 140 141 575 168 356 51 140 141 575 169 358 51 140 141 575 170 359 51 140 141 575 171 360 51 140 457 576 172 361 51 140 141 575 601 324 51 140 141 575 311 362 51 140 141 575 305 308 51 140 586 573 173 363 51 140 141 575 309 310 51 140 141 575 312 364 51 140 141 575 313 365 51 140 141 575 314 366 51 140 141 575 306 307 51 140 586 573 315 367 51 140 586 573 174 368 51 140 141 175 369 51 140 587 573 176 177 51 140 587 573 178 370 51 140 587 573 179 371 51 140 587 573 180 372 51 140 587 573 181 373 51 140 141 182 375 382 140 588 573 376 382 140 588 573 377 382 140 588 573 378 382 140 588 573 379 382 140 588 573 380 382 140 588 573 381 382 140 588 573 381 51 140 141 183 383 51 140 141 184 384 51 140 141 185 385 51 140 141 186 386 51 140 141 387 331 51 140 589 573 187 388 51 140 588 573 188 389 51 140 588 573 189 390 51 140 588 573 190 391 51 140 141 191 392 374 140 141 192 393 51 140 141 193 394 382 140 141 194 395 51 140 141 195 396 374 140 141 196 397 374 140 141 197 398 374 140 141 198 399 374 140 141 199 400 374 140 141 200 401 374 140 141 201 402 374 140 141 202 403 374 140 141 203 404 374 140 141 204 405 374 140 141 205 406 51 140 141 206 407 51 140 141 207 408 51 140 141 208 409 51 140 141 209 410 51 140 141 210 411 51 140 141 211 412 51 140 141 212 413 51 140 141 213 414 51 140 141 214 415 51 140 141 215 416 51 140 141 216 417 51 140 141 217 418 51 140 419 147 420 597 320 421 51 140 590 566 567 150 113 51 140 141 321 114 382 140 590 147 141 567 322 115 51 140 590 566 567 151 435 51 140 141 152 436 51 140 141 424 429 51 140 141 425 430 51 140 141 426 431 51 140 440 568 439 438 51 140 440 568 427 432 51 140 141 153 428 51 140 141 154 434 51 140 141 155 437 51 140 141 423 433 51 140 441 218 442 51 140 441 219 458 51 140 441 220 459 51 140 441 221 460 51 140 441 222 461 51 140 441 223 462 51 140 441 224 463 51 140 441 225 464 51 140 441 226 465 51 140 441 227 466 51 140 441 316 467 51 140 441 317 468 51 140 441 318 469 51 140 441 319 470 51 140 441 228 471 51 140 441 229 472 51 140 441 230 473 51 140 441 536 540 51 140 441 231 474 51 140 441 232 475 51 140 441 233 476 51 140 441 234 477 51 140 441 235 478 51 140 591 5 569 236 479 51 140 141 237 480 51 140 141 238 101 51 140 141 239 102 51 140 141 240 103 51 140 141 241 104 51 140 141 242 105 51 140 141 243 106 51 140 141 244 107 51 140 141 245 108 51 140 141 246 109 51 140 141 247 481 382 140 141 248 482 382 140 141 249 483 382 140 141 250 484 382 140 141 251 485 382 140 141 252 486 382 140 141 253 487 382 140 141 254 89 382 140 141 255 488 382 140 141 256 90 382 140 141 257 489 382 140 141 258 92 382 140 141 259 490 382 140 141 260 491 382 140 141 261 492 382 140 141 262 493 382 140 141 263 494 382 140 141 264 495 382 140 141 265 496 382 140 141 266 498 497 570 267 499 382 140 141 268 500 382 140 141 269 501 382 140 141 270 502 382 140 141 271 503 382 140 141 272 504 382 140 141 273 505 382 140 141 274 96 382 140 141 275 97 382 140 141 276 506 382 140 141 277 98 382 140 141 278 507 51 140 592 569 279 508 51 140 592 569 280 509 382 140 141 281 510 382 140 141 282 511 382 140 141 283 512 382 140 141 537 541 382 140 141 538 542 382 140 141 539 543 382 140 141 284 513 382 140 141 285 514 382 140 141 286 515 382 140 141 287 516 382 140 141 288 517 382 140 141 289 518 382 140 141 290 519 51 140 141 291 520 51 140 141 292 521 51 140 141 293 522 51 140 141 294 524 51 140 591 571 295 525 51 140 591 571 296 526 51 140 141 297 527 51 140 141 298 528 51 140 141 299 529 51 140 141 300 530 51 140 141 301 531 51 140 141 302 532 51 140 141 303 533 51 140 534 304 110 51 140 535 10 11 12 18 139 138 139 138 52 51 140 141 53 51 140 141 74 51 140 141 54 51 140 141 75 51 140 141 55 51 140 141 556 51 140 141 56 51 140 141 57 51 140 141 58 51 140 141 76 51 140 141 59 51 140 141 60 51 140 141 61 51 140 141 62 51 140 141 63 51 140 141 64 51 140 141 65 51 140 141 77 51 140 141 66 51 140 141 67 51 140 141 78 140 141 68 140 141 79 51 140 141 80 51 140 141 69 51 140 141 81 51 140 141 70 51 140 141 82 51 140 141 71 51 140 141 72 51 140 141 72 51 140 141 73 51 140 141 83 557 140 593 598 84 51 140 593 598 85 51 140 593 598 86 51 140 593 598 87 51 140 593 598 555 51 140 141 88 557 593 598 21 22 139 138 139 138 113 51 140 141 114 51 140 141 115 51 140 141 13 139 138 139 138 110 382 140 141 111 112 14 139 138 139 138 101 382 140 141 102 382 140 141 103 382 140 141 104 382 140 141 105 382 140 141 106 382 140 141 107 382 140 141 108 382 140 141 109 382 140 141 15 5 16 558 51 140 593 598 559 51 140 593 598 560 51 140 593 598 561 564 140 593 598 562 564 140 593 598 563 564 140 593 598 5 17 89 422 90 91 92 93 94 95 374 140 594 598 96 97 98 5 523 595 599 600

6 9 99 139 138 139 138 146 118 51 140 145 147 141 119 51 140 145 147 141 120 51 140 145 147 141 121 51 140 145 147 141 117 51 140 577 147 141 572 5 122 51 140 577 147 141 572 123 51 140 578 147 141 596 124 51 140 578 147 141 596 125 51 140 578 147 141 596 126 51 140 578 147 141 596 127 51 140 578 147 141 596 5 128 51 140 578 147 141 596 129 51 140 443 147 141 596 130 51 140 579 147 141 596 131 51 142 141 147 141 132 51 142 141 147 141 133 51 142 141 147 141 134 51 142 141 147 141 135 51 142 141 147 141 136 51 142 141 147 141 137 51 142 141 147 141 19 139 138 139 138 23 51 140 141 147 141 24 51 140 141 147 141 143 144 140 141 147 141 25 51 140 141 147 141 26 51 140 141 147 141 27 51 140 141 147 141 28 51 140 141 147 141 29 51 140 141 147 141 30 51 140 141 147 141 31 148 140 580 147 141 32 51 140 580 147 141 33 51 140 141 147 141 34 51 140 141 147 141 35 51 140 141 147 141 36 51 140 141 147 141 37 51 140 141 147 141 38 51 140 141 147 141 39 51 140 141 147 141 20 139 138 139 138 40 41 42 43 51 140 581 573 44 45 51 140 581 573 46 47 51 140 582 574 48 49 51 140 582 574 446 544 444 140 453 545 444 140 454 546 444 140 455 547 444 140 456 548 444 140 447 549 444 140 448 550 444 140 449 551 444 140 450 552 444 140 451 553 444 140 452 554 444 140 149 50 444 140 445 5 100 139 138 139 138 323 148 140 583 573 325 148 140 583 573 326 148 140 583 573 327 148 140 583 573 328 148 140 583 573 324 148 140 332 573 329 148 140 330 575 331 148 140 333 575 159 334 51 140 141 575 160 335 51 140 141 575 161 336 51 140 141 575 337 51 140 141 575 338 51 140 141 575 339 51 140 141 575 340 51 140 141 575 341 51 140 141 575 342 51 140 141 575 343 51 140 141 575 344 51 140 141 575 345 51 140 141 575 346 51 140 141 575 347 51 140 141 575 348 51 140 141 575 162 349 51 140 141 575 163 350 51 140 141 575 164 351 51 140 141 575 156 565 51 140 584 573 157 352 51 140 585 573 158 353 51 140 585 573 165 354 51 140 141 575 166 355 51 140 141 575 167 357 51 140 141 575 168 356 51 140 141 575 169 358 51 140 141 575 170 359 51 140 141 575 171 360 51 140 457 576 172 361 51 140 141 575 601 324 51 140 141 575 311 362 51 140 141 575 305 308 51 140 586 573 173 363 51 140 141 575 309 310 51 140 141 575 312 364 51 140 141 575 313 365 51 140 141 575 314 366 51 140 141 575 306 307 51 140 586 573 315 367 51 140 586 573 174 368 51 140 141 175 369 51 140 587 573 176 177 51 140 587 573 178 370 51 140 587 573 179 371 51 140 587 573 180 372 51 140 587 573 181 373 51 140 141 182 375 382 140 588 573 376 382 140 588 573 377 382 140 588 573 378 382 140 588 573 379 382 140 588 573 380 382 140 588 573 381 382 140 588 573 381 51 140 141 183 383 51 140 141 184 384 51 140 141 185 385 51 140 141 186 386 51 140 141 387 331 51 140 589 573 187 388 51 140 588 573 188 389 51 140 588 573 189 390 51 140 588 573 190 391 51 140 141 191 392 374 140 141 192 393 51 140 141 193 394 382 140 141 194 395 51 140 141 195 396 374 140 141 196 397 374 140 141 197 398 374 140 141 198 399 374 140 141 199 400 374 140 141 200 401 374 140 141 201 402 374 140 141 202 403 374 140 141 203 404 374 140 141 204 405 374 140 141 205 406 51 140 141 206 407 51 140 141 207 408 51 140 141 208 409 51 140 141 209 410 51 140 141 210 411 51 140 141 211 412 51 140 141 212 413 51 140 141 213 414 51 140 141 214 415 51 140 141 215 416 51 140 141 216 417 51 140 141 217 418 51 140 419 147 420 597 320 421 51 140 590 566 567 150 113 51 140 141 321 114 382 140 590 147 141 567 322 115 51 140 590 566 567 151 435 51 140 141 152 436 51 140 141 424 429 51 140 141 425 430 51 140 141 426 431 51 140 440 568 439 438 51 140 440 568 427 432 51 140 141 153 428 51 140 141 154 434 51 140 141 155 437 51 140 141 423 433 51 140 441 218 442 51 140 441 219 458 51 140 441 220 459 51 140 441 221 460 51 140 441 222 461 51 140 441 223 462 51 140 441 224 463 51 140 441 225 464 51 140 441 226 465 51 140 441 227 466 51 140 441 316 467 51 140 441 317 468 51 140 441 318 469 51 140 441 319 470 51 140 441 228 471 51 140 441 229 472 51 140 441 230 473 51 140 441 536 540 51 140 441 231 474 51 140 441 232 475 51 140 441 233 476 51 140 441 234 477 51 140 441 235 478 51 140 591 5 569 236 479 51 140 141 237 480 51 140 141 238 101 51 140 141 239 102 51 140 141 240 103 51 140 141 241 104 51 140 141 242 105 51 140 141 243 106 51 140 141 244 107 51 140 141 245 108 51 140 141 246 109 51 140 141 247 481 382 140 141 248 482 382 140 141 249 483 382 140 141 250 484 382 140 141 251 485 382 140 141 252 486 382 140 141 253 487 382 140 141 254 89 382 140 141 255 488 382 140 141 256 90 382 140 141 257 489 382 140 141 258 92 382 140 141 259 490 382 140 141 260 491 382 140 141 261 492 382 140 141 262 493 382 140 141 263 494 382 140 141 264 495 382 140 141 265 496 382 140 141 266 498 497 570 267 499 382 140 141 268 500 382 140 141 269 501 382 140 141 270 502 382 140 141 271 503 382 140 141 272 504 382 140 141 273 505 382 140 141 274 96 382 140 141 275 97 382 140 141 276 506 382 140 141 277 98 382 140 141 278 507 51 140 592 569 279 508 51 140 592 569 280 509 382 140 141 281 510 382 140 141 282 511 382 140 141 283 512 382 140 141 537 541 382 140 141 538 542 382 140 141 539 543 382 140 141 284 513 382 140 141 285 514 382 140 141 286 515 382 140 141 287 516 382 140 141 288 517 382 140 141 289 518 382 140 141 290 519 51 140 141 291 520 51 140 141 292 521 51 140 141 293 522 51 140 141 294 524 51 140 591 571 295 525 51 140 591 571 296 526 51 140 141 297 527 51 140 141 298 528 51 140 141 299 529 51 140 141 300 530 51 140 141 301 531 51 140 141 302 532 51 140 141 303 533 51 140 534 304 110 51 140 535 10 11 12 18 139 138 139 138 52 51 140 141 53 51 140 141 74 51 140 141 54 51 140 141 75 51 140 141 55 51 140 141 556 51 140 141 56 51 140 141 57 51 140 141 58 51 140 141 76 51 140 141 59 51 140 141 60 51 140 141 61 51 140 141 62 51 140 141 63 51 140 141 64 51 140 141 65 51 140 141 77 51 140 141 66 51 140 141 67 51 140 141 78 140 141 68 140 141 79 51 140 141 80 51 140 141 69 51 140 141 81 51 140 141 70 51 140 141 82 51 140 141 71 51 140 141 72 51 140 141 72 51 140 141 73 51 140 141 83 557 140 593 598 84 51 140 593 598 85 51 140 593 598 86 51 140 593 598 87 51 140 593 598 555 51 140 141 88 557 593 598 21 22 139 138 139 138 113 51 140 141 114 51 140 141 115 51 140 141 13 139 138 139 138 110 382 140 141 111 112 14 139 138 139 138 101 382 140 141 102 382 140 141 103 382 140 141 104 382 140 141 105 382 140 141 106 382 140 141 107 382 140 141 108 382 140 141 109 382 140 141 15 5 16 558 51 140 593 598 559 51 140 593 598 560 51 140 593 598 561 564 140 593 598 562 564 140 593 598 563 564 140 593 598 5 17 89 422 90 91 92 93 94 95 374 140 594 598 96 97 98 5 523 595 599 600

6 9 99 139 138 139 138 146 118 51 140 145 147 141 119 51 140 145 147 141 120 51 140 145 147 141 121 51 140 145 147 141 117 51 140 577 147 141 572 5 122 51 140 577 147 141 572 123 51 140 578 147 141 596 124 51 140 578 147 141 596 125 51 140 578 147 141 596 126 51 140 578 147 141 596 127 51 140 578 147 141 596 5 128 51 140 578 147 141 596 129 51 140 443 147 141 596 130 51 140 579 147 141 596 131 51 142 141 147 141 132 51 142 141 147 141 133 51 142 141 147 141 134 51 142 141 147 141 135 51 142 141 147 141 136 51 142 141 147 141 137 51 142 141 147 141 19 139 138 139 138 23 51 140 141 147 141 24 51 140 141 147 141 143 144 140 141 147 141 25 51 140 141 147 141 26 51 140 141 147 141 27 51 140 141 147 141 28 51 140 141 147 141 29 51 140 141 147 141 30 51 140 141 147 141 31 148 140 580 147 141 32 51 140 580 147 141 33 51 140 141 147 141 34 51 140 141 147 141 35 51 140 141 147 141 36 51 140 141 147 141 37 51 140 141 147 141 38 51 140 141 147 141 39 51 140 141 147 141 20 139 138 139 138 40 41 42 43 51 140 581 573 44 45 51 140 581 573 46 47 51 140 582 574 48 49 51 140 582 574 446 544 444 140 453 545 444 140 454 546 444 140 455 547 444 140 456 548 444 140 447 549 444 140 448 550 444 140 449 551 444 140 450 552 444 140 451 553 444 140 452 554 444 140 149 50 444 140 445 5 100 139 138 139 138 323 148 140 583 573 325 148 140 583 573 326 148 140 583 573 327 148 140 583 573 328 148 140 583 573 324 148 140 332 573 329 148 140 330 575 331 148 140 333 575 159 334 51 140 141 575 160 335 51 140 141 575 161 336 51 140 141 575 337 51 140 141 575 338 51 140 141 575 339 51 140 141 575 340 51 140 141 575 341 51 140 141 575 342 51 140 141 575 343 51 140 141 575 344 51 140 141 575 345 51 140 141 575 346 51 140 141 575 347 51 140 141 575 348 51 140 141 575 162 349 51 140 141 575 163 350 51 140 141 575 164 351 51 140 141 575 156 565 51 140 584 573 157 352 51 140 585 573 158 353 51 140 585 573 165 354 51 140 141 575 166 355 51 140 141 575 167 357 51 140 141 575 168 356 51 140 141 575 169 358 51 140 141 575 170 359 51 140 141 575 171 360 51 140 457 576 172 361 51 140 141 575 601 324 51 140 141 575 311 362 51 140 141 575 305 308 51 140 586 573 173 363 51 140 141 575 309 310 51 140 141 575 312 364 51 140 141 575 313 365 51 140 141 575 314 366 51 140 141 575 306 307 51 140 586 573 315 367 51 140 586 573 174 368 51 140 141 175 369 51 140 587 573 176 177 51 140 587 573 178 370 51 140 587 573 179 371 51 140 587 573 180 372 51 140 587 573 181 373 51 140 141 182 375 382 140 588 573 376 382 140 588 573 377 382 140 588 573 378 382 140 588 573 379 382 140 588 573 380 382 140 588 573 381 382 140 588 573 381 51 140 141 183 383 51 140 141 184 384 51 140 141 185 385 51 140 141 186 386 51 140 141 387 331 51 140 589 573 187 388 51 140 588 573 188 389 51 140 588 573 189 390 51 140 588 573 190 391 51 140 141 191 392 374 140 141 192 393 51 140 141 193 394 382 140 141 194 395 51 140 141 195 396 374 140 141 196 397 374 140 141 197 398 374 140 141 198 399 374 140 141 199 400 374 140 141 200 401 374 140 141 201 402 374 140 141 202 403 374 140 141 203 404 374 140 141 204 405 374 140 141 205 406 51 140 141 206 407 51 140 141 207 408 51 140 141 208 409 51 140 141 209 410 51 140 141 210 411 51 140 141 211 412 51 140 141 212 413 51 140 141 213 414 51 140 141 214 415 51 140 141 215 416 51 140 141 216 417 51 140 141 217 418 51 140 419 147 420 597 320 421 51 140 590 566 567 150 113 51 140 141 321 114 382 140 590 147 141 567 322 115 51 140 590 566 567 151 435 51 140 141 152 436 51 140 141 424 429 51 140 141 425 430 51 140 141 426 431 51 140 440 568 439 438 51 140 440 568 427 432 51 140 141 153 428 51 140 141 154 434 51 140 141 155 437 51 140 141 423 433 51 140 441 218 442 51 140 441 219 458 51 140 441 220 459 51 140 441 221 460 51 140 441 222 461 51 140 441 223 462 51 140 441 224 463 51 140 441 225 464 51 140 441 226 465 51 140 441 227 466 51 140 441 316 467 51 140 441 317 468 51 140 441 318 469 51 140 441 319 470 51 140 441 228 471 51 140 441 229 472 51 140 441 230 473 51 140 441 536 540 51 140 441 231 474 51 140 441 232 475 51 140 441 233 476 51 140 441 234 477 51 140 441 235 478 51 140 591 5 569 236 479 51 140 141 237 480 51 140 141 238 101 51 140 141 239 102 51 140 141 240 103 51 140 141 241 104 51 140 141 242 105 51 140 141 243 106 51 140 141 244 107 51 140 141 245 108 51 140 141 246 109 51 140 141 247 481 382 140 141 248 482 382 140 141 249 483 382 140 141 250 484 382 140 141 251 485 382 140 141 252 486 382 140 141 253 487 382 140 141 254 89 382 140 141 255 488 382 140 141 256 90 382 140 141 257 489 382 140 141 258 92 382 140 141 259 490 382 140 141 260 491 382 140 141 261 492 382 140 141 262 493 382 140 141 263 494 382 140 141 264 495 382 140 141 265 496 382 140 141 266 498 497 570 267 499 382 140 141 268 500 382 140 141 269 501 382 140 141 270 502 382 140 141 271 503 382 140 141 272 504 382 140 141 273 505 382 140 141 274 96 382 140 141 275 97 382 140 141 276 506 382 140 141 277 98 382 140 141 278 507 51 140 592 569 279 508 51 140 592 569 280 509 382 140 141 281 510 382 140 141 282 511 382 140 141 283 512 382 140 141 537 541 382 140 141 538 542 382 140 141 539 543 382 140 141 284 513 382 140 141 285 514 382 140 141 286 515 382 140 141 287 516 382 140 141 288 517 382 140 141 289 518 382 140 141 290 519 51 140 141 291 520 51 140 141 292 521 51 140 141 293 522 51 140 141 294 524 51 140 591 571 295 525 51 140 591 571 296 526 51 140 141 297 527 51 140 141 298 528 51 140 141 299 529 51 140 141 300 530 51 140 141 301 531 51 140 141 302 532 51 140 141 303 533 51 140 534 304 110 51 140 535 10 11 12 18 139 138 139 138 52 51 140 141 53 51 140 141 74 51 140 141 54 51 140 141 75 51 140 141 55 51 140 141 556 51 140 141 56 51 140 141 57 51 140 141 58 51 140 141 76 51 140 141 59 51 140 141 60 51 140 141 61 51 140 141 62 51 140 141 63 51 140 141 64 51 140 141 65 51 140 141 77 51 140 141 66 51 140 141 67 51 140 141 78 140 141 68 140 141 79 51 140 141 80 51 140 141 69 51 140 141 81 51 140 141 70 51 140 141 82 51 140 141 71 51 140 141 72 51 140 141 72 51 140 141 73 51 140 141 83 557 140 593 598 84 51 140 593 598 85 51 140 593 598 86 51 140 593 598 87 51 140 593 598 555 51 140 141 88 557 593 598 21 22 139 138 139 138 113 51 140 141 114 51 140 141 115 51 140 141 13 139 138 139 138 110 382 140 141 111 112 14 139 138 139 138 101 382 140 141 102 382 140 141 103 382 140 141 104 382 140 141 105 382 140 141 106 382 140 141 107 382 140 141 108 382 140 141 109 382 140 141 15 5 16 558 51 140 593 598 559 51 140 593 598 560 51 140 593 598 561 564 140 593 598 562 564 140 593 598 563 564 140 593 598 5 17 89 422 90 91 92 93 94 95 374 140 594 598 96 97 98 5 523 595 599 600

6 9 99 139 138 139 138 146 118 51 140 145 147 141 119 51 140 145 147 141 120 51 140 145 147 141 121 51 140 145 147 141 117 51 140 577 147 141 572 5 122 51 140 577 147 141 572 123 51 140 578 147 141 596 124 51 140 578 147 141 596 125 51 140 578 147 141 596 126 51 140 578 147 141 596 127 51 140 578 147 141 596 5 128 51 140 578 147 141 596 129 51 140 443 147 141 596 130 51 140 579 147 141 596 131 51 142 141 147 141 132 51 142 141 147 141 133 51 142 141 147 141 134 51 142 141 147 141 135 51 142 141 147 141 136 51 142 141 147 141 137 51 142 141 147 141 19 139 138 139 138 23 51 140 141 147 141 24 51 140 141 147 141 143 144 140 141 147 141 25 51 140 141 147 141 26 51 140 141 147 141 27 51 140 141 147 141 28 51 140 141 147 141 29 51 140 141 147 141 30 51 140 141 147 141 31 148 140 580 147 141 32 51 140 580 147 141 33 51 140 141 147 141 34 51 140 141 147 141 35 51 140 141 147 141 36 51 140 141 147 141 37 51 140 141 147 141 38 51 140 141 147 141 39 51 140 141 147 141 20 139 138 139 138 40 41 42 43 51 140 581 573 44 45 51 140 581 573 46 47 51 140 582 574 48 49 51 140 582 574 446 544 444 140 453 545 444 140 454 546 444 140 455 547 444 140 456 548 444 140 447 549 444 140 448 550 444 140 449 551 444 140 450 552 444 140 451 553 444 140 452 554 444 140 149 50 444 140 445 5 100 139 138 139 138 323 148 140 583 573 325 148 140 583 573 326 148 140 583 573 327 148 140 583 573 328 148 140 583 573 324 148 140 332 573 329 148 140 330 575 331 148 140 333 575 159 334 51 140 141 575 160 335 51 140 141 575 161 336 51 140 141 575 337 51 140 141 575 338 51 140 141 575 339 51 140 141 575 340 51 140 141 575 341 51 140 141 575 342 51 140 141 575 343 51 140 141 575 344 51 140 141 575 345 51 140 141 575 346 51 140 141 575 347 51 140 141 575 348 51 140 141 575 162 349 51 140 141 575 163 350 51 140 141 575 164 351 51 140 141 575 156 565 51 140 584 573 157 352 51 140 585 573 158 353 51 140 585 573 165 354 51 140 141 575 166 355 51 140 141 575 167 357 51 140 141 575 168 356 51 140 141 575 169 358 51 140 141 575 170 359 51 140 141 575 171 360 51 140 457 576 172 361 51 140 141 575 601 324 51 140 141 575 311 362 51 140 141 575 305 308 51 140 586 573 173 363 51 140 141 575 309 310 51 140 141 575 312 364 51 140 141 575 313 365 51 140 141 575 314 366 51 140 141 575 306 307 51 140 586 573 315 367 51 140 586 573 174 368 51 140 141 175 369 51 140 587 573 176 177 51 140 587 573 178 370 51 140 587 573 179 371 51 140 587 573 180 372 51 140 587 573 181 373 51 140 141 182 375 382 140 588 573 376 382 140 588 573 377 382 140 588 573 378 382 140 588 573 379 382 140 588 573 380 382 140 588 573 381 382 140 588 573 381 51 140 141 183 383 51 140 141 184 384 51 140 141 185 385 51 140 141 186 386 51 140 141 387 331 51 140 589 573 187 388 51 140 588 573 188 389 51 140 588 573 189 390 51 140 588 573 190 391 51 140 141 191 392 374 140 141 192 393 51 140 141 193 394 382 140 141 194 395 51 140 141 195 396 374 140 141 196 397 374 140 141 197 398 374 140 141 198 399 374 140 141 199 400 374 140 141 200 401 374 140 141 201 402 374 140 141 202 403 374 140 141 203 404 374 140 141 204 405 374 140 141 205 406 51 140 141 206 407 51 140 141 207 408 51 140 141 208 409 51 140 141 209 410 51 140 141 210 411 51 140 141 211 412 51 140 141 212 413 51 140 141 213 414 51 140 141 214 415 51 140 141 215 416 51 140 141 216 417 51 140 141 217 418 51 140 419 147 420 597 320 421 51 140 590 566 567 150 113 51 140 141 321 114 382 140 590 147 141 567 322 115 51 140 590 566 567 151 435 51 140 141 152 436 51 140 141 424 429 51 140 141 425 430 51 140 141 426 431 51 140 440 568 439 438 51 140 440 568 427 432 51 140 141 153 428 51 140 141 154 434 51 140 141 155 437 51 140 141 423 433 51 140 441 218 442 51 140 441 219 458 51 140 441 220 459 51 140 441 221 460 51 140 441 222 461 51 140 441 223 462 51 140 441 224 463 51 140 441 225 464 51 140 441 226 465 51 140 441 227 466 51 140 441 316 467 51 140 441 317 468 51 140 441 318 469 51 140 441 319 470 51 140 441 228 471 51 140 441 229 472 51 140 441 230 473 51 140 441 536 540 51 140 441 231 474 51 140 441 232 475 51 140 441 233 476 51 140 441 234 477 51 140 441 235 478 51 140 591 5 569 236 479 51 140 141 237 480 51 140 141 238 101 51 140 141 239 102 51 140 141 240 103 51 140 141 241 104 51 140 141 242 105 51 140 141 243 106 51 140 141 244 107 51 140 141 245 108 51 140 141 246 109 51 140 141 247 481 382 140 141 248 482 382 140 141 249 483 382 140 141 250 484 382 140 141 251 485 382 140 141 252 486 382 140 141 253 487 382 140 141 254 89 382 140 141 255 488 382 140 141 256 90 382 140 141 257 489 382 140 141 258 92 382 140 141 259 490 382 140 141 260 491 382 140 141 261 492 382 140 141 262 493 382 140 141 263 494 382 140 141 264 495 382 140 141 265 496 382 140 141 266 498 497 570 267 499 382 140 141 268 500 382 140 141 269 501 382 140 141 270 502 382 140 141 271 503 382 140 141 272 504 382 140 141 273 505 382 140 141 274 96 382 140 141 275 97 382 140 141 276 506 382 140 141 277 98 382 140 141 278 507 51 140 592 569 279 508 51 140 592 569 280 509 382 140 141 281 510 382 140 141 282 511 382 140 141 283 512 382 140 141 537 541 382 140 141 538 542 382 140 141 539 543 382 140 141 284 513 382 140 141 285 514 382 140 141 286 515 382 140 141 287 516 382 140 141 288 517 382 140 141 289 518 382 140 141 290 519 51 140 141 291 520 51 140 141 292 521 51 140 141 293 522 51 140 141 294 524 51 140 591 571 295 525 51 140 591 571 296 526 51 140 141 297 527 51 140 141 298 528 51 140 141 299 529 51 140 141 300 530 51 140 141 301 531 51 140 141 302 532 51 140 141 303 533 51 140 534 304 110 51 140 535 10 11 12 18 139 138 139 138 52 51 140 141 53 51 140 141 74 51 140 141 54 51 140 141 75 51 140 141 55 51 140 141 556 51 140 141 56 51 140 141 57 51 140 141 58 51 140 141 76 51 140 141 59 51 140 141 60 51 140 141 61 51 140 141 62 51 140 141 63 51 140 141 64 51 140 141 65 51 140 141 77 51 140 141 66 51 140 141 67 51 140 141 78 140 141 68 140 141 79 51 140 141 80 51 140 141 69 51 140 141 81 51 140 141 70 51 140 141 82 51 140 141 71 51 140 141 72 51 140 141 72 51 140 141 73 51 140 141 83 557 140 593 598 84 51 140 593 598 85 51 140 593 598 86 51 140 593 598 87 51 140 593 598 555 51 140 141 88 557 593 598 21 22 139 138 139 138 113 51 140 141 114 51 140 141 115 51 140 141 13 139 138 139 138 110 382 140 141 111 112 14 139 138 139 138 101 382 140 141 102 382 140 141 103 382 140 141 104 382 140 141 105 382 140 141 106 382 140 141 107 382 140 141 108 382 140 141 109 382 140 141 15 5 16 558 51 140 593 598 559 51 140 593 598 560 51 140 593 598 561 564 140 593 598 562 564 140 593 598 563 564 140 593 598 5 17 89 422 90 91 92 93 94 95 374 140 594 598 96 97 98 5 523 595 599 600

6 9 99 139 138 139 138 146 118 51 140 145 147 141 119 51 140 145 147 141 120 51 140 145 147 141 121 51 140 145 147 141 117 51 140 577 147 141 572 5 122 51 140 577 147 141 572 123 51 140 578 147 141 596 124 51 140 578 147 141 596 125 51 140 578 147 141 596 126 51 140 578 147 141 596 127 51 140 578 147 141 596 5 128 51 140 578 147 141 596 129 51 140 443 147 141 596 130 51 140 579 147 141 596 131 51 142 141 147 141 132 51 142 141 147 141 133 51 142 141 147 141 134 51 142 141 147 141 135 51 142 141 147 141 136 51 142 141 147 141 137 51 142 141 147 141 19 139 138 139 138 23 51 140 141 147 141 24 51 140 141 147 141 143 144 140 141 147 141 25 51 140 141 147 141 26 51 140 141 147 141 27 51 140 141 147 141 28 51 140 141 147 141 29 51 140 141 147 141 30 51 140 141 147 141 31 148 140 580 147 141 32 51 140 580 147 141 33 51 140 141 147 141 34 51 140 141 147 141 35 51 140 141 147 141 36 51 140 141 147 141 37 51 140 141 147 141 38 51 140 141 147 141 39 51 140 141 147 141 20 139 138 139 138 40 41 42 43 51 140 581 573 44 45 51 140 581 573 46 47 51 140 582 574 48 49 51 140 582 574 446 544 444 140 453 545 444 140 454 546 444 140 455 547 444 140 456 548 444 140 447 549 444 140 448 550 444 140 449 551 444 140 450 552 444 140 451 553 444 140 452 554 444 140 149 50 444 140 445 5 100 139 138 139 138 323 148 140 583 573 325 148 140 583 573 326 148 140 583 573 327 148 140 583 573 328 148 140 583 573 324 148 140 332 573 329 148 140 330 575 331 148 140 333 575 159 334 51 140 141 575 160 335 51 140 141 575 161 336 51 140 141 575 337 51 140 141 575 338 51 140 141 575 339 51 140 141 575 340 51 140 141 575 341 51 140 141 575 342 51 140 141 575 343 51 140 141 575 344 51 140 141 575 345 51 140 141 575 346 51 140 141 575 347 51 140 141 575 348 51 140 141 575 162 349 51 140 141 575 163 350 51 140 141 575 164 351 51 140 141 575 156 565 51 140 584 573 157 352 51 140 585 573 158 353 51 140 585 573 165 354 51 140 141 575 166 355 51 140 141 575 167 357 51 140 141 575 168 356 51 140 141 575 169 358 51 140 141 575 170 359 51 140 141 575 171 360 51 140 457 576 172 361 51 140 141 575 601 324 51 140 141 575 311 362 51 140 141 575 305 308 51 140 586 573 173 363 51 140 141 575 309 310 51 140 141 575 312 364 51 140 141 575 313 365 51 140 141 575 314 366 51 140 141 575 306 307 51 140 586 573 315 367 51 140 586 573 174 368 51 140 141 175 369 51 140 587 573 176 177 51 140 587 573 178 370 51 140 587 573 179 371 51 140 587 573 180 372 51 140 587 573 181 373 51 140 141 182 375 382 140 588 573 376 382 140 588 573 377 382 140 588 573 378 382 140 588 573 379 382 140 588 573 380 382 140 588 573 381 382 140 588 573 381 51 140 141 183 383 51 140 141 184 384 51 140 141 185 385 51 140 141 186 386 51 140 141 387 331 51 140 589 573 187 388 51 140 588 573 188 389 51 140 588 573 189 390 51 140 588 573 190 391 51 140 141 191 392 374 140 141 192 393 51 140 141 193 394 382 140 141 194 395 51 140 141 195 396 374 140 141 196 397 374 140 141 197 398 374 140 141 198 399 374 140 141 199 400 374 140 141 200 401 374 140 141 201 402 374 140 141 202 403 374 140 141 203 404 374 140 141 204 405 374 140 141 205 406 51 140 141 206 407 51 140 141 207 408 51 140 141 208 409 51 140 141 209 410 51 140 141 210 411 51 140 141 211 412 51 140 141 212 413 51 140 141 213 414 51 140 141 214 415 51 140 141 215 416 51 140 141 216 417 51 140 141 217 418 51 140 419 147 420 597 320 421 51 140 590 566 567 150 113 51 140 141 321 114 382 140 590 147 141 567 322 115 51 140 590 566 567 151 435 51 140 141 152 436 51 140 141 424 429 51 140 141 425 430 51 140 141 426 431 51 140 440 568 439 438 51 140 440 568 427 432 51 140 141 153 428 51 140 141 154 434 51 140 141 155 437 51 140 141 423 433 51 140 441 218 442 51 140 441 219 458 51 140 441 220 459 51 140 441 221 460 51 140 441 222 461 51 140 441 223 462 51 140 441 224 463 51 140 441 225 464 51 140 441 226 465 51 140 441 227 466 51 140 441 316 467 51 140 441 317 468 51 140 441 318 469 51 140 441 319 470 51 140 441 228 471 51 140 441 229 472 51 140 441 230 473 51 140 441 536 540 51 140 441 231 474 51 140 441 232 475 51 140 441 233 476 51 140 441 234 477 51 140 441 235 478 51 140 591 5 569 236 479 51 140 141 237 480 51 140 141 238 101 51 140 141 239 102 51 140 141 240 103 51 140 141 241 104 51 140 141 242 105 51 140 141 243 106 51 140 141 244 107 51 140 141 245 108 51 140 141 246 109 51 140 141 247 481 382 140 141 248 482 382 140 141 249 483 382 140 141 250 484 382 140 141 251 485 382 140 141 252 486 382 140 141 253 487 382 140 141 254 89 382 140 141 255 488 382 140 141 256 90 382 140 141 257 489 382 140 141 258 92 382 140 141 259 490 382 140 141 260 491 382 140 141 261 492 382 140 141 262 493 382 140 141 263 494 382 140 141 264 495 382 140 141 265 496 382 140 141 266 498 497 570 267 499 382 140 141 268 500 382 140 141 269 501 382 140 141 270 502 382 140 141 271 503 382 140 141 272 504 382 140 141 273 505 382 140 141 274 96 382 140 141 275 97 382 140 141 276 506 382 140 141 277 98 382 140 141 278 507 51 140 592 569 279 508 51 140 592 569 280 509 382 140 141 281 510 382 140 141 282 511 382 140 141 283 512 382 140 141 537 541 382 140 141 538 542 382 140 141 539 543 382 140 141 284 513 382 140 141 285 514 382 140 141 286 515 382 140 141 287 516 382 140 141 288 517 382 140 141 289 518 382 140 141 290 519 51 140 141 291 520 51 140 141 292 521 51 140 141 293 522 51 140 141 294 524 51 140 591 571 295 525 51 140 591 571 296 526 51 140 141 297 527 51 140 141 298 528 51 140 141 299 529 51 140 141 300 530 51 140 141 301 531 51 140 141 302 532 51 140 141 303 533 51 140 534 304 110 51 140 535 10 11 12 18 139 138 139 138 52 51 140 141 53 51 140 141 74 51 140 141 54 51 140 141 75 51 140 141 55 51 140 141 556 51 140 141 56 51 140 141 57 51 140 141 58 51 140 141 76 51 140 141 59 51 140 141 60 51 140 141 61 51 140 141 62 51 140 141 63 51 140 141 64 51 140 141 65 51 140 141 77 51 140 141 66 51 140 141 67 51 140 141 78 140 141 68 140 141 79 51 140 141 80 51 140 141 69 51 140 141 81 51 140 141 70 51 140 141 82 51 140 141 71 51 140 141 72 51 140 141 72 51 140 141 73 51 140 141 83 557 140 593 598 84 51 140 593 598 85 51 140 593 598 86 51 140 593 598 87 51 140 593 598 555 51 140 141 88 557 593 598 21 22 139 138 139 138 113 51 140 141 114 51 140 141 115 51 140 141 13 139 138 139 138 110 382 140 141 111 112 14 139 138 139 138 101 382 140 141 102 382 140 141 103 382 140 141 104 382 140 141 105 382 140 141 106 382 140 141 107 382 140 141 108 382 140 141 109 382 140 141 15 5 16 558 51 140 593 598 559 51 140 593 598 560 51 140 593 598 561 564 140 593 598 562 564 140 593 598 563 564 140 593 598 5 17 89 422 90 91 92 93 94 95 374 140 594 598 96 97 98 5 523 595 599 600

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

6 9 99 139 138 139 138 146 118 51 140 145 147 141 119 51 140 145 147 141 120 51 140 145 147 141 121 51 140 145 147 141 117 51 140 577 147 141 572 5 122 51 140 577 147 141 572 123 51 140 578 147 141 596 124 51 140 578 147 141 596 125 51 140 578 147 141 596 126 51 140 578 147 141 596 127 51 140 578 147 141 596 5 128 51 140 578 147 141 596 129 51 140 443 147 141 596 130 51 140 579 147 141 596 131 51 142 141 147 141 132 51 142 141 147 141 133 51 142 141 147 141 134 51 142 141 147 141 135 51 142 141 147 141 136 51 142 141 147 141 137 51 142 141 147 141 19 139 138 139 138 23 51 140 141 147 141 24 51 140 141 147 141 143 144 140 141 147 141 25 51 140 141 147 141 26 51 140 141 147 141 27 51 140 141 147 141 28 51 140 141 147 141 29 51 140 141 147 141 30 51 140 141 147 141 31 148 140 580 147 141 32 51 140 580 147 141 33 51 140 141 147 141 34 51 140 141 147 141 35 51 140 141 147 141 36 51 140 141 147 141 37 51 140 141 147 141 38 51 140 141 147 141 39 51 140 141 147 141 20 139 138 139 138 40 41 42 43 51 140 581 573 44 45 51 140 581 573 46 47 51 140 582 574 48 49 51 140 582 574 446 544 444 140 453 545 444 140 454 546 444 140 455 547 444 140 456 548 444 140 447 549 444 140 448 550 444 140 449 551 444 140 450 552 444 140 451 553 444 140 452 554 444 140 149 50 444 140 445 5 100 139 138 139 138 323 148 140 583 573 325 148 140 583 573 326 148 140 583 573 327 148 140 583 573 328 148 140 583 573 324 148 140 332 573 329 148 140 330 575 331 148 140 333 575 159 334 51 140 141 575 160 335 51 140 141 575 161 336 51 140 141 575 337 51 140 141 575 338 51 140 141 575 339 51 140 141 575 340 51 140 141 575 341 51 140 141 575 342 51 140 141 575 343 51 140 141 575 344 51 140 141 575 345 51 140 141 575 346 51 140 141 575 347 51 140 141 575 348 51 140 141 575 162 349 51 140 141 575 163 350 51 140 141 575 164 351 51 140 141 575 156 565 51 140 584 573 157 352 51 140 585 573 158 353 51 140 585 573 165 354 51 140 141 575 166 355 51 140 141 575 167 357 51 140 141 575 168 356 51 140 141 575 169 358 51 140 141 575 170 359 51 140 141 575 171 360 51 140 457 576 172 361 51 140 141 575 601 324 51 140 141 575 311 362 51 140 141 575 305 308 51 140 586 573 173 363 51 140 141 575 309 310 51 140 141 575 312 364 51 140 141 575 313 365 51 140 141 575 314 366 51 140 141 575 306 307 51 140 586 573 315 367 51 140 586 573 174 368 51 140 141 175 369 51 140 587 573 176 177 51 140 587 573 178 370 51 140 587 573 179 371 51 140 587 573 180 372 51 140 587 573 181 373 51 140 141 182 375 382 140 588 573 376 382 140 588 573 377 382 140 588 573 378 382 140 588 573 379 382 140 588 573 380 382 140 588 573 381 382 140 588 573 381 51 140 141 183 383 51 140 141 184 384 51 140 141 185 385 51 140 141 186 386 51 140 141 387 331 51 140 589 573 187 388 51 140 588 573 188 389 51 140 588 573 189 390 51 140 588 573 190 391 51 140 141 191 392 374 140 141 192 393 51 140 141 193 394 382 140 141 194 395 51 140 141 195 396 374 140 141 196 397 374 140 141 197 398 374 140 141 198 399 374 140 141 199 400 374 140 141 200 401 374 140 141 201 402 374 140 141 202 403 374 140 141 203 404 374 140 141 204 405 374 140 141 205 406 51 140 141 206 407 51 140 141 207 408 51 140 141 208 409 51 140 141 209 410 51 140 141 210 411 51 140 141 211 412 51 140 141 212 413 51 140 141 213 414 51 140 141 214 415 51 140 141 215 416 51 140 141 216 417 51 140 141 217 418 51 140 419 147 420 597 320 421 51 140 590 566 567 150 113 51 140 141 321 114 382 140 590 147 141 567 322 115 51 140 590 566 567 151 435 51 140 141 152 436 51 140 141 424 429 51 140 141 425 430 51 140 141 426 431 51 140 440 568 439 438 51 140 440 568 427 432 51 140 141 153 428 51 140 141 154 434 51 140 141 155 437 51 140 141 423 433 51 140 441 218 442 51 140 441 219 458 51 140 441 220 459 51 140 441 221 460 51 140 441 222 461 51 140 441 223 462 51 140 441 224 463 51 140 441 225 464 51 140 441 226 465 51 140 441 227 466 51 140 441 316 467 51 140 441 317 468 51 140 441 318 469 51 140 441 319 470 51 140 441 228 471 51 140 441 229 472 51 140 441 230 473 51 140 441 536 540 51 140 441 231 474 51 140 441 232 475 51 140 441 233 476 51 140 441 234 477 51 140 441 235 478 51 140 591 5 569 236 479 51 140 141 237 480 51 140 141 238 101 51 140 141 239 102 51 140 141 240 103 51 140 141 241 104 51 140 141 242 105 51 140 141 243 106 51 140 141 244 107 51 140 141 245 108 51 140 141 246 109 51 140 141 247 481 382 140 141 248 482 382 140 141 249 483 382 140 141 250 484 382 140 141 251 485 382 140 141 252 486 382 140 141 253 487 382 140 141 254 89 382 140 141 255 488 382 140 141 256 90 382 140 141 257 489 382 140 141 258 92 382 140 141 259 490 382 140 141 260 491 382 140 141 261 492 382 140 141 262 493 382 140 141 263 494 382 140 141 264 495 382 140 141 265 496 382 140 141 266 498 497 570 267 499 382 140 141 268 500 382 140 141 269 501 382 140 141 270 502 382 140 141 271 503 382 140 141 272 504 382 140 141 273 505 382 140 141 274 96 382 140 141 275 97 382 140 141 276 506 382 140 141 277 98 382 140 141 278 507 51 140 592 569 279 508 51 140 592 569 280 509 382 140 141 281 510 382 140 141 282 511 382 140 141 283 512 382 140 141 537 541 382 140 141 538 542 382 140 141 539 543 382 140 141 284 513 382 140 141 285 514 382 140 141 286 515 382 140 141 287 516 382 140 141 288 517 382 140 141 289 518 382 140 141 290 519 51 140 141 291 520 51 140 141 292 521 51 140 141 293 522 51 140 141 294 524 51 140 591 571 295 525 51 140 591 571 296 526 51 140 141 297 527 51 140 141 298 528 51 140 141 299 529 51 140 141 300 530 51 140 141 301 531 51 140 141 302 532 51 140 141 303 533 51 140 534 304 110 51 140 535 10 11 12 18 139 138 139 138 52 51 140 141 53 51 140 141 74 51 140 141 54 51 140 141 75 51 140 141 55 51 140 141 556 51 140 141 56 51 140 141 57 51 140 141 58 51 140 141 76 51 140 141 59 51 140 141 60 51 140 141 61 51 140 141 62 51 140 141 63 51 140 141 64 51 140 141 65 51 140 141 77 51 140 141 66 51 140 141 67 51 140 141 78 140 141 68 140 141 79 51 140 141 80 51 140 141 69 51 140 141 81 51 140 141 70 51 140 141 82 51 140 141 71 51 140 141 72 51 140 141 72 51 140 141 73 51 140 141 83 557 140 593 598 84 51 140 593 598 85 51 140 593 598 86 51 140 593 598 87 51 140 593 598 555 51 140 141 88 557 593 598 21 22 139 138 139 138 113 51 140 141 114 51 140 141 115 51 140 141 13 139 138 139 138 110 382 140 141 111 112 14 139 138 139 138 101 382 140 141 102 382 140 141 103 382 140 141 104 382 140 141 105 382 140 141 106 382 140 141 107 382 140 141 108 382 140 141 109 382 140 141 15 5 16 558 51 140 593 598 559 51 140 593 598 560 51 140 593 598 561 564 140 593 598 562 564 140 593 598 563 564 140 593 598 5 17 89 422 90 91 92 93 94 95 374 140 594 598 96 97 98 5 523 595 599 600

607 661 660 604 602 603 606 138 146 610 620 611 621 612 622 613 623 614 624 615 625 616 626 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 617 627 618 628 633 634 635 636 637 634 638 639 640 641 642 143 619 651 650 649 648 609 647 646 645 644 643 652 653 654 655 656 657 658 659 331 388 388 390

607 661 660 604 602 603 606 138 146 610 620 611 621 612 622 613 623 614 624 615 625 616 626 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 617 627 618 628 633 634 635 636 637 634 638 639 640 641 642 143 619 651 650 649 648 609 647 646 645 644 643 652 653 654 655 656 657 658 659 331 388 388 390

607 661 660 604 602 603 606 138 146 610 620 611 621 612 622 613 623 614 624 615 625 616 626 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 617 627 618 628 633 634 635 636 637 634 638 639 640 641 642 143 619 651 650 649 648 609 647 646 645 644 643 652 653 654 655 656 657 658 659 331 388 388 390

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

6 9 99 139 138 139 138 146 118 51 140 145 147 141 119 51 140 145 147 141 120 51 140 145 147 141 121 51 140 145 147 141 117 51 140 577 147 141 572 5 122 51 140 577 147 141 572 123 51 140 578 147 141 596 124 51 140 578 147 141 596 125 51 140 578 147 141 596 126 51 140 578 147 141 596 127 51 140 578 147 141 596 5 128 51 140 578 147 141 596 129 51 140 443 147 141 596 130 51 140 579 147 141 596 131 51 142 141 147 141 132 51 142 141 147 141 133 51 142 141 147 141 134 51 142 141 147 141 135 51 142 141 147 141 136 51 142 141 147 141 137 51 142 141 147 141 19 139 138 139 138 23 51 140 141 147 141 24 51 140 141 147 141 143 144 140 141 147 141 25 51 140 141 147 141 26 51 140 141 147 141 27 51 140 141 147 141 28 51 140 141 147 141 29 51 140 141 147 141 30 51 140 141 147 141 31 148 140 580 147 141 32 51 140 580 147 141 33 51 140 141 147 141 34 51 140 141 147 141 35 51 140 141 147 141 36 51 140 141 147 141 37 51 140 141 147 141 38 51 140 141 147 141 39 51 140 141 147 141 20 139 138 139 138 40 41 42 43 51 140 581 573 44 45 51 140 581 573 46 47 51 140 582 574 48 49 51 140 582 574 446 544 444 140 453 545 444 140 454 546 444 140 455 547 444 140 456 548 444 140 447 549 444 140 448 550 444 140 449 551 444 140 450 552 444 140 451 553 444 140 452 554 444 140 149 50 444 140 445 5 100 139 138 139 138 323 148 140 583 573 325 148 140 583 573 326 148 140 583 573 327 148 140 583 573 328 148 140 583 573 324 148 140 332 573 329 148 140 330 575 331 148 140 333 575 159 334 51 140 141 575 160 335 51 140 141 575 161 336 51 140 141 575 337 51 140 141 575 338 51 140 141 575 339 51 140 141 575 340 51 140 141 575 341 51 140 141 575 342 51 140 141 575 343 51 140 141 575 344 51 140 141 575 345 51 140 141 575 346 51 140 141 575 347 51 140 141 575 348 51 140 141 575 162 349 51 140 141 575 163 350 51 140 141 575 164 351 51 140 141 575 156 565 51 140 584 573 157 352 51 140 585 573 158 353 51 140 585 573 165 354 51 140 141 575 166 355 51 140 141 575 167 357 51 140 141 575 168 356 51 140 141 575 169 358 51 140 141 575 170 359 51 140 141 575 171 360 51 140 457 576 172 361 51 140 141 575 601 324 51 140 141 575 311 362 51 140 141 575 305 308 51 140 586 573 173 363 51 140 141 575 309 310 51 140 141 575 312 364 51 140 141 575 313 365 51 140 141 575 314 366 51 140 141 575 306 307 51 140 586 573 315 367 51 140 586 573 174 368 51 140 141 175 369 51 140 587 573 176 177 51 140 587 573 178 370 51 140 587 573 179 371 51 140 587 573 180 372 51 140 587 573 181 373 51 140 141 182 375 382 140 588 573 376 382 140 588 573 377 382 140 588 573 378 382 140 588 573 379 382 140 588 573 380 382 140 588 573 381 382 140 588 573 381 51 140 141 183 383 51 140 141 184 384 51 140 141 185 385 51 140 141 186 386 51 140 141 387 331 51 140 589 573 187 388 51 140 588 573 188 389 51 140 588 573 189 390 51 140 588 573 190 391 51 140 141 191 392 374 140 141 192 393 51 140 141 193 394 382 140 141 194 395 51 140 141 195 396 374 140 141 196 397 374 140 141 197 398 374 140 141 198 399 374 140 141 199 400 374 140 141 200 401 374 140 141 201 402 374 140 141 202 403 374 140 141 203 404 374 140 141 204 405 374 140 141 205 406 51 140 141 206 407 51 140 141 207 408 51 140 141 208 409 51 140 141 209 410 51 140 141 210 411 51 140 141 211 412 51 140 141 212 413 51 140 141 213 414 51 140 141 214 415 51 140 141 215 416 51 140 141 216 417 51 140 141 217 418 51 140 419 147 420 597 320 421 51 140 590 566 567 150 113 51 140 141 321 114 382 140 590 147 141 567 322 115 51 140 590 566 567 151 435 51 140 141 152 436 51 140 141 424 429 51 140 141 425 430 51 140 141 426 431 51 140 440 568 439 438 51 140 440 568 427 432 51 140 141 153 428 51 140 141 154 434 51 140 141 155 437 51 140 141 423 433 51 140 441 218 442 51 140 441 219 458 51 140 441 220 459 51 140 441 221 460 51 140 441 222 461 51 140 441 223 462 51 140 441 224 463 51 140 441 225 464 51 140 441 226 465 51 140 441 227 466 51 140 441 316 467 51 140 441 317 468 51 140 441 318 469 51 140 441 319 470 51 140 441 228 471 51 140 441 229 472 51 140 441 230 473 51 140 441 536 540 51 140 441 231 474 51 140 441 232 475 51 140 441 233 476 51 140 441 234 477 51 140 441 235 478 51 140 591 5 569 236 479 51 140 141 237 480 51 140 141 238 101 51 140 141 239 102 51 140 141 240 103 51 140 141 241 104 51 140 141 242 105 51 140 141 243 106 51 140 141 244 107 51 140 141 245 108 51 140 141 246 109 51 140 141 247 481 382 140 141 248 482 382 140 141 249 483 382 140 141 250 484 382 140 141 251 485 382 140 141 252 486 382 140 141 253 487 382 140 141 254 89 382 140 141 255 488 382 140 141 256 90 382 140 141 257 489 382 140 141 258 92 382 140 141 259 490 382 140 141 260 491 382 140 141 261 492 382 140 141 262 493 382 140 141 263 494 382 140 141 264 495 382 140 141 265 496 382 140 141 266 498 497 570 267 499 382 140 141 268 500 382 140 141 269 501 382 140 141 270 502 382 140 141 271 503 382 140 141 272 504 382 140 141 273 505 382 140 141 274 96 382 140 141 275 97 382 140 141 276 506 382 140 141 277 98 382 140 141 278 507 51 140 592 569 279 508 51 140 592 569 280 509 382 140 141 281 510 382 140 141 282 511 382 140 141 283 512 382 140 141 537 541 382 140 141 538 542 382 140 141 539 543 382 140 141 284 513 382 140 141 285 514 382 140 141 286 515 382 140 141 287 516 382 140 141 288 517 382 140 141 289 518 382 140 141 290 519 51 140 141 291 520 51 140 141 292 521 51 140 141 293 522 51 140 141 294 524 51 140 591 571 295 525 51 140 591 571 296 526 51 140 141 297 527 51 140 141 298 528 51 140 141 299 529 51 140 141 300 530 51 140 141 301 531 51 140 141 302 532 51 140 141 303 533 51 140 534 304 110 51 140 535 10 11 12 18 139 138 139 138 52 51 140 141 53 51 140 141 74 51 140 141 54 51 140 141 75 51 140 141 55 51 140 141 556 51 140 141 56 51 140 141 57 51 140 141 58 51 140 141 76 51 140 141 59 51 140 141 60 51 140 141 61 51 140 141 62 51 140 141 63 51 140 141 64 51 140 141 65 51 140 141 77 51 140 141 66 51 140 141 67 51 140 141 78 140 141 68 140 141 79 51 140 141 80 51 140 141 69 51 140 141 81 51 140 141 70 51 140 141 82 51 140 141 71 51 140 141 72 51 140 141 72 51 140 141 73 51 140 141 83 557 140 593 598 84 51 140 593 598 85 51 140 593 598 86 51 140 593 598 87 51 140 593 598 555 51 140 141 88 557 593 598 21 22 139 138 139 138 113 51 140 141 114 51 140 141 115 51 140 141 13 139 138 139 138 110 382 140 141 111 112 14 139 138 139 138 101 382 140 141 102 382 140 141 103 382 140 141 104 382 140 141 105 382 140 141 106 382 140 141 107 382 140 141 108 382 140 141 109 382 140 141 15 5 16 558 51 140 593 598 559 51 140 593 598 560 51 140 593 598 561 564 140 593 598 562 564 140 593 598 563 564 140 593 598 5 17 89 422 90 91 92 93 94 95 374 140 594 598 96 97 98 5 523 595 599 600

6 9 99 139 138 139 138 146 118 51 140 145 147 141 119 51 140 145 147 141 120 51 140 145 147 141 121 51 140 145 147 141 117 51 140 577 147 141 572 5 122 51 140 577 147 141 572 123 51 140 578 147 141 596 124 51 140 578 147 141 596 125 51 140 578 147 141 596 126 51 140 578 147 141 596 127 51 140 578 147 141 596 5 128 51 140 578 147 141 596 129 51 140 443 147 141 596 130 51 140 579 147 141 596 131 51 142 141 147 141 132 51 142 141 147 141 133 51 142 141 147 141 134 51 142 141 147 141 135 51 142 141 147 141 136 51 142 141 147 141 137 51 142 141 147 141 19 139 138 139 138 23 51 140 141 147 141 24 51 140 141 147 141 143 144 140 141 147 141 25 51 140 141 147 141 26 51 140 141 147 141 27 51 140 141 147 141 28 51 140 141 147 141 29 51 140 141 147 141 30 51 140 141 147 141 31 148 140 580 147 141 32 51 140 580 147 141 33 51 140 141 147 141 34 51 140 141 147 141 35 51 140 141 147 141 36 51 140 141 147 141 37 51 140 141 147 141 38 51 140 141 147 141 39 51 140 141 147 141 20 139 138 139 138 40 41 42 43 51 140 581 573 44 45 51 140 581 573 46 47 51 140 582 574 48 49 51 140 582 574 446 544 444 140 453 545 444 140 454 546 444 140 455 547 444 140 456 548 444 140 447 549 444 140 448 550 444 140 449 551 444 140 450 552 444 140 451 553 444 140 452 554 444 140 149 50 444 140 445 5 100 139 138 139 138 323 148 140 583 573 325 148 140 583 573 326 148 140 583 573 327 148 140 583 573 328 148 140 583 573 324 148 140 332 573 329 148 140 330 575 331 148 140 333 575 159 334 51 140 141 575 160 335 51 140 141 575 161 336 51 140 141 575 337 51 140 141 575 338 51 140 141 575 339 51 140 141 575 340 51 140 141 575 341 51 140 141 575 342 51 140 141 575 343 51 140 141 575 344 51 140 141 575 345 51 140 141 575 346 51 140 141 575 347 51 140 141 575 348 51 140 141 575 162 349 51 140 141 575 163 350 51 140 141 575 164 351 51 140 141 575 156 565 51 140 584 573 157 352 51 140 585 573 158 353 51 140 585 573 165 354 51 140 141 575 166 355 51 140 141 575 167 357 51 140 141 575 168 356 51 140 141 575 169 358 51 140 141 575 170 359 51 140 141 575 171 360 51 140 457 576 172 361 51 140 141 575 601 324 51 140 141 575 311 362 51 140 141 575 305 308 51 140 586 573 173 363 51 140 141 575 309 310 51 140 141 575 312 364 51 140 141 575 313 365 51 140 141 575 314 366 51 140 141 575 306 307 51 140 586 573 315 367 51 140 586 573 174 368 51 140 141 175 369 51 140 587 573 176 177 51 140 587 573 178 370 51 140 587 573 179 371 51 140 587 573 180 372 51 140 587 573 181 373 51 140 141 182 375 382 140 588 573 376 382 140 588 573 377 382 140 588 573 378 382 140 588 573 379 382 140 588 573 380 382 140 588 573 381 382 140 588 573 381 51 140 141 183 383 51 140 141 184 384 51 140 141 185 385 51 140 141 186 386 51 140 141 387 331 51 140 589 573 187 388 51 140 588 573 188 389 51 140 588 573 189 390 51 140 588 573 190 391 51 140 141 191 392 374 140 141 192 393 51 140 141 193 394 382 140 141 194 395 51 140 141 195 396 374 140 141 196 397 374 140 141 197 398 374 140 141 198 399 374 140 141 199 400 374 140 141 200 401 374 140 141 201 402 374 140 141 202 403 374 140 141 203 404 374 140 141 204 405 374 140 141 205 406 51 140 141 206 407 51 140 141 207 408 51 140 141 208 409 51 140 141 209 410 51 140 141 210 411 51 140 141 211 412 51 140 141 212 413 51 140 141 213 414 51 140 141 214 415 51 140 141 215 416 51 140 141 216 417 51 140 141 217 418 51 140 419 147 420 597 320 421 51 140 590 566 567 150 113 51 140 141 321 114 382 140 590 147 141 567 322 115 51 140 590 566 567 151 435 51 140 141 152 436 51 140 141 424 429 51 140 141 425 430 51 140 141 426 431 51 140 440 568 439 438 51 140 440 568 427 432 51 140 141 153 428 51 140 141 154 434 51 140 141 155 437 51 140 141 423 433 51 140 441 218 442 51 140 441 219 458 51 140 441 220 459 51 140 441 221 460 51 140 441 222 461 51 140 441 223 462 51 140 441 224 463 51 140 441 225 464 51 140 441 226 465 51 140 441 227 466 51 140 441 316 467 51 140 441 317 468 51 140 441 318 469 51 140 441 319 470 51 140 441 228 471 51 140 441 229 472 51 140 441 230 473 51 140 441 536 540 51 140 441 231 474 51 140 441 232 475 51 140 441 233 476 51 140 441 234 477 51 140 441 235 478 51 140 591 5 569 236 479 51 140 141 237 480 51 140 141 238 101 51 140 141 239 102 51 140 141 240 103 51 140 141 241 104 51 140 141 242 105 51 140 141 243 106 51 140 141 244 107 51 140 141 245 108 51 140 141 246 109 51 140 141 247 481 382 140 141 248 482 382 140 141 249 483 382 140 141 250 484 382 140 141 251 485 382 140 141 252 486 382 140 141 253 487 382 140 141 254 89 382 140 141 255 488 382 140 141 256 90 382 140 141 257 489 382 140 141 258 92 382 140 141 259 490 382 140 141 260 491 382 140 141 261 492 382 140 141 262 493 382 140 141 263 494 382 140 141 264 495 382 140 141 265 496 382 140 141 266 498 497 570 267 499 382 140 141 268 500 382 140 141 269 501 382 140 141 270 502 382 140 141 271 503 382 140 141 272 504 382 140 141 273 505 382 140 141 274 96 382 140 141 275 97 382 140 141 276 506 382 140 141 277 98 382 140 141 278 507 51 140 592 569 279 508 51 140 592 569 280 509 382 140 141 281 510 382 140 141 282 511 382 140 141 283 512 382 140 141 537 541 382 140 141 538 542 382 140 141 539 543 382 140 141 284 513 382 140 141 285 514 382 140 141 286 515 382 140 141 287 516 382 140 141 288 517 382 140 141 289 518 382 140 141 290 519 51 140 141 291 520 51 140 141 292 521 51 140 141 293 522 51 140 141 294 524 51 140 591 571 295 525 51 140 591 571 296 526 51 140 141 297 527 51 140 141 298 528 51 140 141 299 529 51 140 141 300 530 51 140 141 301 531 51 140 141 302 532 51 140 141 303 533 51 140 534 304 110 51 140 535 10 11 12 18 139 138 139 138 52 51 140 141 53 51 140 141 74 51 140 141 54 51 140 141 75 51 140 141 55 51 140 141 556 51 140 141 56 51 140 141 57 51 140 141 58 51 140 141 76 51 140 141 59 51 140 141 60 51 140 141 61 51 140 141 62 51 140 141 63 51 140 141 64 51 140 141 65 51 140 141 77 51 140 141 66 51 140 141 67 51 140 141 78 140 141 68 140 141 79 51 140 141 80 51 140 141 69 51 140 141 81 51 140 141 70 51 140 141 82 51 140 141 71 51 140 141 72 51 140 141 72 51 140 141 73 51 140 141 83 557 140 593 598 84 51 140 593 598 85 51 140 593 598 86 51 140 593 598 87 51 140 593 598 555 51 140 141 88 557 593 598 21 22 139 138 139 138 113 51 140 141 114 51 140 141 115 51 140 141 13 139 138 139 138 110 382 140 141 111 112 14 139 138 139 138 101 382 140 141 102 382 140 141 103 382 140 141 104 382 140 141 105 382 140 141 106 382 140 141 107 382 140 141 108 382 140 141 109 382 140 141 15 5 16 558 51 140 593 598 559 51 140 593 598 560 51 140 593 598 561 564 140 593 598 562 564 140 593 598 563 564 140 593 598 5 17 89 422 90 91 92 93 94 95 374 140 594 598 96 97 98 5 523 595 599 600

6 9 99 139 138 139 138 146 118 51 140 145 147 141 119 51 140 145 147 141 120 51 140 145 147 141 121 51 140 145 147 141 117 51 140 577 147 141 572 5 122 51 140 577 147 141 572 123 51 140 578 147 141 596 124 51 140 578 147 141 596 125 51 140 578 147 141 596 126 51 140 578 147 141 596 127 51 140 578 147 141 596 5 128 51 140 578 147 141 596 129 51 140 443 147 141 596 130 51 140 579 147 141 596 131 51 142 141 147 141 132 51 142 141 147 141 133 51 142 141 147 141 134 51 142 141 147 141 135 51 142 141 147 141 136 51 142 141 147 141 137 51 142 141 147 141 19 139 138 139 138 23 51 140 141 147 141 24 51 140 141 147 141 143 144 140 141 147 141 25 51 140 141 147 141 26 51 140 141 147 141 27 51 140 141 147 141 28 51 140 141 147 141 29 51 140 141 147 141 30 51 140 141 147 141 31 148 140 580 147 141 32 51 140 580 147 141 33 51 140 141 147 141 34 51 140 141 147 141 35 51 140 141 147 141 36 51 140 141 147 141 37 51 140 141 147 141 38 51 140 141 147 141 39 51 140 141 147 141 20 139 138 139 138 40 41 42 43 51 140 581 573 44 45 51 140 581 573 46 47 51 140 582 574 48 49 51 140 582 574 446 544 444 140 453 545 444 140 454 546 444 140 455 547 444 140 456 548 444 140 447 549 444 140 448 550 444 140 449 551 444 140 450 552 444 140 451 553 444 140 452 554 444 140 149 50 444 140 445 5 100 139 138 139 138 323 148 140 583 573 325 148 140 583 573 326 148 140 583 573 327 148 140 583 573 328 148 140 583 573 324 148 140 332 573 329 148 140 330 575 331 148 140 333 575 159 334 51 140 141 575 160 335 51 140 141 575 161 336 51 140 141 575 337 51 140 141 575 338 51 140 141 575 339 51 140 141 575 340 51 140 141 575 341 51 140 141 575 342 51 140 141 575 343 51 140 141 575 344 51 140 141 575 345 51 140 141 575 346 51 140 141 575 347 51 140 141 575 348 51 140 141 575 162 349 51 140 141 575 163 350 51 140 141 575 164 351 51 140 141 575 156 565 51 140 584 573 157 352 51 140 585 573 158 353 51 140 585 573 165 354 51 140 141 575 166 355 51 140 141 575 167 357 51 140 141 575 168 356 51 140 141 575 169 358 51 140 141 575 170 359 51 140 141 575 171 360 51 140 457 576 172 361 51 140 141 575 601 324 51 140 141 575 311 362 51 140 141 575 305 308 51 140 586 573 173 363 51 140 141 575 309 310 51 140 141 575 312 364 51 140 141 575 313 365 51 140 141 575 314 366 51 140 141 575 306 307 51 140 586 573 315 367 51 140 586 573 174 368 51 140 141 175 369 51 140 587 573 176 177 51 140 587 573 178 370 51 140 587 573 179 371 51 140 587 573 180 372 51 140 587 573 181 373 51 140 141 182 375 382 140 588 573 376 382 140 588 573 377 382 140 588 573 378 382 140 588 573 379 382 140 588 573 380 382 140 588 573 381 382 140 588 573 381 51 140 141 183 383 51 140 141 184 384 51 140 141 185 385 51 140 141 186 386 51 140 141 387 331 51 140 589 573 187 388 51 140 588 573 188 389 51 140 588 573 189 390 51 140 588 573 190 391 51 140 141 191 392 374 140 141 192 393 51 140 141 193 394 382 140 141 194 395 51 140 141 195 396 374 140 141 196 397 374 140 141 197 398 374 140 141 198 399 374 140 141 199 400 374 140 141 200 401 374 140 141 201 402 374 140 141 202 403 374 140 141 203 404 374 140 141 204 405 374 140 141 205 406 51 140 141 206 407 51 140 141 207 408 51 140 141 208 409 51 140 141 209 410 51 140 141 210 411 51 140 141 211 412 51 140 141 212 413 51 140 141 213 414 51 140 141 214 415 51 140 141 215 416 51 140 141 216 417 51 140 141 217 418 51 140 419 147 420 597 320 421 51 140 590 566 567 150 113 51 140 141 321 114 382 140 590 147 141 567 322 115 51 140 590 566 567 151 435 51 140 141 152 436 51 140 141 424 429 51 140 141 425 430 51 140 141 426 431 51 140 440 568 439 438 51 140 440 568 427 432 51 140 141 153 428 51 140 141 154 434 51 140 141 155 437 51 140 141 423 433 51 140 441 218 442 51 140 441 219 458 51 140 441 220 459 51 140 441 221 460 51 140 441 222 461 51 140 441 223 462 51 140 441 224 463 51 140 441 225 464 51 140 441 226 465 51 140 441 227 466 51 140 441 316 467 51 140 441 317 468 51 140 441 318 469 51 140 441 319 470 51 140 441 228 471 51 140 441 229 472 51 140 441 230 473 51 140 441 536 540 51 140 441 231 474 51 140 441 232 475 51 140 441 233 476 51 140 441 234 477 51 140 441 235 478 51 140 591 5 569 236 479 51 140 141 237 480 51 140 141 238 101 51 140 141 239 102 51 140 141 240 103 51 140 141 241 104 51 140 141 242 105 51 140 141 243 106 51 140 141 244 107 51 140 141 245 108 51 140 141 246 109 51 140 141 247 481 382 140 141 248 482 382 140 141 249 483 382 140 141 250 484 382 140 141 251 485 382 140 141 252 486 382 140 141 253 487 382 140 141 254 89 382 140 141 255 488 382 140 141 256 90 382 140 141 257 489 382 140 141 258 92 382 140 141 259 490 382 140 141 260 491 382 140 141 261 492 382 140 141 262 493 382 140 141 263 494 382 140 141 264 495 382 140 141 265 496 382 140 141 266 498 497 570 267 499 382 140 141 268 500 382 140 141 269 501 382 140 141 270 502 382 140 141 271 503 382 140 141 272 504 382 140 141 273 505 382 140 141 274 96 382 140 141 275 97 382 140 141 276 506 382 140 141 277 98 382 140 141 278 507 51 140 592 569 279 508 51 140 592 569 280 509 382 140 141 281 510 382 140 141 282 511 382 140 141 283 512 382 140 141 537 541 382 140 141 538 542 382 140 141 539 543 382 140 141 284 513 382 140 141 285 514 382 140 141 286 515 382 140 141 287 516 382 140 141 288 517 382 140 141 289 518 382 140 141 290 519 51 140 141 291 520 51 140 141 292 521 51 140 141 293 522 51 140 141 294 524 51 140 591 571 295 525 51 140 591 571 296 526 51 140 141 297 527 51 140 141 298 528 51 140 141 299 529 51 140 141 300 530 51 140 141 301 531 51 140 141 302 532 51 140 141 303 533 51 140 534 304 110 51 140 535 10 11 12 18 139 138 139 138 52 51 140 141 53 51 140 141 74 51 140 141 54 51 140 141 75 51 140 141 55 51 140 141 556 51 140 141 56 51 140 141 57 51 140 141 58 51 140 141 76 51 140 141 59 51 140 141 60 51 140 141 61 51 140 141 62 51 140 141 63 51 140 141 64 51 140 141 65 51 140 141 77 51 140 141 66 51 140 141 67 51 140 141 78 140 141 68 140 141 79 51 140 141 80 51 140 141 69 51 140 141 81 51 140 141 70 51 140 141 82 51 140 141 71 51 140 141 72 51 140 141 72 51 140 141 73 51 140 141 83 557 140 593 598 84 51 140 593 598 85 51 140 593 598 86 51 140 593 598 87 51 140 593 598 555 51 140 141 88 557 593 598 21 22 139 138 139 138 113 51 140 141 114 51 140 141 115 51 140 141 13 139 138 139 138 110 382 140 141 111 112 14 139 138 139 138 101 382 140 141 102 382 140 141 103 382 140 141 104 382 140 141 105 382 140 141 106 382 140 141 107 382 140 141 108 382 140 141 109 382 140 141 15 5 16 558 51 140 593 598 559 51 140 593 598 560 51 140 593 598 561 564 140 593 598 562 564 140 593 598 563 564 140 593 598 5 17 89 422 90 91 92 93 94 95 374 140 594 598 96 97 98 5 523 595 599 600

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

6 9 99 139 138 139 138 146 118 51 140 145 147 141 119 51 140 145 147 141 120 51 140 145 147 141 121 51 140 145 147 141 117 51 140 577 147 141 572 5 122 51 140 577 147 141 572 123 51 140 578 147 141 596 124 51 140 578 147 141 596 125 51 140 578 147 141 596 126 51 140 578 147 141 596 127 51 140 578 147 141 596 5 128 51 140 578 147 141 596 129 51 140 443 147 141 596 130 51 140 579 147 141 596 131 51 142 141 147 141 132 51 142 141 147 141 133 51 142 141 147 141 134 51 142 141 147 141 135 51 142 141 147 141 136 51 142 141 147 141 137 51 142 141 147 141 19 139 138 139 138 23 51 140 141 147 141 24 51 140 141 147 141 143 144 140 141 147 141 25 51 140 141 147 141 26 51 140 141 147 141 27 51 140 141 147 141 28 51 140 141 147 141 29 51 140 141 147 141 30 51 140 141 147 141 31 148 140 580 147 141 32 51 140 580 147 141 33 51 140 141 147 141 34 51 140 141 147 141 35 51 140 141 147 141 36 51 140 141 147 141 37 51 140 141 147 141 38 51 140 141 147 141 39 51 140 141 147 141 20 139 138 139 138 40 41 42 43 51 140 581 573 44 45 51 140 581 573 46 47 51 140 582 574 48 49 51 140 582 574 446 544 444 140 453 545 444 140 454 546 444 140 455 547 444 140 456 548 444 140 447 549 444 140 448 550 444 140 449 551 444 140 450 552 444 140 451 553 444 140 452 554 444 140 149 50 444 140 445 5 100 139 138 139 138 323 148 140 583 573 325 148 140 583 573 326 148 140 583 573 327 148 140 583 573 328 148 140 583 573 324 148 140 332 573 329 148 140 330 575 331 148 140 333 575 159 334 51 140 141 575 160 335 51 140 141 575 161 336 51 140 141 575 337 51 140 141 575 338 51 140 141 575 339 51 140 141 575 340 51 140 141 575 341 51 140 141 575 342 51 140 141 575 343 51 140 141 575 344 51 140 141 575 345 51 140 141 575 346 51 140 141 575 347 51 140 141 575 348 51 140 141 575 162 349 51 140 141 575 163 350 51 140 141 575 164 351 51 140 141 575 156 565 51 140 584 573 157 352 51 140 585 573 158 353 51 140 585 573 165 354 51 140 141 575 166 355 51 140 141 575 167 357 51 140 141 575 168 356 51 140 141 575 169 358 51 140 141 575 170 359 51 140 141 575 171 360 51 140 457 576 172 361 51 140 141 575 601 324 51 140 141 575 311 362 51 140 141 575 305 308 51 140 586 573 173 363 51 140 141 575 309 310 51 140 141 575 312 364 51 140 141 575 313 365 51 140 141 575 314 366 51 140 141 575 306 307 51 140 586 573 315 367 51 140 586 573 174 368 51 140 141 175 369 51 140 587 573 176 177 51 140 587 573 178 370 51 140 587 573 179 371 51 140 587 573 180 372 51 140 587 573 181 373 51 140 141 182 375 382 140 588 573 376 382 140 588 573 377 382 140 588 573 378 382 140 588 573 379 382 140 588 573 380 382 140 588 573 381 382 140 588 573 381 51 140 141 183 383 51 140 141 184 384 51 140 141 185 385 51 140 141 186 386 51 140 141 387 331 51 140 589 573 187 388 51 140 588 573 188 389 51 140 588 573 189 390 51 140 588 573 190 391 51 140 141 191 392 374 140 141 192 393 51 140 141 193 394 382 140 141 194 395 51 140 141 195 396 374 140 141 196 397 374 140 141 197 398 374 140 141 198 399 374 140 141 199 400 374 140 141 200 401 374 140 141 201 402 374 140 141 202 403 374 140 141 203 404 374 140 141 204 405 374 140 141 205 406 51 140 141 206 407 51 140 141 207 408 51 140 141 208 409 51 140 141 209 410 51 140 141 210 411 51 140 141 211 412 51 140 141 212 413 51 140 141 213 414 51 140 141 214 415 51 140 141 215 416 51 140 141 216 417 51 140 141 217 418 51 140 419 147 420 597 320 421 51 140 590 566 567 150 113 51 140 141 321 114 382 140 590 147 141 567 322 115 51 140 590 566 567 151 435 51 140 141 152 436 51 140 141 424 429 51 140 141 425 430 51 140 141 426 431 51 140 440 568 439 438 51 140 440 568 427 432 51 140 141 153 428 51 140 141 154 434 51 140 141 155 437 51 140 141 423 433 51 140 441 218 442 51 140 441 219 458 51 140 441 220 459 51 140 441 221 460 51 140 441 222 461 51 140 441 223 462 51 140 441 224 463 51 140 441 225 464 51 140 441 226 465 51 140 441 227 466 51 140 441 316 467 51 140 441 317 468 51 140 441 318 469 51 140 441 319 470 51 140 441 228 471 51 140 441 229 472 51 140 441 230 473 51 140 441 536 540 51 140 441 231 474 51 140 441 232 475 51 140 441 233 476 51 140 441 234 477 51 140 441 235 478 51 140 591 5 569 236 479 51 140 141 237 480 51 140 141 238 101 51 140 141 239 102 51 140 141 240 103 51 140 141 241 104 51 140 141 242 105 51 140 141 243 106 51 140 141 244 107 51 140 141 245 108 51 140 141 246 109 51 140 141 247 481 382 140 141 248 482 382 140 141 249 483 382 140 141 250 484 382 140 141 251 485 382 140 141 252 486 382 140 141 253 487 382 140 141 254 89 382 140 141 255 488 382 140 141 256 90 382 140 141 257 489 382 140 141 258 92 382 140 141 259 490 382 140 141 260 491 382 140 141 261 492 382 140 141 262 493 382 140 141 263 494 382 140 141 264 495 382 140 141 265 496 382 140 141 266 498 497 570 267 499 382 140 141 268 500 382 140 141 269 501 382 140 141 270 502 382 140 141 271 503 382 140 141 272 504 382 140 141 273 505 382 140 141 274 96 382 140 141 275 97 382 140 141 276 506 382 140 141 277 98 382 140 141 278 507 51 140 592 569 279 508 51 140 592 569 280 509 382 140 141 281 510 382 140 141 282 511 382 140 141 283 512 382 140 141 537 541 382 140 141 538 542 382 140 141 539 543 382 140 141 284 513 382 140 141 285 514 382 140 141 286 515 382 140 141 287 516 382 140 141 288 517 382 140 141 289 518 382 140 141 290 519 51 140 141 291 520 51 140 141 292 521 51 140 141 293 522 51 140 141 294 524 51 140 591 571 295 525 51 140 591 571 296 526 51 140 141 297 527 51 140 141 298 528 51 140 141 299 529 51 140 141 300 530 51 140 141 301 531 51 140 141 302 532 51 140 141 303 533 51 140 534 304 110 51 140 535 10 11 12 18 139 138 139 138 52 51 140 141 53 51 140 141 74 51 140 141 54 51 140 141 75 51 140 141 55 51 140 141 556 51 140 141 56 51 140 141 57 51 140 141 58 51 140 141 76 51 140 141 59 51 140 141 60 51 140 141 61 51 140 141 62 51 140 141 63 51 140 141 64 51 140 141 65 51 140 141 77 51 140 141 66 51 140 141 67 51 140 141 78 140 141 68 140 141 79 51 140 141 80 51 140 141 69 51 140 141 81 51 140 141 70 51 140 141 82 51 140 141 71 51 140 141 72 51 140 141 72 51 140 141 73 51 140 141 83 557 140 593 598 84 51 140 593 598 85 51 140 593 598 86 51 140 593 598 87 51 140 593 598 555 51 140 141 88 557 593 598 21 22 139 138 139 138 113 51 140 141 114 51 140 141 115 51 140 141 13 139 138 139 138 110 382 140 141 111 112 14 139 138 139 138 101 382 140 141 102 382 140 141 103 382 140 141 104 382 140 141 105 382 140 141 106 382 140 141 107 382 140 141 108 382 140 141 109 382 140 141 15 5 16 558 51 140 593 598 559 51 140 593 598 560 51 140 593 598 561 564 140 593 598 562 564 140 593 598 563 564 140 593 598 5 17 89 422 90 91 92 93 94 95 374 140 594 598 96 97 98 5 523 595 599 600

6 9 99 139 138 139 138 146 118 51 140 145 147 141 119 51 140 145 147 141 120 51 140 145 147 141 121 51 140 145 147 141 117 51 140 577 147 141 572 5 122 51 140 577 147 141 572 123 51 140 578 147 141 596 124 51 140 578 147 141 596 125 51 140 578 147 141 596 126 51 140 578 147 141 596 127 51 140 578 147 141 596 5 128 51 140 578 147 141 596 129 51 140 443 147 141 596 130 51 140 579 147 141 596 131 51 142 141 147 141 132 51 142 141 147 141 133 51 142 141 147 141 134 51 142 141 147 141 135 51 142 141 147 141 136 51 142 141 147 141 137 51 142 141 147 141 19 139 138 139 138 23 51 140 141 147 141 24 51 140 141 147 141 143 144 140 141 147 141 25 51 140 141 147 141 26 51 140 141 147 141 27 51 140 141 147 141 28 51 140 141 147 141 29 51 140 141 147 141 30 51 140 141 147 141 31 148 140 580 147 141 32 51 140 580 147 141 33 51 140 141 147 141 34 51 140 141 147 141 35 51 140 141 147 141 36 51 140 141 147 141 37 51 140 141 147 141 38 51 140 141 147 141 39 51 140 141 147 141 20 139 138 139 138 40 41 42 43 51 140 581 573 44 45 51 140 581 573 46 47 51 140 582 574 48 49 51 140 582 574 446 544 444 140 453 545 444 140 454 546 444 140 455 547 444 140 456 548 444 140 447 549 444 140 448 550 444 140 449 551 444 140 450 552 444 140 451 553 444 140 452 554 444 140 149 50 444 140 445 5 100 139 138 139 138 323 148 140 583 573 325 148 140 583 573 326 148 140 583 573 327 148 140 583 573 328 148 140 583 573 324 148 140 332 573 329 148 140 330 575 331 148 140 333 575 159 334 51 140 141 575 160 335 51 140 141 575 161 336 51 140 141 575 337 51 140 141 575 338 51 140 141 575 339 51 140 141 575 340 51 140 141 575 341 51 140 141 575 342 51 140 141 575 343 51 140 141 575 344 51 140 141 575 345 51 140 141 575 346 51 140 141 575 347 51 140 141 575 348 51 140 141 575 162 349 51 140 141 575 163 350 51 140 141 575 164 351 51 140 141 575 156 565 51 140 584 573 157 352 51 140 585 573 158 353 51 140 585 573 165 354 51 140 141 575 166 355 51 140 141 575 167 357 51 140 141 575 168 356 51 140 141 575 169 358 51 140 141 575 170 359 51 140 141 575 171 360 51 140 457 576 172 361 51 140 141 575 601 324 51 140 141 575 311 362 51 140 141 575 305 308 51 140 586 573 173 363 51 140 141 575 309 310 51 140 141 575 312 364 51 140 141 575 313 365 51 140 141 575 314 366 51 140 141 575 306 307 51 140 586 573 315 367 51 140 586 573 174 368 51 140 141 175 369 51 140 587 573 176 177 51 140 587 573 178 370 51 140 587 573 179 371 51 140 587 573 180 372 51 140 587 573 181 373 51 140 141 182 375 382 140 588 573 376 382 140 588 573 377 382 140 588 573 378 382 140 588 573 379 382 140 588 573 380 382 140 588 573 381 382 140 588 573 381 51 140 141 183 383 51 140 141 184 384 51 140 141 185 385 51 140 141 186 386 51 140 141 387 331 51 140 589 573 187 388 51 140 588 573 188 389 51 140 588 573 189 390 51 140 588 573 190 391 51 140 141 191 392 374 140 141 192 393 51 140 141 193 394 382 140 141 194 395 51 140 141 195 396 374 140 141 196 397 374 140 141 197 398 374 140 141 198 399 374 140 141 199 400 374 140 141 200 401 374 140 141 201 402 374 140 141 202 403 374 140 141 203 404 374 140 141 204 405 374 140 141 205 406 51 140 141 206 407 51 140 141 207 408 51 140 141 208 409 51 140 141 209 410 51 140 141 210 411 51 140 141 211 412 51 140 141 212 413 51 140 141 213 414 51 140 141 214 415 51 140 141 215 416 51 140 141 216 417 51 140 141 217 418 51 140 419 147 420 597 320 421 51 140 590 566 567 150 113 51 140 141 321 114 382 140 590 147 141 567 322 115 51 140 590 566 567 151 435 51 140 141 152 436 51 140 141 424 429 51 140 141 425 430 51 140 141 426 431 51 140 440 568 439 438 51 140 440 568 427 432 51 140 141 153 428 51 140 141 154 434 51 140 141 155 437 51 140 141 423 433 51 140 441 218 442 51 140 441 219 458 51 140 441 220 459 51 140 441 221 460 51 140 441 222 461 51 140 441 223 462 51 140 441 224 463 51 140 441 225 464 51 140 441 226 465 51 140 441 227 466 51 140 441 316 467 51 140 441 317 468 51 140 441 318 469 51 140 441 319 470 51 140 441 228 471 51 140 441 229 472 51 140 441 230 473 51 140 441 536 540 51 140 441 231 474 51 140 441 232 475 51 140 441 233 476 51 140 441 234 477 51 140 441 235 478 51 140 591 5 569 236 479 51 140 141 237 480 51 140 141 238 101 51 140 141 239 102 51 140 141 240 103 51 140 141 241 104 51 140 141 242 105 51 140 141 243 106 51 140 141 244 107 51 140 141 245 108 51 140 141 246 109 51 140 141 247 481 382 140 141 248 482 382 140 141 249 483 382 140 141 250 484 382 140 141 251 485 382 140 141 252 486 382 140 141 253 487 382 140 141 254 89 382 140 141 255 488 382 140 141 256 90 382 140 141 257 489 382 140 141 258 92 382 140 141 259 490 382 140 141 260 491 382 140 141 261 492 382 140 141 262 493 382 140 141 263 494 382 140 141 264 495 382 140 141 265 496 382 140 141 266 498 497 570 267 499 382 140 141 268 500 382 140 141 269 501 382 140 141 270 502 382 140 141 271 503 382 140 141 272 504 382 140 141 273 505 382 140 141 274 96 382 140 141 275 97 382 140 141 276 506 382 140 141 277 98 382 140 141 278 507 51 140 592 569 279 508 51 140 592 569 280 509 382 140 141 281 510 382 140 141 282 511 382 140 141 283 512 382 140 141 537 541 382 140 141 538 542 382 140 141 539 543 382 140 141 284 513 382 140 141 285 514 382 140 141 286 515 382 140 141 287 516 382 140 141 288 517 382 140 141 289 518 382 140 141 290 519 51 140 141 291 520 51 140 141 292 521 51 140 141 293 522 51 140 141 294 524 51 140 591 571 295 525 51 140 591 571 296 526 51 140 141 297 527 51 140 141 298 528 51 140 141 299 529 51 140 141 300 530 51 140 141 301 531 51 140 141 302 532 51 140 141 303 533 51 140 534 304 110 51 140 535 10 11 12 18 139 138 139 138 52 51 140 141 53 51 140 141 74 51 140 141 54 51 140 141 75 51 140 141 55 51 140 141 556 51 140 141 56 51 140 141 57 51 140 141 58 51 140 141 76 51 140 141 59 51 140 141 60 51 140 141 61 51 140 141 62 51 140 141 63 51 140 141 64 51 140 141 65 51 140 141 77 51 140 141 66 51 140 141 67 51 140 141 78 140 141 68 140 141 79 51 140 141 80 51 140 141 69 51 140 141 81 51 140 141 70 51 140 141 82 51 140 141 71 51 140 141 72 51 140 141 72 51 140 141 73 51 140 141 83 557 140 593 598 84 51 140 593 598 85 51 140 593 598 86 51 140 593 598 87 51 140 593 598 555 51 140 141 88 557 593 598 21 22 139 138 139 138 113 51 140 141 114 51 140 141 115 51 140 141 13 139 138 139 138 110 382 140 141 111 112 14 139 138 139 138 101 382 140 141 102 382 140 141 103 382 140 141 104 382 140 141 105 382 140 141 106 382 140 141 107 382 140 141 108 382 140 141 109 382 140 141 15 5 16 558 51 140 593 598 559 51 140 593 598 560 51 140 593 598 561 564 140 593 598 562 564 140 593 598 563 564 140 593 598 5 17 89 422 90 91 92 93 94 95 374 140 594 598 96 97 98 5 523 595 599 600

6 9 99 139 138 139 138 146 118 51 140 145 147 141 119 51 140 145 147 141 120 51 140 145 147 141 121 51 140 145 147 141 117 51 140 577 147 141 572 5 122 51 140 577 147 141 572 123 51 140 578 147 141 596 124 51 140 578 147 141 596 125 51 140 578 147 141 596 126 51 140 578 147 141 596 127 51 140 578 147 141 596 5 128 51 140 578 147 141 596 129 51 140 443 147 141 596 130 51 140 579 147 141 596 131 51 142 141 147 141 132 51 142 141 147 141 133 51 142 141 147 141 134 51 142 141 147 141 135 51 142 141 147 141 136 51 142 141 147 141 137 51 142 141 147 141 19 139 138 139 138 23 51 140 141 147 141 24 51 140 141 147 141 143 144 140 141 147 141 25 51 140 141 147 141 26 51 140 141 147 141 27 51 140 141 147 141 28 51 140 141 147 141 29 51 140 141 147 141 30 51 140 141 147 141 31 148 140 580 147 141 32 51 140 580 147 141 33 51 140 141 147 141 34 51 140 141 147 141 35 51 140 141 147 141 36 51 140 141 147 141 37 51 140 141 147 141 38 51 140 141 147 141 39 51 140 141 147 141 20 139 138 139 138 40 41 42 43 51 140 581 573 44 45 51 140 581 573 46 47 51 140 582 574 48 49 51 140 582 574 446 544 444 140 453 545 444 140 454 546 444 140 455 547 444 140 456 548 444 140 447 549 444 140 448 550 444 140 449 551 444 140 450 552 444 140 451 553 444 140 452 554 444 140 149 50 444 140 445 5 100 139 138 139 138 323 148 140 583 573 325 148 140 583 573 326 148 140 583 573 327 148 140 583 573 328 148 140 583 573 324 148 140 332 573 329 148 140 330 575 331 148 140 333 575 159 334 51 140 141 575 160 335 51 140 141 575 161 336 51 140 141 575 337 51 140 141 575 338 51 140 141 575 339 51 140 141 575 340 51 140 141 575 341 51 140 141 575 342 51 140 141 575 343 51 140 141 575 344 51 140 141 575 345 51 140 141 575 346 51 140 141 575 347 51 140 141 575 348 51 140 141 575 162 349 51 140 141 575 163 350 51 140 141 575 164 351 51 140 141 575 156 565 51 140 584 573 157 352 51 140 585 573 158 353 51 140 585 573 165 354 51 140 141 575 166 355 51 140 141 575 167 357 51 140 141 575 168 356 51 140 141 575 169 358 51 140 141 575 170 359 51 140 141 575 171 360 51 140 457 576 172 361 51 140 141 575 601 324 51 140 141 575 311 362 51 140 141 575 305 308 51 140 586 573 173 363 51 140 141 575 309 310 51 140 141 575 312 364 51 140 141 575 313 365 51 140 141 575 314 366 51 140 141 575 306 307 51 140 586 573 315 367 51 140 586 573 174 368 51 140 141 175 369 51 140 587 573 176 177 51 140 587 573 178 370 51 140 587 573 179 371 51 140 587 573 180 372 51 140 587 573 181 373 51 140 141 182 375 382 140 588 573 376 382 140 588 573 377 382 140 588 573 378 382 140 588 573 379 382 140 588 573 380 382 140 588 573 381 382 140 588 573 381 51 140 141 183 383 51 140 141 184 384 51 140 141 185 385 51 140 141 186 386 51 140 141 387 331 51 140 589 573 187 388 51 140 588 573 188 389 51 140 588 573 189 390 51 140 588 573 190 391 51 140 141 191 392 374 140 141 192 393 51 140 141 193 394 382 140 141 194 395 51 140 141 195 396 374 140 141 196 397 374 140 141 197 398 374 140 141 198 399 374 140 141 199 400 374 140 141 200 401 374 140 141 201 402 374 140 141 202 403 374 140 141 203 404 374 140 141 204 405 374 140 141 205 406 51 140 141 206 407 51 140 141 207 408 51 140 141 208 409 51 140 141 209 410 51 140 141 210 411 51 140 141 211 412 51 140 141 212 413 51 140 141 213 414 51 140 141 214 415 51 140 141 215 416 51 140 141 216 417 51 140 141 217 418 51 140 419 147 420 597 320 421 51 140 590 566 567 150 113 51 140 141 321 114 382 140 590 147 141 567 322 115 51 140 590 566 567 151 435 51 140 141 152 436 51 140 141 424 429 51 140 141 425 430 51 140 141 426 431 51 140 440 568 439 438 51 140 440 568 427 432 51 140 141 153 428 51 140 141 154 434 51 140 141 155 437 51 140 141 423 433 51 140 441 218 442 51 140 441 219 458 51 140 441 220 459 51 140 441 221 460 51 140 441 222 461 51 140 441 223 462 51 140 441 224 463 51 140 441 225 464 51 140 441 226 465 51 140 441 227 466 51 140 441 316 467 51 140 441 317 468 51 140 441 318 469 51 140 441 319 470 51 140 441 228 471 51 140 441 229 472 51 140 441 230 473 51 140 441 536 540 51 140 441 231 474 51 140 441 232 475 51 140 441 233 476 51 140 441 234 477 51 140 441 235 478 51 140 591 5 569 236 479 51 140 141 237 480 51 140 141 238 101 51 140 141 239 102 51 140 141 240 103 51 140 141 241 104 51 140 141 242 105 51 140 141 243 106 51 140 141 244 107 51 140 141 245 108 51 140 141 246 109 51 140 141 247 481 382 140 141 248 482 382 140 141 249 483 382 140 141 250 484 382 140 141 251 485 382 140 141 252 486 382 140 141 253 487 382 140 141 254 89 382 140 141 255 488 382 140 141 256 90 382 140 141 257 489 382 140 141 258 92 382 140 141 259 490 382 140 141 260 491 382 140 141 261 492 382 140 141 262 493 382 140 141 263 494 382 140 141 264 495 382 140 141 265 496 382 140 141 266 498 497 570 267 499 382 140 141 268 500 382 140 141 269 501 382 140 141 270 502 382 140 141 271 503 382 140 141 272 504 382 140 141 273 505 382 140 141 274 96 382 140 141 275 97 382 140 141 276 506 382 140 141 277 98 382 140 141 278 507 51 140 592 569 279 508 51 140 592 569 280 509 382 140 141 281 510 382 140 141 282 511 382 140 141 283 512 382 140 141 537 541 382 140 141 538 542 382 140 141 539 543 382 140 141 284 513 382 140 141 285 514 382 140 141 286 515 382 140 141 287 516 382 140 141 288 517 382 140 141 289 518 382 140 141 290 519 51 140 141 291 520 51 140 141 292 521 51 140 141 293 522 51 140 141 294 524 51 140 591 571 295 525 51 140 591 571 296 526 51 140 141 297 527 51 140 141 298 528 51 140 141 299 529 51 140 141 300 530 51 140 141 301 531 51 140 141 302 532 51 140 141 303 533 51 140 534 304 110 51 140 535 10 11 12 18 139 138 139 138 52 51 140 141 53 51 140 141 74 51 140 141 54 51 140 141 75 51 140 141 55 51 140 141 556 51 140 141 56 51 140 141 57 51 140 141 58 51 140 141 76 51 140 141 59 51 140 141 60 51 140 141 61 51 140 141 62 51 140 141 63 51 140 141 64 51 140 141 65 51 140 141 77 51 140 141 66 51 140 141 67 51 140 141 78 140 141 68 140 141 79 51 140 141 80 51 140 141 69 51 140 141 81 51 140 141 70 51 140 141 82 51 140 141 71 51 140 141 72 51 140 141 72 51 140 141 73 51 140 141 83 557 140 593 598 84 51 140 593 598 85 51 140 593 598 86 51 140 593 598 87 51 140 593 598 555 51 140 141 88 557 593 598 21 22 139 138 139 138 113 51 140 141 114 51 140 141 115 51 140 141 13 139 138 139 138 110 382 140 141 111 112 14 139 138 139 138 101 382 140 141 102 382 140 141 103 382 140 141 104 382 140 141 105 382 140 141 106 382 140 141 107 382 140 141 108 382 140 141 109 382 140 141 15 5 16 558 51 140 593 598 559 51 140 593 598 560 51 140 593 598 561 564 140 593 598 562 564 140 593 598 563 564 140 593 598 5 17 89 422 90 91 92 93 94 95 374 140 594 598 96 97 98 5 523 595 599 600

6 9 99 139 138 139 138 146 118 51 140 145 147 141 119 51 140 145 147 141 120 51 140 145 147 141 121 51 140 145 147 141 117 51 140 577 147 141 572 5 122 51 140 577 147 141 572 123 51 140 578 147 141 596 124 51 140 578 147 141 596 125 51 140 578 147 141 596 126 51 140 578 147 141 596 127 51 140 578 147 141 596 5 128 51 140 578 147 141 596 129 51 140 443 147 141 596 130 51 140 579 147 141 596 131 51 142 141 147 141 132 51 142 141 147 141 133 51 142 141 147 141 134 51 142 141 147 141 135 51 142 141 147 141 136 51 142 141 147 141 137 51 142 141 147 141 19 139 138 139 138 23 51 140 141 147 141 24 51 140 141 147 141 143 144 140 141 147 141 25 51 140 141 147 141 26 51 140 141 147 141 27 51 140 141 147 141 28 51 140 141 147 141 29 51 140 141 147 141 30 51 140 141 147 141 31 148 140 580 147 141 32 51 140 580 147 141 33 51 140 141 147 141 34 51 140 141 147 141 35 51 140 141 147 141 36 51 140 141 147 141 37 51 140 141 147 141 38 51 140 141 147 141 39 51 140 141 147 141 20 139 138 139 138 40 41 42 43 51 140 581 573 44 45 51 140 581 573 46 47 51 140 582 574 48 49 51 140 582 574 446 544 444 140 453 545 444 140 454 546 444 140 455 547 444 140 456 548 444 140 447 549 444 140 448 550 444 140 449 551 444 140 450 552 444 140 451 553 444 140 452 554 444 140 149 50 444 140 445 5 100 139 138 139 138 323 148 140 583 573 325 148 140 583 573 326 148 140 583 573 327 148 140 583 573 328 148 140 583 573 324 148 140 332 573 329 148 140 330 575 331 148 140 333 575 159 334 51 140 141 575 160 335 51 140 141 575 161 336 51 140 141 575 337 51 140 141 575 338 51 140 141 575 339 51 140 141 575 340 51 140 141 575 341 51 140 141 575 342 51 140 141 575 343 51 140 141 575 344 51 140 141 575 345 51 140 141 575 346 51 140 141 575 347 51 140 141 575 348 51 140 141 575 162 349 51 140 141 575 163 350 51 140 141 575 164 351 51 140 141 575 156 565 51 140 584 573 157 352 51 140 585 573 158 353 51 140 585 573 165 354 51 140 141 575 166 355 51 140 141 575 167 357 51 140 141 575 168 356 51 140 141 575 169 358 51 140 141 575 170 359 51 140 141 575 171 360 51 140 457 576 172 361 51 140 141 575 601 324 51 140 141 575 311 362 51 140 141 575 305 308 51 140 586 573 173 363 51 140 141 575 309 310 51 140 141 575 312 364 51 140 141 575 313 365 51 140 141 575 314 366 51 140 141 575 306 307 51 140 586 573 315 367 51 140 586 573 174 368 51 140 141 175 369 51 140 587 573 176 177 51 140 587 573 178 370 51 140 587 573 179 371 51 140 587 573 180 372 51 140 587 573 181 373 51 140 141 182 375 382 140 588 573 376 382 140 588 573 377 382 140 588 573 378 382 140 588 573 379 382 140 588 573 380 382 140 588 573 381 382 140 588 573 381 51 140 141 183 383 51 140 141 184 384 51 140 141 185 385 51 140 141 186 386 51 140 141 387 331 51 140 589 573 187 388 51 140 588 573 188 389 51 140 588 573 189 390 51 140 588 573 190 391 51 140 141 191 392 374 140 141 192 393 51 140 141 193 394 382 140 141 194 395 51 140 141 195 396 374 140 141 196 397 374 140 141 197 398 374 140 141 198 399 374 140 141 199 400 374 140 141 200 401 374 140 141 201 402 374 140 141 202 403 374 140 141 203 404 374 140 141 204 405 374 140 141 205 406 51 140 141 206 407 51 140 141 207 408 51 140 141 208 409 51 140 141 209 410 51 140 141 210 411 51 140 141 211 412 51 140 141 212 413 51 140 141 213 414 51 140 141 214 415 51 140 141 215 416 51 140 141 216 417 51 140 141 217 418 51 140 419 147 420 597 320 421 51 140 590 566 567 150 113 51 140 141 321 114 382 140 590 147 141 567 322 115 51 140 590 566 567 151 435 51 140 141 152 436 51 140 141 424 429 51 140 141 425 430 51 140 141 426 431 51 140 440 568 439 438 51 140 440 568 427 432 51 140 141 153 428 51 140 141 154 434 51 140 141 155 437 51 140 141 423 433 51 140 441 218 442 51 140 441 219 458 51 140 441 220 459 51 140 441 221 460 51 140 441 222 461 51 140 441 223 462 51 140 441 224 463 51 140 441 225 464 51 140 441 226 465 51 140 441 227 466 51 140 441 316 467 51 140 441 317 468 51 140 441 318 469 51 140 441 319 470 51 140 441 228 471 51 140 441 229 472 51 140 441 230 473 51 140 441 536 540 51 140 441 231 474 51 140 441 232 475 51 140 441 233 476 51 140 441 234 477 51 140 441 235 478 51 140 591 5 569 236 479 51 140 141 237 480 51 140 141 238 101 51 140 141 239 102 51 140 141 240 103 51 140 141 241 104 51 140 141 242 105 51 140 141 243 106 51 140 141 244 107 51 140 141 245 108 51 140 141 246 109 51 140 141 247 481 382 140 141 248 482 382 140 141 249 483 382 140 141 250 484 382 140 141 251 485 382 140 141 252 486 382 140 141 253 487 382 140 141 254 89 382 140 141 255 488 382 140 141 256 90 382 140 141 257 489 382 140 141 258 92 382 140 141 259 490 382 140 141 260 491 382 140 141 261 492 382 140 141 262 493 382 140 141 263 494 382 140 141 264 495 382 140 141 265 496 382 140 141 266 498 497 570 267 499 382 140 141 268 500 382 140 141 269 501 382 140 141 270 502 382 140 141 271 503 382 140 141 272 504 382 140 141 273 505 382 140 141 274 96 382 140 141 275 97 382 140 141 276 506 382 140 141 277 98 382 140 141 278 507 51 140 592 569 279 508 51 140 592 569 280 509 382 140 141 281 510 382 140 141 282 511 382 140 141 283 512 382 140 141 537 541 382 140 141 538 542 382 140 141 539 543 382 140 141 284 513 382 140 141 285 514 382 140 141 286 515 382 140 141 287 516 382 140 141 288 517 382 140 141 289 518 382 140 141 290 519 51 140 141 291 520 51 140 141 292 521 51 140 141 293 522 51 140 141 294 524 51 140 591 571 295 525 51 140 591 571 296 526 51 140 141 297 527 51 140 141 298 528 51 140 141 299 529 51 140 141 300 530 51 140 141 301 531 51 140 141 302 532 51 140 141 303 533 51 140 534 304 110 51 140 535 10 11 12 18 139 138 139 138 52 51 140 141 53 51 140 141 74 51 140 141 54 51 140 141 75 51 140 141 55 51 140 141 556 51 140 141 56 51 140 141 57 51 140 141 58 51 140 141 76 51 140 141 59 51 140 141 60 51 140 141 61 51 140 141 62 51 140 141 63 51 140 141 64 51 140 141 65 51 140 141 77 51 140 141 66 51 140 141 67 51 140 141 78 140 141 68 140 141 79 51 140 141 80 51 140 141 69 51 140 141 81 51 140 141 70 51 140 141 82 51 140 141 71 51 140 141 72 51 140 141 72 51 140 141 73 51 140 141 83 557 140 593 598 84 51 140 593 598 85 51 140 593 598 86 51 140 593 598 87 51 140 593 598 555 51 140 141 88 557 593 598 21 22 139 138 139 138 113 51 140 141 114 51 140 141 115 51 140 141 13 139 138 139 138 110 382 140 141 111 112 14 139 138 139 138 101 382 140 141 102 382 140 141 103 382 140 141 104 382 140 141 105 382 140 141 106 382 140 141 107 382 140 141 108 382 140 141 109 382 140 141 15 5 16 558 51 140 593 598 559 51 140 593 598 560 51 140 593 598 561 564 140 593 598 562 564 140 593 598 563 564 140 593 598 5 17 89 422 90 91 92 93 94 95 374 140 594 598 96 97 98 5 523 595 599 600

6 9 99 139 138 139 138 146 118 51 140 145 147 141 119 51 140 145 147 141 120 51 140 145 147 141 121 51 140 145 147 141 117 51 140 577 147 141 572 5 122 51 140 577 147 141 572 123 51 140 578 147 141 596 124 51 140 578 147 141 596 125 51 140 578 147 141 596 126 51 140 578 147 141 596 127 51 140 578 147 141 596 5 128 51 140 578 147 141 596 129 51 140 443 147 141 596 130 51 140 579 147 141 596 131 51 142 141 147 141 132 51 142 141 147 141 133 51 142 141 147 141 134 51 142 141 147 141 135 51 142 141 147 141 136 51 142 141 147 141 137 51 142 141 147 141 19 139 138 139 138 23 51 140 141 147 141 24 51 140 141 147 141 143 144 140 141 147 141 25 51 140 141 147 141 26 51 140 141 147 141 27 51 140 141 147 141 28 51 140 141 147 141 29 51 140 141 147 141 30 51 140 141 147 141 31 148 140 580 147 141 32 51 140 580 147 141 33 51 140 141 147 141 34 51 140 141 147 141 35 51 140 141 147 141 36 51 140 141 147 141 37 51 140 141 147 141 38 51 140 141 147 141 39 51 140 141 147 141 20 139 138 139 138 40 41 42 43 51 140 581 573 44 45 51 140 581 573 46 47 51 140 582 574 48 49 51 140 582 574 446 544 444 140 453 545 444 140 454 546 444 140 455 547 444 140 456 548 444 140 447 549 444 140 448 550 444 140 449 551 444 140 450 552 444 140 451 553 444 140 452 554 444 140 149 50 444 140 445 5 100 139 138 139 138 323 148 140 583 573 325 148 140 583 573 326 148 140 583 573 327 148 140 583 573 328 148 140 583 573 324 148 140 332 573 329 148 140 330 575 331 148 140 333 575 159 334 51 140 141 575 160 335 51 140 141 575 161 336 51 140 141 575 337 51 140 141 575 338 51 140 141 575 339 51 140 141 575 340 51 140 141 575 341 51 140 141 575 342 51 140 141 575 343 51 140 141 575 344 51 140 141 575 345 51 140 141 575 346 51 140 141 575 347 51 140 141 575 348 51 140 141 575 162 349 51 140 141 575 163 350 51 140 141 575 164 351 51 140 141 575 156 565 51 140 584 573 157 352 51 140 585 573 158 353 51 140 585 573 165 354 51 140 141 575 166 355 51 140 141 575 167 357 51 140 141 575 168 356 51 140 141 575 169 358 51 140 141 575 170 359 51 140 141 575 171 360 51 140 457 576 172 361 51 140 141 575 601 324 51 140 141 575 311 362 51 140 141 575 305 308 51 140 586 573 173 363 51 140 141 575 309 310 51 140 141 575 312 364 51 140 141 575 313 365 51 140 141 575 314 366 51 140 141 575 306 307 51 140 586 573 315 367 51 140 586 573 174 368 51 140 141 175 369 51 140 587 573 176 177 51 140 587 573 178 370 51 140 587 573 179 371 51 140 587 573 180 372 51 140 587 573 181 373 51 140 141 182 375 382 140 588 573 376 382 140 588 573 377 382 140 588 573 378 382 140 588 573 379 382 140 588 573 380 382 140 588 573 381 382 140 588 573 381 51 140 141 183 383 51 140 141 184 384 51 140 141 185 385 51 140 141 186 386 51 140 141 387 331 51 140 589 573 187 388 51 140 588 573 188 389 51 140 588 573 189 390 51 140 588 573 190 391 51 140 141 191 392 374 140 141 192 393 51 140 141 193 394 382 140 141 194 395 51 140 141 195 396 374 140 141 196 397 374 140 141 197 398 374 140 141 198 399 374 140 141 199 400 374 140 141 200 401 374 140 141 201 402 374 140 141 202 403 374 140 141 203 404 374 140 141 204 405 374 140 141 205 406 51 140 141 206 407 51 140 141 207 408 51 140 141 208 409 51 140 141 209 410 51 140 141 210 411 51 140 141 211 412 51 140 141 212 413 51 140 141 213 414 51 140 141 214 415 51 140 141 215 416 51 140 141 216 417 51 140 141 217 418 51 140 419 147 420 597 320 421 51 140 590 566 567 150 113 51 140 141 321 114 382 140 590 147 141 567 322 115 51 140 590 566 567 151 435 51 140 141 152 436 51 140 141 424 429 51 140 141 425 430 51 140 141 426 431 51 140 440 568 439 438 51 140 440 568 427 432 51 140 141 153 428 51 140 141 154 434 51 140 141 155 437 51 140 141 423 433 51 140 441 218 442 51 140 441 219 458 51 140 441 220 459 51 140 441 221 460 51 140 441 222 461 51 140 441 223 462 51 140 441 224 463 51 140 441 225 464 51 140 441 226 465 51 140 441 227 466 51 140 441 316 467 51 140 441 317 468 51 140 441 318 469 51 140 441 319 470 51 140 441 228 471 51 140 441 229 472 51 140 441 230 473 51 140 441 536 540 51 140 441 231 474 51 140 441 232 475 51 140 441 233 476 51 140 441 234 477 51 140 441 235 478 51 140 591 5 569 236 479 51 140 141 237 480 51 140 141 238 101 51 140 141 239 102 51 140 141 240 103 51 140 141 241 104 51 140 141 242 105 51 140 141 243 106 51 140 141 244 107 51 140 141 245 108 51 140 141 246 109 51 140 141 247 481 382 140 141 248 482 382 140 141 249 483 382 140 141 250 484 382 140 141 251 485 382 140 141 252 486 382 140 141 253 487 382 140 141 254 89 382 140 141 255 488 382 140 141 256 90 382 140 141 257 489 382 140 141 258 92 382 140 141 259 490 382 140 141 260 491 382 140 141 261 492 382 140 141 262 493 382 140 141 263 494 382 140 141 264 495 382 140 141 265 496 382 140 141 266 498 497 570 267 499 382 140 141 268 500 382 140 141 269 501 382 140 141 270 502 382 140 141 271 503 382 140 141 272 504 382 140 141 273 505 382 140 141 274 96 382 140 141 275 97 382 140 141 276 506 382 140 141 277 98 382 140 141 278 507 51 140 592 569 279 508 51 140 592 569 280 509 382 140 141 281 510 382 140 141 282 511 382 140 141 283 512 382 140 141 537 541 382 140 141 538 542 382 140 141 539 543 382 140 141 284 513 382 140 141 285 514 382 140 141 286 515 382 140 141 287 516 382 140 141 288 517 382 140 141 289 518 382 140 141 290 519 51 140 141 291 520 51 140 141 292 521 51 140 141 293 522 51 140 141 294 524 51 140 591 571 295 525 51 140 591 571 296 526 51 140 141 297 527 51 140 141 298 528 51 140 141 299 529 51 140 141 300 530 51 140 141 301 531 51 140 141 302 532 51 140 141 303 533 51 140 534 304 110 51 140 535 10 11 12 18 139 138 139 138 52 51 140 141 53 51 140 141 74 51 140 141 54 51 140 141 75 51 140 141 55 51 140 141 556 51 140 141 56 51 140 141 57 51 140 141 58 51 140 141 76 51 140 141 59 51 140 141 60 51 140 141 61 51 140 141 62 51 140 141 63 51 140 141 64 51 140 141 65 51 140 141 77 51 140 141 66 51 140 141 67 51 140 141 78 140 141 68 140 141 79 51 140 141 80 51 140 141 69 51 140 141 81 51 140 141 70 51 140 141 82 51 140 141 71 51 140 141 72 51 140 141 72 51 140 141 73 51 140 141 83 557 140 593 598 84 51 140 593 598 85 51 140 593 598 86 51 140 593 598 87 51 140 593 598 555 51 140 141 88 557 593 598 21 22 139 138 139 138 113 51 140 141 114 51 140 141 115 51 140 141 13 139 138 139 138 110 382 140 141 111 112 14 139 138 139 138 101 382 140 141 102 382 140 141 103 382 140 141 104 382 140 141 105 382 140 141 106 382 140 141 107 382 140 141 108 382 140 141 109 382 140 141 15 5 16 558 51 140 593 598 559 51 140 593 598 560 51 140 593 598 561 564 140 593 598 562 564 140 593 598 563 564 140 593 598 5 17 89 422 90 91 92 93 94 95 374 140 594 598 96 97 98 5 523 595 599 600

6 9 99 139 138 139 138 146 118 51 140 145 147 141 119 51 140 145 147 141 120 51 140 145 147 141 121 51 140 145 147 141 117 51 140 577 147 141 572 5 122 51 140 577 147 141 572 123 51 140 578 147 141 596 124 51 140 578 147 141 596 125 51 140 578 147 141 596 126 51 140 578 147 141 596 127 51 140 578 147 141 596 5 128 51 140 578 147 141 596 129 51 140 443 147 141 596 130 51 140 579 147 141 596 131 51 142 141 147 141 132 51 142 141 147 141 133 51 142 141 147 141 134 51 142 141 147 141 135 51 142 141 147 141 136 51 142 141 147 141 137 51 142 141 147 141 19 139 138 139 138 23 51 140 141 147 141 24 51 140 141 147 141 143 144 140 141 147 141 25 51 140 141 147 141 26 51 140 141 147 141 27 51 140 141 147 141 28 51 140 141 147 141 29 51 140 141 147 141 30 51 140 141 147 141 31 148 140 580 147 141 32 51 140 580 147 141 33 51 140 141 147 141 34 51 140 141 147 141 35 51 140 141 147 141 36 51 140 141 147 141 37 51 140 141 147 141 38 51 140 141 147 141 39 51 140 141 147 141 20 139 138 139 138 40 41 42 43 51 140 581 573 44 45 51 140 581 573 46 47 51 140 582 574 48 49 51 140 582 574 446 544 444 140 453 545 444 140 454 546 444 140 455 547 444 140 456 548 444 140 447 549 444 140 448 550 444 140 449 551 444 140 450 552 444 140 451 553 444 140 452 554 444 140 149 50 444 140 445 5 100 139 138 139 138 323 148 140 583 573 325 148 140 583 573 326 148 140 583 573 327 148 140 583 573 328 148 140 583 573 324 148 140 332 573 329 148 140 330 575 331 148 140 333 575 159 334 51 140 141 575 160 335 51 140 141 575 161 336 51 140 141 575 337 51 140 141 575 338 51 140 141 575 339 51 140 141 575 340 51 140 141 575 341 51 140 141 575 342 51 140 141 575 343 51 140 141 575 344 51 140 141 575 345 51 140 141 575 346 51 140 141 575 347 51 140 141 575 348 51 140 141 575 162 349 51 140 141 575 163 350 51 140 141 575 164 351 51 140 141 575 156 565 51 140 584 573 157 352 51 140 585 573 158 353 51 140 585 573 165 354 51 140 141 575 166 355 51 140 141 575 167 357 51 140 141 575 168 356 51 140 141 575 169 358 51 140 141 575 170 359 51 140 141 575 171 360 51 140 457 576 172 361 51 140 141 575 601 324 51 140 141 575 311 362 51 140 141 575 305 308 51 140 586 573 173 363 51 140 141 575 309 310 51 140 141 575 312 364 51 140 141 575 313 365 51 140 141 575 314 366 51 140 141 575 306 307 51 140 586 573 315 367 51 140 586 573 174 368 51 140 141 175 369 51 140 587 573 176 177 51 140 587 573 178 370 51 140 587 573 179 371 51 140 587 573 180 372 51 140 587 573 181 373 51 140 141 182 375 382 140 588 573 376 382 140 588 573 377 382 140 588 573 378 382 140 588 573 379 382 140 588 573 380 382 140 588 573 381 382 140 588 573 381 51 140 141 183 383 51 140 141 184 384 51 140 141 185 385 51 140 141 186 386 51 140 141 387 331 51 140 589 573 187 388 51 140 588 573 188 389 51 140 588 573 189 390 51 140 588 573 190 391 51 140 141 191 392 374 140 141 192 393 51 140 141 193 394 382 140 141 194 395 51 140 141 195 396 374 140 141 196 397 374 140 141 197 398 374 140 141 198 399 374 140 141 199 400 374 140 141 200 401 374 140 141 201 402 374 140 141 202 403 374 140 141 203 404 374 140 141 204 405 374 140 141 205 406 51 140 141 206 407 51 140 141 207 408 51 140 141 208 409 51 140 141 209 410 51 140 141 210 411 51 140 141 211 412 51 140 141 212 413 51 140 141 213 414 51 140 141 214 415 51 140 141 215 416 51 140 141 216 417 51 140 141 217 418 51 140 419 147 420 597 320 421 51 140 590 566 567 150 113 51 140 141 321 114 382 140 590 147 141 567 322 115 51 140 590 566 567 151 435 51 140 141 152 436 51 140 141 424 429 51 140 141 425 430 51 140 141 426 431 51 140 440 568 439 438 51 140 440 568 427 432 51 140 141 153 428 51 140 141 154 434 51 140 141 155 437 51 140 141 423 433 51 140 441 218 442 51 140 441 219 458 51 140 441 220 459 51 140 441 221 460 51 140 441 222 461 51 140 441 223 462 51 140 441 224 463 51 140 441 225 464 51 140 441 226 465 51 140 441 227 466 51 140 441 316 467 51 140 441 317 468 51 140 441 318 469 51 140 441 319 470 51 140 441 228 471 51 140 441 229 472 51 140 441 230 473 51 140 441 536 540 51 140 441 231 474 51 140 441 232 475 51 140 441 233 476 51 140 441 234 477 51 140 441 235 478 51 140 591 5 569 236 479 51 140 141 237 480 51 140 141 238 101 51 140 141 239 102 51 140 141 240 103 51 140 141 241 104 51 140 141 242 105 51 140 141 243 106 51 140 141 244 107 51 140 141 245 108 51 140 141 246 109 51 140 141 247 481 382 140 141 248 482 382 140 141 249 483 382 140 141 250 484 382 140 141 251 485 382 140 141 252 486 382 140 141 253 487 382 140 141 254 89 382 140 141 255 488 382 140 141 256 90 382 140 141 257 489 382 140 141 258 92 382 140 141 259 490 382 140 141 260 491 382 140 141 261 492 382 140 141 262 493 382 140 141 263 494 382 140 141 264 495 382 140 141 265 496 382 140 141 266 498 497 570 267 499 382 140 141 268 500 382 140 141 269 501 382 140 141 270 502 382 140 141 271 503 382 140 141 272 504 382 140 141 273 505 382 140 141 274 96 382 140 141 275 97 382 140 141 276 506 382 140 141 277 98 382 140 141 278 507 51 140 592 569 279 508 51 140 592 569 280 509 382 140 141 281 510 382 140 141 282 511 382 140 141 283 512 382 140 141 537 541 382 140 141 538 542 382 140 141 539 543 382 140 141 284 513 382 140 141 285 514 382 140 141 286 515 382 140 141 287 516 382 140 141 288 517 382 140 141 289 518 382 140 141 290 519 51 140 141 291 520 51 140 141 292 521 51 140 141 293 522 51 140 141 294 524 51 140 591 571 295 525 51 140 591 571 296 526 51 140 141 297 527 51 140 141 298 528 51 140 141 299 529 51 140 141 300 530 51 140 141 301 531 51 140 141 302 532 51 140 141 303 533 51 140 534 304 110 51 140 535 10 11 12 18 139 138 139 138 52 51 140 141 53 51 140 141 74 51 140 141 54 51 140 141 75 51 140 141 55 51 140 141 556 51 140 141 56 51 140 141 57 51 140 141 58 51 140 141 76 51 140 141 59 51 140 141 60 51 140 141 61 51 140 141 62 51 140 141 63 51 140 141 64 51 140 141 65 51 140 141 77 51 140 141 66 51 140 141 67 51 140 141 78 140 141 68 140 141 79 51 140 141 80 51 140 141 69 51 140 141 81 51 140 141 70 51 140 141 82 51 140 141 71 51 140 141 72 51 140 141 72 51 140 141 73 51 140 141 83 557 140 593 598 84 51 140 593 598 85 51 140 593 598 86 51 140 593 598 87 51 140 593 598 555 51 140 141 88 557 593 598 21 22 139 138 139 138 113 51 140 141 114 51 140 141 115 51 140 141 13 139 138 139 138 110 382 140 141 111 112 14 139 138 139 138 101 382 140 141 102 382 140 141 103 382 140 141 104 382 140 141 105 382 140 141 106 382 140 141 107 382 140 141 108 382 140 141 109 382 140 141 15 5 16 558 51 140 593 598 559 51 140 593 598 560 51 140 593 598 561 564 140 593 598 562 564 140 593 598 563 564 140 593 598 5 17 89 422 90 91 92 93 94 95 374 140 594 598 96 97 98 5 523 595 599 600

6 9 99 139 138 139 138 146 118 51 140 145 147 141 119 51 140 145 147 141 120 51 140 145 147 141 121 51 140 145 147 141 117 51 140 577 147 141 572 5 122 51 140 577 147 141 572 123 51 140 578 147 141 596 124 51 140 578 147 141 596 125 51 140 578 147 141 596 126 51 140 578 147 141 596 127 51 140 578 147 141 596 5 128 51 140 578 147 141 596 129 51 140 443 147 141 596 130 51 140 579 147 141 596 131 51 142 141 147 141 132 51 142 141 147 141 133 51 142 141 147 141 134 51 142 141 147 141 135 51 142 141 147 141 136 51 142 141 147 141 137 51 142 141 147 141 19 139 138 139 138 23 51 140 141 147 141 24 51 140 141 147 141 143 144 140 141 147 141 25 51 140 141 147 141 26 51 140 141 147 141 27 51 140 141 147 141 28 51 140 141 147 141 29 51 140 141 147 141 30 51 140 141 147 141 31 148 140 580 147 141 32 51 140 580 147 141 33 51 140 141 147 141 34 51 140 141 147 141 35 51 140 141 147 141 36 51 140 141 147 141 37 51 140 141 147 141 38 51 140 141 147 141 39 51 140 141 147 141 20 139 138 139 138 40 41 42 43 51 140 581 573 44 45 51 140 581 573 46 47 51 140 582 574 48 49 51 140 582 574 446 544 444 140 453 545 444 140 454 546 444 140 455 547 444 140 456 548 444 140 447 549 444 140 448 550 444 140 449 551 444 140 450 552 444 140 451 553 444 140 452 554 444 140 149 50 444 140 445 5 100 139 138 139 138 323 148 140 583 573 325 148 140 583 573 326 148 140 583 573 327 148 140 583 573 328 148 140 583 573 324 148 140 332 573 329 148 140 330 575 331 148 140 333 575 159 334 51 140 141 575 160 335 51 140 141 575 161 336 51 140 141 575 337 51 140 141 575 338 51 140 141 575 339 51 140 141 575 340 51 140 141 575 341 51 140 141 575 342 51 140 141 575 343 51 140 141 575 344 51 140 141 575 345 51 140 141 575 346 51 140 141 575 347 51 140 141 575 348 51 140 141 575 162 349 51 140 141 575 163 350 51 140 141 575 164 351 51 140 141 575 156 565 51 140 584 573 157 352 51 140 585 573 158 353 51 140 585 573 165 354 51 140 141 575 166 355 51 140 141 575 167 357 51 140 141 575 168 356 51 140 141 575 169 358 51 140 141 575 170 359 51 140 141 575 171 360 51 140 457 576 172 361 51 140 141 575 601 324 51 140 141 575 311 362 51 140 141 575 305 308 51 140 586 573 173 363 51 140 141 575 309 310 51 140 141 575 312 364 51 140 141 575 313 365 51 140 141 575 314 366 51 140 141 575 306 307 51 140 586 573 315 367 51 140 586 573 174 368 51 140 141 175 369 51 140 587 573 176 177 51 140 587 573 178 370 51 140 587 573 179 371 51 140 587 573 180 372 51 140 587 573 181 373 51 140 141 182 375 382 140 588 573 376 382 140 588 573 377 382 140 588 573 378 382 140 588 573 379 382 140 588 573 380 382 140 588 573 381 382 140 588 573 381 51 140 141 183 383 51 140 141 184 384 51 140 141 185 385 51 140 141 186 386 51 140 141 387 331 51 140 589 573 187 388 51 140 588 573 188 389 51 140 588 573 189 390 51 140 588 573 190 391 51 140 141 191 392 374 140 141 192 393 51 140 141 193 394 382 140 141 194 395 51 140 141 195 396 374 140 141 196 397 374 140 141 197 398 374 140 141 198 399 374 140 141 199 400 374 140 141 200 401 374 140 141 201 402 374 140 141 202 403 374 140 141 203 404 374 140 141 204 405 374 140 141 205 406 51 140 141 206 407 51 140 141 207 408 51 140 141 208 409 51 140 141 209 410 51 140 141 210 411 51 140 141 211 412 51 140 141 212 413 51 140 141 213 414 51 140 141 214 415 51 140 141 215 416 51 140 141 216 417 51 140 141 217 418 51 140 419 147 420 597 320 421 51 140 590 566 567 150 113 51 140 141 321 114 382 140 590 147 141 567 322 115 51 140 590 566 567 151 435 51 140 141 152 436 51 140 141 424 429 51 140 141 425 430 51 140 141 426 431 51 140 440 568 439 438 51 140 440 568 427 432 51 140 141 153 428 51 140 141 154 434 51 140 141 155 437 51 140 141 423 433 51 140 441 218 442 51 140 441 219 458 51 140 441 220 459 51 140 441 221 460 51 140 441 222 461 51 140 441 223 462 51 140 441 224 463 51 140 441 225 464 51 140 441 226 465 51 140 441 227 466 51 140 441 316 467 51 140 441 317 468 51 140 441 318 469 51 140 441 319 470 51 140 441 228 471 51 140 441 229 472 51 140 441 230 473 51 140 441 536 540 51 140 441 231 474 51 140 441 232 475 51 140 441 233 476 51 140 441 234 477 51 140 441 235 478 51 140 591 5 569 236 479 51 140 141 237 480 51 140 141 238 101 51 140 141 239 102 51 140 141 240 103 51 140 141 241 104 51 140 141 242 105 51 140 141 243 106 51 140 141 244 107 51 140 141 245 108 51 140 141 246 109 51 140 141 247 481 382 140 141 248 482 382 140 141 249 483 382 140 141 250 484 382 140 141 251 485 382 140 141 252 486 382 140 141 253 487 382 140 141 254 89 382 140 141 255 488 382 140 141 256 90 382 140 141 257 489 382 140 141 258 92 382 140 141 259 490 382 140 141 260 491 382 140 141 261 492 382 140 141 262 493 382 140 141 263 494 382 140 141 264 495 382 140 141 265 496 382 140 141 266 498 497 570 267 499 382 140 141 268 500 382 140 141 269 501 382 140 141 270 502 382 140 141 271 503 382 140 141 272 504 382 140 141 273 505 382 140 141 274 96 382 140 141 275 97 382 140 141 276 506 382 140 141 277 98 382 140 141 278 507 51 140 592 569 279 508 51 140 592 569 280 509 382 140 141 281 510 382 140 141 282 511 382 140 141 283 512 382 140 141 537 541 382 140 141 538 542 382 140 141 539 543 382 140 141 284 513 382 140 141 285 514 382 140 141 286 515 382 140 141 287 516 382 140 141 288 517 382 140 141 289 518 382 140 141 290 519 51 140 141 291 520 51 140 141 292 521 51 140 141 293 522 51 140 141 294 524 51 140 591 571 295 525 51 140 591 571 296 526 51 140 141 297 527 51 140 141 298 528 51 140 141 299 529 51 140 141 300 530 51 140 141 301 531 51 140 141 302 532 51 140 141 303 533 51 140 534 304 110 51 140 535 10 11 12 18 139 138 139 138 52 51 140 141 53 51 140 141 74 51 140 141 54 51 140 141 75 51 140 141 55 51 140 141 556 51 140 141 56 51 140 141 57 51 140 141 58 51 140 141 76 51 140 141 59 51 140 141 60 51 140 141 61 51 140 141 62 51 140 141 63 51 140 141 64 51 140 141 65 51 140 141 77 51 140 141 66 51 140 141 67 51 140 141 78 140 141 68 140 141 79 51 140 141 80 51 140 141 69 51 140 141 81 51 140 141 70 51 140 141 82 51 140 141 71 51 140 141 72 51 140 141 72 51 140 141 73 51 140 141 83 557 140 593 598 84 51 140 593 598 85 51 140 593 598 86 51 140 593 598 87 51 140 593 598 555 51 140 141 88 557 593 598 21 22 139 138 139 138 113 51 140 141 114 51 140 141 115 51 140 141 13 139 138 139 138 110 382 140 141 111 112 14 139 138 139 138 101 382 140 141 102 382 140 141 103 382 140 141 104 382 140 141 105 382 140 141 106 382 140 141 107 382 140 141 108 382 140 141 109 382 140 141 15 5 16 558 51 140 593 598 559 51 140 593 598 560 51 140 593 598 561 564 140 593 598 562 564 140 593 598 563 564 140 593 598 5 17 89 422 90 91 92 93 94 95 374 140 594 598 96 97 98 5 523 595 599 600

6 9 99 139 138 139 138 146 118 51 140 145 147 141 119 51 140 145 147 141 120 51 140 145 147 141 121 51 140 145 147 141 117 51 140 577 147 141 572 5 122 51 140 577 147 141 572 123 51 140 578 147 141 596 124 51 140 578 147 141 596 125 51 140 578 147 141 596 126 51 140 578 147 141 596 127 51 140 578 147 141 596 5 128 51 140 578 147 141 596 129 51 140 443 147 141 596 130 51 140 579 147 141 596 131 51 142 141 147 141 132 51 142 141 147 141 133 51 142 141 147 141 134 51 142 141 147 141 135 51 142 141 147 141 136 51 142 141 147 141 137 51 142 141 147 141 19 139 138 139 138 23 51 140 141 147 141 24 51 140 141 147 141 143 144 140 141 147 141 25 51 140 141 147 141 26 51 140 141 147 141 27 51 140 141 147 141 28 51 140 141 147 141 29 51 140 141 147 141 30 51 140 141 147 141 31 148 140 580 147 141 32 51 140 580 147 141 33 51 140 141 147 141 34 51 140 141 147 141 35 51 140 141 147 141 36 51 140 141 147 141 37 51 140 141 147 141 38 51 140 141 147 141 39 51 140 141 147 141 20 139 138 139 138 40 41 42 43 51 140 581 573 44 45 51 140 581 573 46 47 51 140 582 574 48 49 51 140 582 574 446 544 444 140 453 545 444 140 454 546 444 140 455 547 444 140 456 548 444 140 447 549 444 140 448 550 444 140 449 551 444 140 450 552 444 140 451 553 444 140 452 554 444 140 149 50 444 140 445 5 100 139 138 139 138 323 148 140 583 573 325 148 140 583 573 326 148 140 583 573 327 148 140 583 573 328 148 140 583 573 324 148 140 332 573 329 148 140 330 575 331 148 140 333 575 159 334 51 140 141 575 160 335 51 140 141 575 161 336 51 140 141 575 337 51 140 141 575 338 51 140 141 575 339 51 140 141 575 340 51 140 141 575 341 51 140 141 575 342 51 140 141 575 343 51 140 141 575 344 51 140 141 575 345 51 140 141 575 346 51 140 141 575 347 51 140 141 575 348 51 140 141 575 162 349 51 140 141 575 163 350 51 140 141 575 164 351 51 140 141 575 156 565 51 140 584 573 157 352 51 140 585 573 158 353 51 140 585 573 165 354 51 140 141 575 166 355 51 140 141 575 167 357 51 140 141 575 168 356 51 140 141 575 169 358 51 140 141 575 170 359 51 140 141 575 171 360 51 140 457 576 172 361 51 140 141 575 601 324 51 140 141 575 311 362 51 140 141 575 305 308 51 140 586 573 173 363 51 140 141 575 309 310 51 140 141 575 312 364 51 140 141 575 313 365 51 140 141 575 314 366 51 140 141 575 306 307 51 140 586 573 315 367 51 140 586 573 174 368 51 140 141 175 369 51 140 587 573 176 177 51 140 587 573 178 370 51 140 587 573 179 371 51 140 587 573 180 372 51 140 587 573 181 373 51 140 141 182 375 382 140 588 573 376 382 140 588 573 377 382 140 588 573 378 382 140 588 573 379 382 140 588 573 380 382 140 588 573 381 382 140 588 573 381 51 140 141 183 383 51 140 141 184 384 51 140 141 185 385 51 140 141 186 386 51 140 141 387 331 51 140 589 573 187 388 51 140 588 573 188 389 51 140 588 573 189 390 51 140 588 573 190 391 51 140 141 191 392 374 140 141 192 393 51 140 141 193 394 382 140 141 194 395 51 140 141 195 396 374 140 141 196 397 374 140 141 197 398 374 140 141 198 399 374 140 141 199 400 374 140 141 200 401 374 140 141 201 402 374 140 141 202 403 374 140 141 203 404 374 140 141 204 405 374 140 141 205 406 51 140 141 206 407 51 140 141 207 408 51 140 141 208 409 51 140 141 209 410 51 140 141 210 411 51 140 141 211 412 51 140 141 212 413 51 140 141 213 414 51 140 141 214 415 51 140 141 215 416 51 140 141 216 417 51 140 141 217 418 51 140 419 147 420 597 320 421 51 140 590 566 567 150 113 51 140 141 321 114 382 140 590 147 141 567 322 115 51 140 590 566 567 151 435 51 140 141 152 436 51 140 141 424 429 51 140 141 425 430 51 140 141 426 431 51 140 440 568 439 438 51 140 440 568 427 432 51 140 141 153 428 51 140 141 154 434 51 140 141 155 437 51 140 141 423 433 51 140 441 218 442 51 140 441 219 458 51 140 441 220 459 51 140 441 221 460 51 140 441 222 461 51 140 441 223 462 51 140 441 224 463 51 140 441 225 464 51 140 441 226 465 51 140 441 227 466 51 140 441 316 467 51 140 441 317 468 51 140 441 318 469 51 140 441 319 470 51 140 441 228 471 51 140 441 229 472 51 140 441 230 473 51 140 441 536 540 51 140 441 231 474 51 140 441 232 475 51 140 441 233 476 51 140 441 234 477 51 140 441 235 478 51 140 591 5 569 236 479 51 140 141 237 480 51 140 141 238 101 51 140 141 239 102 51 140 141 240 103 51 140 141 241 104 51 140 141 242 105 51 140 141 243 106 51 140 141 244 107 51 140 141 245 108 51 140 141 246 109 51 140 141 247 481 382 140 141 248 482 382 140 141 249 483 382 140 141 250 484 382 140 141 251 485 382 140 141 252 486 382 140 141 253 487 382 140 141 254 89 382 140 141 255 488 382 140 141 256 90 382 140 141 257 489 382 140 141 258 92 382 140 141 259 490 382 140 141 260 491 382 140 141 261 492 382 140 141 262 493 382 140 141 263 494 382 140 141 264 495 382 140 141 265 496 382 140 141 266 498 497 570 267 499 382 140 141 268 500 382 140 141 269 501 382 140 141 270 502 382 140 141 271 503 382 140 141 272 504 382 140 141 273 505 382 140 141 274 96 382 140 141 275 97 382 140 141 276 506 382 140 141 277 98 382 140 141 278 507 51 140 592 569 279 508 51 140 592 569 280 509 382 140 141 281 510 382 140 141 282 511 382 140 141 283 512 382 140 141 537 541 382 140 141 538 542 382 140 141 539 543 382 140 141 284 513 382 140 141 285 514 382 140 141 286 515 382 140 141 287 516 382 140 141 288 517 382 140 141 289 518 382 140 141 290 519 51 140 141 291 520 51 140 141 292 521 51 140 141 293 522 51 140 141 294 524 51 140 591 571 295 525 51 140 591 571 296 526 51 140 141 297 527 51 140 141 298 528 51 140 141 299 529 51 140 141 300 530 51 140 141 301 531 51 140 141 302 532 51 140 141 303 533 51 140 534 304 110 51 140 535 10 11 12 18 139 138 139 138 52 51 140 141 53 51 140 141 74 51 140 141 54 51 140 141 75 51 140 141 55 51 140 141 556 51 140 141 56 51 140 141 57 51 140 141 58 51 140 141 76 51 140 141 59 51 140 141 60 51 140 141 61 51 140 141 62 51 140 141 63 51 140 141 64 51 140 141 65 51 140 141 77 51 140 141 66 51 140 141 67 51 140 141 78 140 141 68 140 141 79 51 140 141 80 51 140 141 69 51 140 141 81 51 140 141 70 51 140 141 82 51 140 141 71 51 140 141 72 51 140 141 72 51 140 141 73 51 140 141 83 557 140 593 598 84 51 140 593 598 85 51 140 593 598 86 51 140 593 598 87 51 140 593 598 555 51 140 141 88 557 593 598 21 22 139 138 139 138 113 51 140 141 114 51 140 141 115 51 140 141 13 139 138 139 138 110 382 140 141 111 112 14 139 138 139 138 101 382 140 141 102 382 140 141 103 382 140 141 104 382 140 141 105 382 140 141 106 382 140 141 107 382 140 141 108 382 140 141 109 382 140 141 15 5 16 558 51 140 593 598 559 51 140 593 598 560 51 140 593 598 561 564 140 593 598 562 564 140 593 598 563 564 140 593 598 5 17 89 422 90 91 92 93 94 95 374 140 594 598 96 97 98 5 523 595 599 600

6 9 99 139 138 139 138 146 118 51 140 145 147 141 119 51 140 145 147 141 120 51 140 145 147 141 121 51 140 145 147 141 117 51 140 577 147 141 572 5 122 51 140 577 147 141 572 123 51 140 578 147 141 596 124 51 140 578 147 141 596 125 51 140 578 147 141 596 126 51 140 578 147 141 596 127 51 140 578 147 141 596 5 128 51 140 578 147 141 596 129 51 140 443 147 141 596 130 51 140 579 147 141 596 131 51 142 141 147 141 132 51 142 141 147 141 133 51 142 141 147 141 134 51 142 141 147 141 135 51 142 141 147 141 136 51 142 141 147 141 137 51 142 141 147 141 19 139 138 139 138 23 51 140 141 147 141 24 51 140 141 147 141 143 144 140 141 147 141 25 51 140 141 147 141 26 51 140 141 147 141 27 51 140 141 147 141 28 51 140 141 147 141 29 51 140 141 147 141 30 51 140 141 147 141 31 148 140 580 147 141 32 51 140 580 147 141 33 51 140 141 147 141 34 51 140 141 147 141 35 51 140 141 147 141 36 51 140 141 147 141 37 51 140 141 147 141 38 51 140 141 147 141 39 51 140 141 147 141 20 139 138 139 138 40 41 42 43 51 140 581 573 44 45 51 140 581 573 46 47 51 140 582 574 48 49 51 140 582 574 446 544 444 140 453 545 444 140 454 546 444 140 455 547 444 140 456 548 444 140 447 549 444 140 448 550 444 140 449 551 444 140 450 552 444 140 451 553 444 140 452 554 444 140 149 50 444 140 445 5 100 139 138 139 138 323 148 140 583 573 325 148 140 583 573 326 148 140 583 573 327 148 140 583 573 328 148 140 583 573 324 148 140 332 573 329 148 140 330 575 331 148 140 333 575 159 334 51 140 141 575 160 335 51 140 141 575 161 336 51 140 141 575 337 51 140 141 575 338 51 140 141 575 339 51 140 141 575 340 51 140 141 575 341 51 140 141 575 342 51 140 141 575 343 51 140 141 575 344 51 140 141 575 345 51 140 141 575 346 51 140 141 575 347 51 140 141 575 348 51 140 141 575 162 349 51 140 141 575 163 350 51 140 141 575 164 351 51 140 141 575 156 565 51 140 584 573 157 352 51 140 585 573 158 353 51 140 585 573 165 354 51 140 141 575 166 355 51 140 141 575 167 357 51 140 141 575 168 356 51 140 141 575 169 358 51 140 141 575 170 359 51 140 141 575 171 360 51 140 457 576 172 361 51 140 141 575 601 324 51 140 141 575 311 362 51 140 141 575 305 308 51 140 586 573 173 363 51 140 141 575 309 310 51 140 141 575 312 364 51 140 141 575 313 365 51 140 141 575 314 366 51 140 141 575 306 307 51 140 586 573 315 367 51 140 586 573 174 368 51 140 141 175 369 51 140 587 573 176 177 51 140 587 573 178 370 51 140 587 573 179 371 51 140 587 573 180 372 51 140 587 573 181 373 51 140 141 182 375 382 140 588 573 376 382 140 588 573 377 382 140 588 573 378 382 140 588 573 379 382 140 588 573 380 382 140 588 573 381 382 140 588 573 381 51 140 141 183 383 51 140 141 184 384 51 140 141 185 385 51 140 141 186 386 51 140 141 387 331 51 140 589 573 187 388 51 140 588 573 188 389 51 140 588 573 189 390 51 140 588 573 190 391 51 140 141 191 392 374 140 141 192 393 51 140 141 193 394 382 140 141 194 395 51 140 141 195 396 374 140 141 196 397 374 140 141 197 398 374 140 141 198 399 374 140 141 199 400 374 140 141 200 401 374 140 141 201 402 374 140 141 202 403 374 140 141 203 404 374 140 141 204 405 374 140 141 205 406 51 140 141 206 407 51 140 141 207 408 51 140 141 208 409 51 140 141 209 410 51 140 141 210 411 51 140 141 211 412 51 140 141 212 413 51 140 141 213 414 51 140 141 214 415 51 140 141 215 416 51 140 141 216 417 51 140 141 217 418 51 140 419 147 420 597 320 421 51 140 590 566 567 150 113 51 140 141 321 114 382 140 590 147 141 567 322 115 51 140 590 566 567 151 435 51 140 141 152 436 51 140 141 424 429 51 140 141 425 430 51 140 141 426 431 51 140 440 568 439 438 51 140 440 568 427 432 51 140 141 153 428 51 140 141 154 434 51 140 141 155 437 51 140 141 423 433 51 140 441 218 442 51 140 441 219 458 51 140 441 220 459 51 140 441 221 460 51 140 441 222 461 51 140 441 223 462 51 140 441 224 463 51 140 441 225 464 51 140 441 226 465 51 140 441 227 466 51 140 441 316 467 51 140 441 317 468 51 140 441 318 469 51 140 441 319 470 51 140 441 228 471 51 140 441 229 472 51 140 441 230 473 51 140 441 536 540 51 140 441 231 474 51 140 441 232 475 51 140 441 233 476 51 140 441 234 477 51 140 441 235 478 51 140 591 5 569 236 479 51 140 141 237 480 51 140 141 238 101 51 140 141 239 102 51 140 141 240 103 51 140 141 241 104 51 140 141 242 105 51 140 141 243 106 51 140 141 244 107 51 140 141 245 108 51 140 141 246 109 51 140 141 247 481 382 140 141 248 482 382 140 141 249 483 382 140 141 250 484 382 140 141 251 485 382 140 141 252 486 382 140 141 253 487 382 140 141 254 89 382 140 141 255 488 382 140 141 256 90 382 140 141 257 489 382 140 141 258 92 382 140 141 259 490 382 140 141 260 491 382 140 141 261 492 382 140 141 262 493 382 140 141 263 494 382 140 141 264 495 382 140 141 265 496 382 140 141 266 498 497 570 267 499 382 140 141 268 500 382 140 141 269 501 382 140 141 270 502 382 140 141 271 503 382 140 141 272 504 382 140 141 273 505 382 140 141 274 96 382 140 141 275 97 382 140 141 276 506 382 140 141 277 98 382 140 141 278 507 51 140 592 569 279 508 51 140 592 569 280 509 382 140 141 281 510 382 140 141 282 511 382 140 141 283 512 382 140 141 537 541 382 140 141 538 542 382 140 141 539 543 382 140 141 284 513 382 140 141 285 514 382 140 141 286 515 382 140 141 287 516 382 140 141 288 517 382 140 141 289 518 382 140 141 290 519 51 140 141 291 520 51 140 141 292 521 51 140 141 293 522 51 140 141 294 524 51 140 591 571 295 525 51 140 591 571 296 526 51 140 141 297 527 51 140 141 298 528 51 140 141 299 529 51 140 141 300 530 51 140 141 301 531 51 140 141 302 532 51 140 141 303 533 51 140 534 304 110 51 140 535 10 11 12 18 139 138 139 138 52 51 140 141 53 51 140 141 74 51 140 141 54 51 140 141 75 51 140 141 55 51 140 141 556 51 140 141 56 51 140 141 57 51 140 141 58 51 140 141 76 51 140 141 59 51 140 141 60 51 140 141 61 51 140 141 62 51 140 141 63 51 140 141 64 51 140 141 65 51 140 141 77 51 140 141 66 51 140 141 67 51 140 141 78 140 141 68 140 141 79 51 140 141 80 51 140 141 69 51 140 141 81 51 140 141 70 51 140 141 82 51 140 141 71 51 140 141 72 51 140 141 72 51 140 141 73 51 140 141 83 557 140 593 598 84 51 140 593 598 85 51 140 593 598 86 51 140 593 598 87 51 140 593 598 555 51 140 141 88 557 593 598 21 22 139 138 139 138 113 51 140 141 114 51 140 141 115 51 140 141 13 139 138 139 138 110 382 140 141 111 112 14 139 138 139 138 101 382 140 141 102 382 140 141 103 382 140 141 104 382 140 141 105 382 140 141 106 382 140 141 107 382 140 141 108 382 140 141 109 382 140 141 15 5 16 558 51 140 593 598 559 51 140 593 598 560 51 140 593 598 561 564 140 593 598 562 564 140 593 598 563 564 140 593 598 5 17 89 422 90 91 92 93 94 95 374 140 594 598 96 97 98 5 523 595 599 600

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

6 9 99 139 138 139 138 146 118 51 140 145 147 141 119 51 140 145 147 141 120 51 140 145 147 141 121 51 140 145 147 141 117 51 140 577 147 141 572 5 122 51 140 577 147 141 572 123 51 140 578 147 141 596 124 51 140 578 147 141 596 125 51 140 578 147 141 596 126 51 140 578 147 141 596 127 51 140 578 147 141 596 5 128 51 140 578 147 141 596 129 51 140 443 147 141 596 130 51 140 579 147 141 596 131 51 142 141 147 141 132 51 142 141 147 141 133 51 142 141 147 141 134 51 142 141 147 141 135 51 142 141 147 141 136 51 142 141 147 141 137 51 142 141 147 141 19 139 138 139 138 23 51 140 141 147 141 24 51 140 141 147 141 143 144 140 141 147 141 25 51 140 141 147 141 26 51 140 141 147 141 27 51 140 141 147 141 28 51 140 141 147 141 29 51 140 141 147 141 30 51 140 141 147 141 31 148 140 580 147 141 32 51 140 580 147 141 33 51 140 141 147 141 34 51 140 141 147 141 35 51 140 141 147 141 36 51 140 141 147 141 37 51 140 141 147 141 38 51 140 141 147 141 39 51 140 141 147 141 20 139 138 139 138 40 41 42 43 51 140 581 573 44 45 51 140 581 573 46 47 51 140 582 574 48 49 51 140 582 574 446 544 444 140 453 545 444 140 454 546 444 140 455 547 444 140 456 548 444 140 447 549 444 140 448 550 444 140 449 551 444 140 450 552 444 140 451 553 444 140 452 554 444 140 149 50 444 140 445 5 100 139 138 139 138 323 148 140 583 573 325 148 140 583 573 326 148 140 583 573 327 148 140 583 573 328 148 140 583 573 324 148 140 332 573 329 148 140 330 575 331 148 140 333 575 159 334 51 140 141 575 160 335 51 140 141 575 161 336 51 140 141 575 337 51 140 141 575 338 51 140 141 575 339 51 140 141 575 340 51 140 141 575 341 51 140 141 575 342 51 140 141 575 343 51 140 141 575 344 51 140 141 575 345 51 140 141 575 346 51 140 141 575 347 51 140 141 575 348 51 140 141 575 162 349 51 140 141 575 163 350 51 140 141 575 164 351 51 140 141 575 156 565 51 140 584 573 157 352 51 140 585 573 158 353 51 140 585 573 165 354 51 140 141 575 166 355 51 140 141 575 167 357 51 140 141 575 168 356 51 140 141 575 169 358 51 140 141 575 170 359 51 140 141 575 171 360 51 140 457 576 172 361 51 140 141 575 601 324 51 140 141 575 311 362 51 140 141 575 305 308 51 140 586 573 173 363 51 140 141 575 309 310 51 140 141 575 312 364 51 140 141 575 313 365 51 140 141 575 314 366 51 140 141 575 306 307 51 140 586 573 315 367 51 140 586 573 174 368 51 140 141 175 369 51 140 587 573 176 177 51 140 587 573 178 370 51 140 587 573 179 371 51 140 587 573 180 372 51 140 587 573 181 373 51 140 141 182 375 382 140 588 573 376 382 140 588 573 377 382 140 588 573 378 382 140 588 573 379 382 140 588 573 380 382 140 588 573 381 382 140 588 573 381 51 140 141 183 383 51 140 141 184 384 51 140 141 185 385 51 140 141 186 386 51 140 141 387 331 51 140 589 573 187 388 51 140 588 573 188 389 51 140 588 573 189 390 51 140 588 573 190 391 51 140 141 191 392 374 140 141 192 393 51 140 141 193 394 382 140 141 194 395 51 140 141 195 396 374 140 141 196 397 374 140 141 197 398 374 140 141 198 399 374 140 141 199 400 374 140 141 200 401 374 140 141 201 402 374 140 141 202 403 374 140 141 203 404 374 140 141 204 405 374 140 141 205 406 51 140 141 206 407 51 140 141 207 408 51 140 141 208 409 51 140 141 209 410 51 140 141 210 411 51 140 141 211 412 51 140 141 212 413 51 140 141 213 414 51 140 141 214 415 51 140 141 215 416 51 140 141 216 417 51 140 141 217 418 51 140 419 147 420 597 320 421 51 140 590 566 567 150 113 51 140 141 321 114 382 140 590 147 141 567 322 115 51 140 590 566 567 151 435 51 140 141 152 436 51 140 141 424 429 51 140 141 425 430 51 140 141 426 431 51 140 440 568 439 438 51 140 440 568 427 432 51 140 141 153 428 51 140 141 154 434 51 140 141 155 437 51 140 141 423 433 51 140 441 218 442 51 140 441 219 458 51 140 441 220 459 51 140 441 221 460 51 140 441 222 461 51 140 441 223 462 51 140 441 224 463 51 140 441 225 464 51 140 441 226 465 51 140 441 227 466 51 140 441 316 467 51 140 441 317 468 51 140 441 318 469 51 140 441 319 470 51 140 441 228 471 51 140 441 229 472 51 140 441 230 473 51 140 441 536 540 51 140 441 231 474 51 140 441 232 475 51 140 441 233 476 51 140 441 234 477 51 140 441 235 478 51 140 591 5 569 236 479 51 140 141 237 480 51 140 141 238 101 51 140 141 239 102 51 140 141 240 103 51 140 141 241 104 51 140 141 242 105 51 140 141 243 106 51 140 141 244 107 51 140 141 245 108 51 140 141 246 109 51 140 141 247 481 382 140 141 248 482 382 140 141 249 483 382 140 141 250 484 382 140 141 251 485 382 140 141 252 486 382 140 141 253 487 382 140 141 254 89 382 140 141 255 488 382 140 141 256 90 382 140 141 257 489 382 140 141 258 92 382 140 141 259 490 382 140 141 260 491 382 140 141 261 492 382 140 141 262 493 382 140 141 263 494 382 140 141 264 495 382 140 141 265 496 382 140 141 266 498 497 570 267 499 382 140 141 268 500 382 140 141 269 501 382 140 141 270 502 382 140 141 271 503 382 140 141 272 504 382 140 141 273 505 382 140 141 274 96 382 140 141 275 97 382 140 141 276 506 382 140 141 277 98 382 140 141 278 507 51 140 592 569 279 508 51 140 592 569 280 509 382 140 141 281 510 382 140 141 282 511 382 140 141 283 512 382 140 141 537 541 382 140 141 538 542 382 140 141 539 543 382 140 141 284 513 382 140 141 285 514 382 140 141 286 515 382 140 141 287 516 382 140 141 288 517 382 140 141 289 518 382 140 141 290 519 51 140 141 291 520 51 140 141 292 521 51 140 141 293 522 51 140 141 294 524 51 140 591 571 295 525 51 140 591 571 296 526 51 140 141 297 527 51 140 141 298 528 51 140 141 299 529 51 140 141 300 530 51 140 141 301 531 51 140 141 302 532 51 140 141 303 533 51 140 534 304 110 51 140 535 10 11 12 18 139 138 139 138 52 51 140 141 53 51 140 141 74 51 140 141 54 51 140 141 75 51 140 141 55 51 140 141 556 51 140 141 56 51 140 141 57 51 140 141 58 51 140 141 76 51 140 141 59 51 140 141 60 51 140 141 61 51 140 141 62 51 140 141 63 51 140 141 64 51 140 141 65 51 140 141 77 51 140 141 66 51 140 141 67 51 140 141 78 140 141 68 140 141 79 51 140 141 80 51 140 141 69 51 140 141 81 51 140 141 70 51 140 141 82 51 140 141 71 51 140 141 72 51 140 141 72 51 140 141 73 51 140 141 83 557 140 593 598 84 51 140 593 598 85 51 140 593 598 86 51 140 593 598 87 51 140 593 598 555 51 140 141 88 557 593 598 21 22 139 138 139 138 113 51 140 141 114 51 140 141 115 51 140 141 13 139 138 139 138 110 382 140 141 111 112 14 139 138 139 138 101 382 140 141 102 382 140 141 103 382 140 141 104 382 140 141 105 382 140 141 106 382 140 141 107 382 140 141 108 382 140 141 109 382 140 141 15 5 16 558 51 140 593 598 559 51 140 593 598 560 51 140 593 598 561 564 140 593 598 562 564 140 593 598 563 564 140 593 598 5 17 89 422 90 91 92 93 94 95 374 140 594 598 96 97 98 5 523 595 599 600

6 9 99 139 138 139 138 146 118 51 140 145 147 141 119 51 140 145 147 141 120 51 140 145 147 141 121 51 140 145 147 141 117 51 140 577 147 141 572 5 122 51 140 577 147 141 572 123 51 140 578 147 141 596 124 51 140 578 147 141 596 125 51 140 578 147 141 596 126 51 140 578 147 141 596 127 51 140 578 147 141 596 5 128 51 140 578 147 141 596 129 51 140 443 147 141 596 130 51 140 579 147 141 596 131 51 142 141 147 141 132 51 142 141 147 141 133 51 142 141 147 141 134 51 142 141 147 141 135 51 142 141 147 141 136 51 142 141 147 141 137 51 142 141 147 141 19 139 138 139 138 23 51 140 141 147 141 24 51 140 141 147 141 143 144 140 141 147 141 25 51 140 141 147 141 26 51 140 141 147 141 27 51 140 141 147 141 28 51 140 141 147 141 29 51 140 141 147 141 30 51 140 141 147 141 31 148 140 580 147 141 32 51 140 580 147 141 33 51 140 141 147 141 34 51 140 141 147 141 35 51 140 141 147 141 36 51 140 141 147 141 37 51 140 141 147 141 38 51 140 141 147 141 39 51 140 141 147 141 20 139 138 139 138 40 41 42 43 51 140 581 573 44 45 51 140 581 573 46 47 51 140 582 574 48 49 51 140 582 574 446 544 444 140 453 545 444 140 454 546 444 140 455 547 444 140 456 548 444 140 447 549 444 140 448 550 444 140 449 551 444 140 450 552 444 140 451 553 444 140 452 554 444 140 149 50 444 140 445 5 100 139 138 139 138 323 148 140 583 573 325 148 140 583 573 326 148 140 583 573 327 148 140 583 573 328 148 140 583 573 324 148 140 332 573 329 148 140 330 575 331 148 140 333 575 159 334 51 140 141 575 160 335 51 140 141 575 161 336 51 140 141 575 337 51 140 141 575 338 51 140 141 575 339 51 140 141 575 340 51 140 141 575 341 51 140 141 575 342 51 140 141 575 343 51 140 141 575 344 51 140 141 575 345 51 140 141 575 346 51 140 141 575 347 51 140 141 575 348 51 140 141 575 162 349 51 140 141 575 163 350 51 140 141 575 164 351 51 140 141 575 156 565 51 140 584 573 157 352 51 140 585 573 158 353 51 140 585 573 165 354 51 140 141 575 166 355 51 140 141 575 167 357 51 140 141 575 168 356 51 140 141 575 169 358 51 140 141 575 170 359 51 140 141 575 171 360 51 140 457 576 172 361 51 140 141 575 601 324 51 140 141 575 311 362 51 140 141 575 305 308 51 140 586 573 173 363 51 140 141 575 309 310 51 140 141 575 312 364 51 140 141 575 313 365 51 140 141 575 314 366 51 140 141 575 306 307 51 140 586 573 315 367 51 140 586 573 174 368 51 140 141 175 369 51 140 587 573 176 177 51 140 587 573 178 370 51 140 587 573 179 371 51 140 587 573 180 372 51 140 587 573 181 373 51 140 141 182 375 382 140 588 573 376 382 140 588 573 377 382 140 588 573 378 382 140 588 573 379 382 140 588 573 380 382 140 588 573 381 382 140 588 573 381 51 140 141 183 383 51 140 141 184 384 51 140 141 185 385 51 140 141 186 386 51 140 141 387 331 51 140 589 573 187 388 51 140 588 573 188 389 51 140 588 573 189 390 51 140 588 573 190 391 51 140 141 191 392 374 140 141 192 393 51 140 141 193 394 382 140 141 194 395 51 140 141 195 396 374 140 141 196 397 374 140 141 197 398 374 140 141 198 399 374 140 141 199 400 374 140 141 200 401 374 140 141 201 402 374 140 141 202 403 374 140 141 203 404 374 140 141 204 405 374 140 141 205 406 51 140 141 206 407 51 140 141 207 408 51 140 141 208 409 51 140 141 209 410 51 140 141 210 411 51 140 141 211 412 51 140 141 212 413 51 140 141 213 414 51 140 141 214 415 51 140 141 215 416 51 140 141 216 417 51 140 141 217 418 51 140 419 147 420 597 320 421 51 140 590 566 567 150 113 51 140 141 321 114 382 140 590 147 141 567 322 115 51 140 590 566 567 151 435 51 140 141 152 436 51 140 141 424 429 51 140 141 425 430 51 140 141 426 431 51 140 440 568 439 438 51 140 440 568 427 432 51 140 141 153 428 51 140 141 154 434 51 140 141 155 437 51 140 141 423 433 51 140 441 218 442 51 140 441 219 458 51 140 441 220 459 51 140 441 221 460 51 140 441 222 461 51 140 441 223 462 51 140 441 224 463 51 140 441 225 464 51 140 441 226 465 51 140 441 227 466 51 140 441 316 467 51 140 441 317 468 51 140 441 318 469 51 140 441 319 470 51 140 441 228 471 51 140 441 229 472 51 140 441 230 473 51 140 441 536 540 51 140 441 231 474 51 140 441 232 475 51 140 441 233 476 51 140 441 234 477 51 140 441 235 478 51 140 591 5 569 236 479 51 140 141 237 480 51 140 141 238 101 51 140 141 239 102 51 140 141 240 103 51 140 141 241 104 51 140 141 242 105 51 140 141 243 106 51 140 141 244 107 51 140 141 245 108 51 140 141 246 109 51 140 141 247 481 382 140 141 248 482 382 140 141 249 483 382 140 141 250 484 382 140 141 251 485 382 140 141 252 486 382 140 141 253 487 382 140 141 254 89 382 140 141 255 488 382 140 141 256 90 382 140 141 257 489 382 140 141 258 92 382 140 141 259 490 382 140 141 260 491 382 140 141 261 492 382 140 141 262 493 382 140 141 263 494 382 140 141 264 495 382 140 141 265 496 382 140 141 266 498 497 570 267 499 382 140 141 268 500 382 140 141 269 501 382 140 141 270 502 382 140 141 271 503 382 140 141 272 504 382 140 141 273 505 382 140 141 274 96 382 140 141 275 97 382 140 141 276 506 382 140 141 277 98 382 140 141 278 507 51 140 592 569 279 508 51 140 592 569 280 509 382 140 141 281 510 382 140 141 282 511 382 140 141 283 512 382 140 141 537 541 382 140 141 538 542 382 140 141 539 543 382 140 141 284 513 382 140 141 285 514 382 140 141 286 515 382 140 141 287 516 382 140 141 288 517 382 140 141 289 518 382 140 141 290 519 51 140 141 291 520 51 140 141 292 521 51 140 141 293 522 51 140 141 294 524 51 140 591 571 295 525 51 140 591 571 296 526 51 140 141 297 527 51 140 141 298 528 51 140 141 299 529 51 140 141 300 530 51 140 141 301 531 51 140 141 302 532 51 140 141 303 533 51 140 534 304 110 51 140 535 10 11 12 18 139 138 139 138 52 51 140 141 53 51 140 141 74 51 140 141 54 51 140 141 75 51 140 141 55 51 140 141 556 51 140 141 56 51 140 141 57 51 140 141 58 51 140 141 76 51 140 141 59 51 140 141 60 51 140 141 61 51 140 141 62 51 140 141 63 51 140 141 64 51 140 141 65 51 140 141 77 51 140 141 66 51 140 141 67 51 140 141 78 140 141 68 140 141 79 51 140 141 80 51 140 141 69 51 140 141 81 51 140 141 70 51 140 141 82 51 140 141 71 51 140 141 72 51 140 141 72 51 140 141 73 51 140 141 83 557 140 593 598 84 51 140 593 598 85 51 140 593 598 86 51 140 593 598 87 51 140 593 598 555 51 140 141 88 557 593 598 21 22 139 138 139 138 113 51 140 141 114 51 140 141 115 51 140 141 13 139 138 139 138 110 382 140 141 111 112 14 139 138 139 138 101 382 140 141 102 382 140 141 103 382 140 141 104 382 140 141 105 382 140 141 106 382 140 141 107 382 140 141 108 382 140 141 109 382 140 141 15 5 16 558 51 140 593 598 559 51 140 593 598 560 51 140 593 598 561 564 140 593 598 562 564 140 593 598 563 564 140 593 598 5 17 89 422 90 91 92 93 94 95 374 140 594 598 96 97 98 5 523 595 599 600

6 9 99 139 138 139 138 146 118 51 140 145 147 141 119 51 140 145 147 141 120 51 140 145 147 141 121 51 140 145 147 141 117 51 140 577 147 141 572 5 122 51 140 577 147 141 572 123 51 140 578 147 141 596 124 51 140 578 147 141 596 125 51 140 578 147 141 596 126 51 140 578 147 141 596 127 51 140 578 147 141 596 5 128 51 140 578 147 141 596 129 51 140 443 147 141 596 130 51 140 579 147 141 596 131 51 142 141 147 141 132 51 142 141 147 141 133 51 142 141 147 141 134 51 142 141 147 141 135 51 142 141 147 141 136 51 142 141 147 141 137 51 142 141 147 141 19 139 138 139 138 23 51 140 141 147 141 24 51 140 141 147 141 143 144 140 141 147 141 25 51 140 141 147 141 26 51 140 141 147 141 27 51 140 141 147 141 28 51 140 141 147 141 29 51 140 141 147 141 30 51 140 141 147 141 31 148 140 580 147 141 32 51 140 580 147 141 33 51 140 141 147 141 34 51 140 141 147 141 35 51 140 141 147 141 36 51 140 141 147 141 37 51 140 141 147 141 38 51 140 141 147 141 39 51 140 141 147 141 20 139 138 139 138 40 41 42 43 51 140 581 573 44 45 51 140 581 573 46 47 51 140 582 574 48 49 51 140 582 574 446 544 444 140 453 545 444 140 454 546 444 140 455 547 444 140 456 548 444 140 447 549 444 140 448 550 444 140 449 551 444 140 450 552 444 140 451 553 444 140 452 554 444 140 149 50 444 140 445 5 100 139 138 139 138 323 148 140 583 573 325 148 140 583 573 326 148 140 583 573 327 148 140 583 573 328 148 140 583 573 324 148 140 332 573 329 148 140 330 575 331 148 140 333 575 159 334 51 140 141 575 160 335 51 140 141 575 161 336 51 140 141 575 337 51 140 141 575 338 51 140 141 575 339 51 140 141 575 340 51 140 141 575 341 51 140 141 575 342 51 140 141 575 343 51 140 141 575 344 51 140 141 575 345 51 140 141 575 346 51 140 141 575 347 51 140 141 575 348 51 140 141 575 162 349 51 140 141 575 163 350 51 140 141 575 164 351 51 140 141 575 156 565 51 140 584 573 157 352 51 140 585 573 158 353 51 140 585 573 165 354 51 140 141 575 166 355 51 140 141 575 167 357 51 140 141 575 168 356 51 140 141 575 169 358 51 140 141 575 170 359 51 140 141 575 171 360 51 140 457 576 172 361 51 140 141 575 601 324 51 140 141 575 311 362 51 140 141 575 305 308 51 140 586 573 173 363 51 140 141 575 309 310 51 140 141 575 312 364 51 140 141 575 313 365 51 140 141 575 314 366 51 140 141 575 306 307 51 140 586 573 315 367 51 140 586 573 174 368 51 140 141 175 369 51 140 587 573 176 177 51 140 587 573 178 370 51 140 587 573 179 371 51 140 587 573 180 372 51 140 587 573 181 373 51 140 141 182 375 382 140 588 573 376 382 140 588 573 377 382 140 588 573 378 382 140 588 573 379 382 140 588 573 380 382 140 588 573 381 382 140 588 573 381 51 140 141 183 383 51 140 141 184 384 51 140 141 185 385 51 140 141 186 386 51 140 141 387 331 51 140 589 573 187 388 51 140 588 573 188 389 51 140 588 573 189 390 51 140 588 573 190 391 51 140 141 191 392 374 140 141 192 393 51 140 141 193 394 382 140 141 194 395 51 140 141 195 396 374 140 141 196 397 374 140 141 197 398 374 140 141 198 399 374 140 141 199 400 374 140 141 200 401 374 140 141 201 402 374 140 141 202 403 374 140 141 203 404 374 140 141 204 405 374 140 141 205 406 51 140 141 206 407 51 140 141 207 408 51 140 141 208 409 51 140 141 209 410 51 140 141 210 411 51 140 141 211 412 51 140 141 212 413 51 140 141 213 414 51 140 141 214 415 51 140 141 215 416 51 140 141 216 417 51 140 141 217 418 51 140 419 147 420 597 320 421 51 140 590 566 567 150 113 51 140 141 321 114 382 140 590 147 141 567 322 115 51 140 590 566 567 151 435 51 140 141 152 436 51 140 141 424 429 51 140 141 425 430 51 140 141 426 431 51 140 440 568 439 438 51 140 440 568 427 432 51 140 141 153 428 51 140 141 154 434 51 140 141 155 437 51 140 141 423 433 51 140 441 218 442 51 140 441 219 458 51 140 441 220 459 51 140 441 221 460 51 140 441 222 461 51 140 441 223 462 51 140 441 224 463 51 140 441 225 464 51 140 441 226 465 51 140 441 227 466 51 140 441 316 467 51 140 441 317 468 51 140 441 318 469 51 140 441 319 470 51 140 441 228 471 51 140 441 229 472 51 140 441 230 473 51 140 441 536 540 51 140 441 231 474 51 140 441 232 475 51 140 441 233 476 51 140 441 234 477 51 140 441 235 478 51 140 591 5 569 236 479 51 140 141 237 480 51 140 141 238 101 51 140 141 239 102 51 140 141 240 103 51 140 141 241 104 51 140 141 242 105 51 140 141 243 106 51 140 141 244 107 51 140 141 245 108 51 140 141 246 109 51 140 141 247 481 382 140 141 248 482 382 140 141 249 483 382 140 141 250 484 382 140 141 251 485 382 140 141 252 486 382 140 141 253 487 382 140 141 254 89 382 140 141 255 488 382 140 141 256 90 382 140 141 257 489 382 140 141 258 92 382 140 141 259 490 382 140 141 260 491 382 140 141 261 492 382 140 141 262 493 382 140 141 263 494 382 140 141 264 495 382 140 141 265 496 382 140 141 266 498 497 570 267 499 382 140 141 268 500 382 140 141 269 501 382 140 141 270 502 382 140 141 271 503 382 140 141 272 504 382 140 141 273 505 382 140 141 274 96 382 140 141 275 97 382 140 141 276 506 382 140 141 277 98 382 140 141 278 507 51 140 592 569 279 508 51 140 592 569 280 509 382 140 141 281 510 382 140 141 282 511 382 140 141 283 512 382 140 141 537 541 382 140 141 538 542 382 140 141 539 543 382 140 141 284 513 382 140 141 285 514 382 140 141 286 515 382 140 141 287 516 382 140 141 288 517 382 140 141 289 518 382 140 141 290 519 51 140 141 291 520 51 140 141 292 521 51 140 141 293 522 51 140 141 294 524 51 140 591 571 295 525 51 140 591 571 296 526 51 140 141 297 527 51 140 141 298 528 51 140 141 299 529 51 140 141 300 530 51 140 141 301 531 51 140 141 302 532 51 140 141 303 533 51 140 534 304 110 51 140 535 10 11 12 18 139 138 139 138 52 51 140 141 53 51 140 141 74 51 140 141 54 51 140 141 75 51 140 141 55 51 140 141 556 51 140 141 56 51 140 141 57 51 140 141 58 51 140 141 76 51 140 141 59 51 140 141 60 51 140 141 61 51 140 141 62 51 140 141 63 51 140 141 64 51 140 141 65 51 140 141 77 51 140 141 66 51 140 141 67 51 140 141 78 140 141 68 140 141 79 51 140 141 80 51 140 141 69 51 140 141 81 51 140 141 70 51 140 141 82 51 140 141 71 51 140 141 72 51 140 141 72 51 140 141 73 51 140 141 83 557 140 593 598 84 51 140 593 598 85 51 140 593 598 86 51 140 593 598 87 51 140 593 598 555 51 140 141 88 557 593 598 21 22 139 138 139 138 113 51 140 141 114 51 140 141 115 51 140 141 13 139 138 139 138 110 382 140 141 111 112 14 139 138 139 138 101 382 140 141 102 382 140 141 103 382 140 141 104 382 140 141 105 382 140 141 106 382 140 141 107 382 140 141 108 382 140 141 109 382 140 141 15 5 16 558 51 140 593 598 559 51 140 593 598 560 51 140 593 598 561 564 140 593 598 562 564 140 593 598 563 564 140 593 598 5 17 89 422 90 91 92 93 94 95 374 140 594 598 96 97 98 5 523 595 599 600

6 9 99 139 138 139 138 146 118 51 140 145 147 141 119 51 140 145 147 141 120 51 140 145 147 141 121 51 140 145 147 141 117 51 140 577 147 141 572 5 122 51 140 577 147 141 572 123 51 140 578 147 141 596 124 51 140 578 147 141 596 125 51 140 578 147 141 596 126 51 140 578 147 141 596 127 51 140 578 147 141 596 5 128 51 140 578 147 141 596 129 51 140 443 147 141 596 130 51 140 579 147 141 596 131 51 142 141 147 141 132 51 142 141 147 141 133 51 142 141 147 141 134 51 142 141 147 141 135 51 142 141 147 141 136 51 142 141 147 141 137 51 142 141 147 141 19 139 138 139 138 23 51 140 141 147 141 24 51 140 141 147 141 143 144 140 141 147 141 25 51 140 141 147 141 26 51 140 141 147 141 27 51 140 141 147 141 28 51 140 141 147 141 29 51 140 141 147 141 30 51 140 141 147 141 31 148 140 580 147 141 32 51 140 580 147 141 33 51 140 141 147 141 34 51 140 141 147 141 35 51 140 141 147 141 36 51 140 141 147 141 37 51 140 141 147 141 38 51 140 141 147 141 39 51 140 141 147 141 20 139 138 139 138 40 41 42 43 51 140 581 573 44 45 51 140 581 573 46 47 51 140 582 574 48 49 51 140 582 574 446 544 444 140 453 545 444 140 454 546 444 140 455 547 444 140 456 548 444 140 447 549 444 140 448 550 444 140 449 551 444 140 450 552 444 140 451 553 444 140 452 554 444 140 149 50 444 140 445 5 100 139 138 139 138 323 148 140 583 573 325 148 140 583 573 326 148 140 583 573 327 148 140 583 573 328 148 140 583 573 324 148 140 332 573 329 148 140 330 575 331 148 140 333 575 159 334 51 140 141 575 160 335 51 140 141 575 161 336 51 140 141 575 337 51 140 141 575 338 51 140 141 575 339 51 140 141 575 340 51 140 141 575 341 51 140 141 575 342 51 140 141 575 343 51 140 141 575 344 51 140 141 575 345 51 140 141 575 346 51 140 141 575 347 51 140 141 575 348 51 140 141 575 162 349 51 140 141 575 163 350 51 140 141 575 164 351 51 140 141 575 156 565 51 140 584 573 157 352 51 140 585 573 158 353 51 140 585 573 165 354 51 140 141 575 166 355 51 140 141 575 167 357 51 140 141 575 168 356 51 140 141 575 169 358 51 140 141 575 170 359 51 140 141 575 171 360 51 140 457 576 172 361 51 140 141 575 601 324 51 140 141 575 311 362 51 140 141 575 305 308 51 140 586 573 173 363 51 140 141 575 309 310 51 140 141 575 312 364 51 140 141 575 313 365 51 140 141 575 314 366 51 140 141 575 306 307 51 140 586 573 315 367 51 140 586 573 174 368 51 140 141 175 369 51 140 587 573 176 177 51 140 587 573 178 370 51 140 587 573 179 371 51 140 587 573 180 372 51 140 587 573 181 373 51 140 141 182 375 382 140 588 573 376 382 140 588 573 377 382 140 588 573 378 382 140 588 573 379 382 140 588 573 380 382 140 588 573 381 382 140 588 573 381 51 140 141 183 383 51 140 141 184 384 51 140 141 185 385 51 140 141 186 386 51 140 141 387 331 51 140 589 573 187 388 51 140 588 573 188 389 51 140 588 573 189 390 51 140 588 573 190 391 51 140 141 191 392 374 140 141 192 393 51 140 141 193 394 382 140 141 194 395 51 140 141 195 396 374 140 141 196 397 374 140 141 197 398 374 140 141 198 399 374 140 141 199 400 374 140 141 200 401 374 140 141 201 402 374 140 141 202 403 374 140 141 203 404 374 140 141 204 405 374 140 141 205 406 51 140 141 206 407 51 140 141 207 408 51 140 141 208 409 51 140 141 209 410 51 140 141 210 411 51 140 141 211 412 51 140 141 212 413 51 140 141 213 414 51 140 141 214 415 51 140 141 215 416 51 140 141 216 417 51 140 141 217 418 51 140 419 147 420 597 320 421 51 140 590 566 567 150 113 51 140 141 321 114 382 140 590 147 141 567 322 115 51 140 590 566 567 151 435 51 140 141 152 436 51 140 141 424 429 51 140 141 425 430 51 140 141 426 431 51 140 440 568 439 438 51 140 440 568 427 432 51 140 141 153 428 51 140 141 154 434 51 140 141 155 437 51 140 141 423 433 51 140 441 218 442 51 140 441 219 458 51 140 441 220 459 51 140 441 221 460 51 140 441 222 461 51 140 441 223 462 51 140 441 224 463 51 140 441 225 464 51 140 441 226 465 51 140 441 227 466 51 140 441 316 467 51 140 441 317 468 51 140 441 318 469 51 140 441 319 470 51 140 441 228 471 51 140 441 229 472 51 140 441 230 473 51 140 441 536 540 51 140 441 231 474 51 140 441 232 475 51 140 441 233 476 51 140 441 234 477 51 140 441 235 478 51 140 591 5 569 236 479 51 140 141 237 480 51 140 141 238 101 51 140 141 239 102 51 140 141 240 103 51 140 141 241 104 51 140 141 242 105 51 140 141 243 106 51 140 141 244 107 51 140 141 245 108 51 140 141 246 109 51 140 141 247 481 382 140 141 248 482 382 140 141 249 483 382 140 141 250 484 382 140 141 251 485 382 140 141 252 486 382 140 141 253 487 382 140 141 254 89 382 140 141 255 488 382 140 141 256 90 382 140 141 257 489 382 140 141 258 92 382 140 141 259 490 382 140 141 260 491 382 140 141 261 492 382 140 141 262 493 382 140 141 263 494 382 140 141 264 495 382 140 141 265 496 382 140 141 266 498 497 570 267 499 382 140 141 268 500 382 140 141 269 501 382 140 141 270 502 382 140 141 271 503 382 140 141 272 504 382 140 141 273 505 382 140 141 274 96 382 140 141 275 97 382 140 141 276 506 382 140 141 277 98 382 140 141 278 507 51 140 592 569 279 508 51 140 592 569 280 509 382 140 141 281 510 382 140 141 282 511 382 140 141 283 512 382 140 141 537 541 382 140 141 538 542 382 140 141 539 543 382 140 141 284 513 382 140 141 285 514 382 140 141 286 515 382 140 141 287 516 382 140 141 288 517 382 140 141 289 518 382 140 141 290 519 51 140 141 291 520 51 140 141 292 521 51 140 141 293 522 51 140 141 294 524 51 140 591 571 295 525 51 140 591 571 296 526 51 140 141 297 527 51 140 141 298 528 51 140 141 299 529 51 140 141 300 530 51 140 141 301 531 51 140 141 302 532 51 140 141 303 533 51 140 534 304 110 51 140 535 10 11 12 18 139 138 139 138 52 51 140 141 53 51 140 141 74 51 140 141 54 51 140 141 75 51 140 141 55 51 140 141 556 51 140 141 56 51 140 141 57 51 140 141 58 51 140 141 76 51 140 141 59 51 140 141 60 51 140 141 61 51 140 141 62 51 140 141 63 51 140 141 64 51 140 141 65 51 140 141 77 51 140 141 66 51 140 141 67 51 140 141 78 140 141 68 140 141 79 51 140 141 80 51 140 141 69 51 140 141 81 51 140 141 70 51 140 141 82 51 140 141 71 51 140 141 72 51 140 141 72 51 140 141 73 51 140 141 83 557 140 593 598 84 51 140 593 598 85 51 140 593 598 86 51 140 593 598 87 51 140 593 598 555 51 140 141 88 557 593 598 21 22 139 138 139 138 113 51 140 141 114 51 140 141 115 51 140 141 13 139 138 139 138 110 382 140 141 111 112 14 139 138 139 138 101 382 140 141 102 382 140 141 103 382 140 141 104 382 140 141 105 382 140 141 106 382 140 141 107 382 140 141 108 382 140 141 109 382 140 141 15 5 16 558 51 140 593 598 559 51 140 593 598 560 51 140 593 598 561 564 140 593 598 562 564 140 593 598 563 564 140 593 598 5 17 89 422 90 91 92 93 94 95 374 140 594 598 96 97 98 5 523 595 599 600

6 9 99 139 138 139 138 146 118 51 140 145 147 141 119 51 140 145 147 141 120 51 140 145 147 141 121 51 140 145 147 141 117 51 140 577 147 141 572 5 122 51 140 577 147 141 572 123 51 140 578 147 141 596 124 51 140 578 147 141 596 125 51 140 578 147 141 596 126 51 140 578 147 141 596 127 51 140 578 147 141 596 5 128 51 140 578 147 141 596 129 51 140 443 147 141 596 130 51 140 579 147 141 596 131 51 142 141 147 141 132 51 142 141 147 141 133 51 142 141 147 141 134 51 142 141 147 141 135 51 142 141 147 141 136 51 142 141 147 141 137 51 142 141 147 141 19 139 138 139 138 23 51 140 141 147 141 24 51 140 141 147 141 143 144 140 141 147 141 25 51 140 141 147 141 26 51 140 141 147 141 27 51 140 141 147 141 28 51 140 141 147 141 29 51 140 141 147 141 30 51 140 141 147 141 31 148 140 580 147 141 32 51 140 580 147 141 33 51 140 141 147 141 34 51 140 141 147 141 35 51 140 141 147 141 36 51 140 141 147 141 37 51 140 141 147 141 38 51 140 141 147 141 39 51 140 141 147 141 20 139 138 139 138 40 41 42 43 51 140 581 573 44 45 51 140 581 573 46 47 51 140 582 574 48 49 51 140 582 574 446 544 444 140 453 545 444 140 454 546 444 140 455 547 444 140 456 548 444 140 447 549 444 140 448 550 444 140 449 551 444 140 450 552 444 140 451 553 444 140 452 554 444 140 149 50 444 140 445 5 100 139 138 139 138 323 148 140 583 573 325 148 140 583 573 326 148 140 583 573 327 148 140 583 573 328 148 140 583 573 324 148 140 332 573 329 148 140 330 575 331 148 140 333 575 159 334 51 140 141 575 160 335 51 140 141 575 161 336 51 140 141 575 337 51 140 141 575 338 51 140 141 575 339 51 140 141 575 340 51 140 141 575 341 51 140 141 575 342 51 140 141 575 343 51 140 141 575 344 51 140 141 575 345 51 140 141 575 346 51 140 141 575 347 51 140 141 575 348 51 140 141 575 162 349 51 140 141 575 163 350 51 140 141 575 164 351 51 140 141 575 156 565 51 140 584 573 157 352 51 140 585 573 158 353 51 140 585 573 165 354 51 140 141 575 166 355 51 140 141 575 167 357 51 140 141 575 168 356 51 140 141 575 169 358 51 140 141 575 170 359 51 140 141 575 171 360 51 140 457 576 172 361 51 140 141 575 601 324 51 140 141 575 311 362 51 140 141 575 305 308 51 140 586 573 173 363 51 140 141 575 309 310 51 140 141 575 312 364 51 140 141 575 313 365 51 140 141 575 314 366 51 140 141 575 306 307 51 140 586 573 315 367 51 140 586 573 174 368 51 140 141 175 369 51 140 587 573 176 177 51 140 587 573 178 370 51 140 587 573 179 371 51 140 587 573 180 372 51 140 587 573 181 373 51 140 141 182 375 382 140 588 573 376 382 140 588 573 377 382 140 588 573 378 382 140 588 573 379 382 140 588 573 380 382 140 588 573 381 382 140 588 573 381 51 140 141 183 383 51 140 141 184 384 51 140 141 185 385 51 140 141 186 386 51 140 141 387 331 51 140 589 573 187 388 51 140 588 573 188 389 51 140 588 573 189 390 51 140 588 573 190 391 51 140 141 191 392 374 140 141 192 393 51 140 141 193 394 382 140 141 194 395 51 140 141 195 396 374 140 141 196 397 374 140 141 197 398 374 140 141 198 399 374 140 141 199 400 374 140 141 200 401 374 140 141 201 402 374 140 141 202 403 374 140 141 203 404 374 140 141 204 405 374 140 141 205 406 51 140 141 206 407 51 140 141 207 408 51 140 141 208 409 51 140 141 209 410 51 140 141 210 411 51 140 141 211 412 51 140 141 212 413 51 140 141 213 414 51 140 141 214 415 51 140 141 215 416 51 140 141 216 417 51 140 141 217 418 51 140 419 147 420 597 320 421 51 140 590 566 567 150 113 51 140 141 321 114 382 140 590 147 141 567 322 115 51 140 590 566 567 151 435 51 140 141 152 436 51 140 141 424 429 51 140 141 425 430 51 140 141 426 431 51 140 440 568 439 438 51 140 440 568 427 432 51 140 141 153 428 51 140 141 154 434 51 140 141 155 437 51 140 141 423 433 51 140 441 218 442 51 140 441 219 458 51 140 441 220 459 51 140 441 221 460 51 140 441 222 461 51 140 441 223 462 51 140 441 224 463 51 140 441 225 464 51 140 441 226 465 51 140 441 227 466 51 140 441 316 467 51 140 441 317 468 51 140 441 318 469 51 140 441 319 470 51 140 441 228 471 51 140 441 229 472 51 140 441 230 473 51 140 441 536 540 51 140 441 231 474 51 140 441 232 475 51 140 441 233 476 51 140 441 234 477 51 140 441 235 478 51 140 591 5 569 236 479 51 140 141 237 480 51 140 141 238 101 51 140 141 239 102 51 140 141 240 103 51 140 141 241 104 51 140 141 242 105 51 140 141 243 106 51 140 141 244 107 51 140 141 245 108 51 140 141 246 109 51 140 141 247 481 382 140 141 248 482 382 140 141 249 483 382 140 141 250 484 382 140 141 251 485 382 140 141 252 486 382 140 141 253 487 382 140 141 254 89 382 140 141 255 488 382 140 141 256 90 382 140 141 257 489 382 140 141 258 92 382 140 141 259 490 382 140 141 260 491 382 140 141 261 492 382 140 141 262 493 382 140 141 263 494 382 140 141 264 495 382 140 141 265 496 382 140 141 266 498 497 570 267 499 382 140 141 268 500 382 140 141 269 501 382 140 141 270 502 382 140 141 271 503 382 140 141 272 504 382 140 141 273 505 382 140 141 274 96 382 140 141 275 97 382 140 141 276 506 382 140 141 277 98 382 140 141 278 507 51 140 592 569 279 508 51 140 592 569 280 509 382 140 141 281 510 382 140 141 282 511 382 140 141 283 512 382 140 141 537 541 382 140 141 538 542 382 140 141 539 543 382 140 141 284 513 382 140 141 285 514 382 140 141 286 515 382 140 141 287 516 382 140 141 288 517 382 140 141 289 518 382 140 141 290 519 51 140 141 291 520 51 140 141 292 521 51 140 141 293 522 51 140 141 294 524 51 140 591 571 295 525 51 140 591 571 296 526 51 140 141 297 527 51 140 141 298 528 51 140 141 299 529 51 140 141 300 530 51 140 141 301 531 51 140 141 302 532 51 140 141 303 533 51 140 534 304 110 51 140 535 10 11 12 18 139 138 139 138 52 51 140 141 53 51 140 141 74 51 140 141 54 51 140 141 75 51 140 141 55 51 140 141 556 51 140 141 56 51 140 141 57 51 140 141 58 51 140 141 76 51 140 141 59 51 140 141 60 51 140 141 61 51 140 141 62 51 140 141 63 51 140 141 64 51 140 141 65 51 140 141 77 51 140 141 66 51 140 141 67 51 140 141 78 140 141 68 140 141 79 51 140 141 80 51 140 141 69 51 140 141 81 51 140 141 70 51 140 141 82 51 140 141 71 51 140 141 72 51 140 141 72 51 140 141 73 51 140 141 83 557 140 593 598 84 51 140 593 598 85 51 140 593 598 86 51 140 593 598 87 51 140 593 598 555 51 140 141 88 557 593 598 21 22 139 138 139 138 113 51 140 141 114 51 140 141 115 51 140 141 13 139 138 139 138 110 382 140 141 111 112 14 139 138 139 138 101 382 140 141 102 382 140 141 103 382 140 141 104 382 140 141 105 382 140 141 106 382 140 141 107 382 140 141 108 382 140 141 109 382 140 141 15 5 16 558 51 140 593 598 559 51 140 593 598 560 51 140 593 598 561 564 140 593 598 562 564 140 593 598 563 564 140 593 598 5 17 89 422 90 91 92 93 94 95 374 140 594 598 96 97 98 5 523 595 599 600

6 9 99 139 138 139 138 146 118 51 140 145 147 141 119 51 140 145 147 141 120 51 140 145 147 141 121 51 140 145 147 141 117 51 140 577 147 141 572 5 122 51 140 577 147 141 572 123 51 140 578 147 141 596 124 51 140 578 147 141 596 125 51 140 578 147 141 596 126 51 140 578 147 141 596 127 51 140 578 147 141 596 5 128 51 140 578 147 141 596 129 51 140 443 147 141 596 130 51 140 579 147 141 596 131 51 142 141 147 141 132 51 142 141 147 141 133 51 142 141 147 141 134 51 142 141 147 141 135 51 142 141 147 141 136 51 142 141 147 141 137 51 142 141 147 141 19 139 138 139 138 23 51 140 141 147 141 24 51 140 141 147 141 143 144 140 141 147 141 25 51 140 141 147 141 26 51 140 141 147 141 27 51 140 141 147 141 28 51 140 141 147 141 29 51 140 141 147 141 30 51 140 141 147 141 31 148 140 580 147 141 32 51 140 580 147 141 33 51 140 141 147 141 34 51 140 141 147 141 35 51 140 141 147 141 36 51 140 141 147 141 37 51 140 141 147 141 38 51 140 141 147 141 39 51 140 141 147 141 20 139 138 139 138 40 41 42 43 51 140 581 573 44 45 51 140 581 573 46 47 51 140 582 574 48 49 51 140 582 574 446 544 444 140 453 545 444 140 454 546 444 140 455 547 444 140 456 548 444 140 447 549 444 140 448 550 444 140 449 551 444 140 450 552 444 140 451 553 444 140 452 554 444 140 149 50 444 140 445 5 100 139 138 139 138 323 148 140 583 573 325 148 140 583 573 326 148 140 583 573 327 148 140 583 573 328 148 140 583 573 324 148 140 332 573 329 148 140 330 575 331 148 140 333 575 159 334 51 140 141 575 160 335 51 140 141 575 161 336 51 140 141 575 337 51 140 141 575 338 51 140 141 575 339 51 140 141 575 340 51 140 141 575 341 51 140 141 575 342 51 140 141 575 343 51 140 141 575 344 51 140 141 575 345 51 140 141 575 346 51 140 141 575 347 51 140 141 575 348 51 140 141 575 162 349 51 140 141 575 163 350 51 140 141 575 164 351 51 140 141 575 156 565 51 140 584 573 157 352 51 140 585 573 158 353 51 140 585 573 165 354 51 140 141 575 166 355 51 140 141 575 167 357 51 140 141 575 168 356 51 140 141 575 169 358 51 140 141 575 170 359 51 140 141 575 171 360 51 140 457 576 172 361 51 140 141 575 601 324 51 140 141 575 311 362 51 140 141 575 305 308 51 140 586 573 173 363 51 140 141 575 309 310 51 140 141 575 312 364 51 140 141 575 313 365 51 140 141 575 314 366 51 140 141 575 306 307 51 140 586 573 315 367 51 140 586 573 174 368 51 140 141 175 369 51 140 587 573 176 177 51 140 587 573 178 370 51 140 587 573 179 371 51 140 587 573 180 372 51 140 587 573 181 373 51 140 141 182 375 382 140 588 573 376 382 140 588 573 377 382 140 588 573 378 382 140 588 573 379 382 140 588 573 380 382 140 588 573 381 382 140 588 573 381 51 140 141 183 383 51 140 141 184 384 51 140 141 185 385 51 140 141 186 386 51 140 141 387 331 51 140 589 573 187 388 51 140 588 573 188 389 51 140 588 573 189 390 51 140 588 573 190 391 51 140 141 191 392 374 140 141 192 393 51 140 141 193 394 382 140 141 194 395 51 140 141 195 396 374 140 141 196 397 374 140 141 197 398 374 140 141 198 399 374 140 141 199 400 374 140 141 200 401 374 140 141 201 402 374 140 141 202 403 374 140 141 203 404 374 140 141 204 405 374 140 141 205 406 51 140 141 206 407 51 140 141 207 408 51 140 141 208 409 51 140 141 209 410 51 140 141 210 411 51 140 141 211 412 51 140 141 212 413 51 140 141 213 414 51 140 141 214 415 51 140 141 215 416 51 140 141 216 417 51 140 141 217 418 51 140 419 147 420 597 320 421 51 140 590 566 567 150 113 51 140 141 321 114 382 140 590 147 141 567 322 115 51 140 590 566 567 151 435 51 140 141 152 436 51 140 141 424 429 51 140 141 425 430 51 140 141 426 431 51 140 440 568 439 438 51 140 440 568 427 432 51 140 141 153 428 51 140 141 154 434 51 140 141 155 437 51 140 141 423 433 51 140 441 218 442 51 140 441 219 458 51 140 441 220 459 51 140 441 221 460 51 140 441 222 461 51 140 441 223 462 51 140 441 224 463 51 140 441 225 464 51 140 441 226 465 51 140 441 227 466 51 140 441 316 467 51 140 441 317 468 51 140 441 318 469 51 140 441 319 470 51 140 441 228 471 51 140 441 229 472 51 140 441 230 473 51 140 441 536 540 51 140 441 231 474 51 140 441 232 475 51 140 441 233 476 51 140 441 234 477 51 140 441 235 478 51 140 591 5 569 236 479 51 140 141 237 480 51 140 141 238 101 51 140 141 239 102 51 140 141 240 103 51 140 141 241 104 51 140 141 242 105 51 140 141 243 106 51 140 141 244 107 51 140 141 245 108 51 140 141 246 109 51 140 141 247 481 382 140 141 248 482 382 140 141 249 483 382 140 141 250 484 382 140 141 251 485 382 140 141 252 486 382 140 141 253 487 382 140 141 254 89 382 140 141 255 488 382 140 141 256 90 382 140 141 257 489 382 140 141 258 92 382 140 141 259 490 382 140 141 260 491 382 140 141 261 492 382 140 141 262 493 382 140 141 263 494 382 140 141 264 495 382 140 141 265 496 382 140 141 266 498 497 570 267 499 382 140 141 268 500 382 140 141 269 501 382 140 141 270 502 382 140 141 271 503 382 140 141 272 504 382 140 141 273 505 382 140 141 274 96 382 140 141 275 97 382 140 141 276 506 382 140 141 277 98 382 140 141 278 507 51 140 592 569 279 508 51 140 592 569 280 509 382 140 141 281 510 382 140 141 282 511 382 140 141 283 512 382 140 141 537 541 382 140 141 538 542 382 140 141 539 543 382 140 141 284 513 382 140 141 285 514 382 140 141 286 515 382 140 141 287 516 382 140 141 288 517 382 140 141 289 518 382 140 141 290 519 51 140 141 291 520 51 140 141 292 521 51 140 141 293 522 51 140 141 294 524 51 140 591 571 295 525 51 140 591 571 296 526 51 140 141 297 527 51 140 141 298 528 51 140 141 299 529 51 140 141 300 530 51 140 141 301 531 51 140 141 302 532 51 140 141 303 533 51 140 534 304 110 51 140 535 10 11 12 18 139 138 139 138 52 51 140 141 53 51 140 141 74 51 140 141 54 51 140 141 75 51 140 141 55 51 140 141 556 51 140 141 56 51 140 141 57 51 140 141 58 51 140 141 76 51 140 141 59 51 140 141 60 51 140 141 61 51 140 141 62 51 140 141 63 51 140 141 64 51 140 141 65 51 140 141 77 51 140 141 66 51 140 141 67 51 140 141 78 140 141 68 140 141 79 51 140 141 80 51 140 141 69 51 140 141 81 51 140 141 70 51 140 141 82 51 140 141 71 51 140 141 72 51 140 141 72 51 140 141 73 51 140 141 83 557 140 593 598 84 51 140 593 598 85 51 140 593 598 86 51 140 593 598 87 51 140 593 598 555 51 140 141 88 557 593 598 21 22 139 138 139 138 113 51 140 141 114 51 140 141 115 51 140 141 13 139 138 139 138 110 382 140 141 111 112 14 139 138 139 138 101 382 140 141 102 382 140 141 103 382 140 141 104 382 140 141 105 382 140 141 106 382 140 141 107 382 140 141 108 382 140 141 109 382 140 141 15 5 16 558 51 140 593 598 559 51 140 593 598 560 51 140 593 598 561 564 140 593 598 562 564 140 593 598 563 564 140 593 598 5 17 89 422 90 91 92 93 94 95 374 140 594 598 96 97 98 5 523 595 599 600

6 9 99 139 138 139 138 146 118 51 140 145 147 141 119 51 140 145 147 141 120 51 140 145 147 141 121 51 140 145 147 141 117 51 140 577 147 141 572 5 122 51 140 577 147 141 572 123 51 140 578 147 141 596 124 51 140 578 147 141 596 125 51 140 578 147 141 596 126 51 140 578 147 141 596 127 51 140 578 147 141 596 5 128 51 140 578 147 141 596 129 51 140 443 147 141 596 130 51 140 579 147 141 596 131 51 142 141 147 141 132 51 142 141 147 141 133 51 142 141 147 141 134 51 142 141 147 141 135 51 142 141 147 141 136 51 142 141 147 141 137 51 142 141 147 141 19 139 138 139 138 23 51 140 141 147 141 24 51 140 141 147 141 143 144 140 141 147 141 25 51 140 141 147 141 26 51 140 141 147 141 27 51 140 141 147 141 28 51 140 141 147 141 29 51 140 141 147 141 30 51 140 141 147 141 31 148 140 580 147 141 32 51 140 580 147 141 33 51 140 141 147 141 34 51 140 141 147 141 35 51 140 141 147 141 36 51 140 141 147 141 37 51 140 141 147 141 38 51 140 141 147 141 39 51 140 141 147 141 20 139 138 139 138 40 41 42 43 51 140 581 573 44 45 51 140 581 573 46 47 51 140 582 574 48 49 51 140 582 574 446 544 444 140 453 545 444 140 454 546 444 140 455 547 444 140 456 548 444 140 447 549 444 140 448 550 444 140 449 551 444 140 450 552 444 140 451 553 444 140 452 554 444 140 149 50 444 140 445 5 100 139 138 139 138 323 148 140 583 573 325 148 140 583 573 326 148 140 583 573 327 148 140 583 573 328 148 140 583 573 324 148 140 332 573 329 148 140 330 575 331 148 140 333 575 159 334 51 140 141 575 160 335 51 140 141 575 161 336 51 140 141 575 337 51 140 141 575 338 51 140 141 575 339 51 140 141 575 340 51 140 141 575 341 51 140 141 575 342 51 140 141 575 343 51 140 141 575 344 51 140 141 575 345 51 140 141 575 346 51 140 141 575 347 51 140 141 575 348 51 140 141 575 162 349 51 140 141 575 163 350 51 140 141 575 164 351 51 140 141 575 156 565 51 140 584 573 157 352 51 140 585 573 158 353 51 140 585 573 165 354 51 140 141 575 166 355 51 140 141 575 167 357 51 140 141 575 168 356 51 140 141 575 169 358 51 140 141 575 170 359 51 140 141 575 171 360 51 140 457 576 172 361 51 140 141 575 601 324 51 140 141 575 311 362 51 140 141 575 305 308 51 140 586 573 173 363 51 140 141 575 309 310 51 140 141 575 312 364 51 140 141 575 313 365 51 140 141 575 314 366 51 140 141 575 306 307 51 140 586 573 315 367 51 140 586 573 174 368 51 140 141 175 369 51 140 587 573 176 177 51 140 587 573 178 370 51 140 587 573 179 371 51 140 587 573 180 372 51 140 587 573 181 373 51 140 141 182 375 382 140 588 573 376 382 140 588 573 377 382 140 588 573 378 382 140 588 573 379 382 140 588 573 380 382 140 588 573 381 382 140 588 573 381 51 140 141 183 383 51 140 141 184 384 51 140 141 185 385 51 140 141 186 386 51 140 141 387 331 51 140 589 573 187 388 51 140 588 573 188 389 51 140 588 573 189 390 51 140 588 573 190 391 51 140 141 191 392 374 140 141 192 393 51 140 141 193 394 382 140 141 194 395 51 140 141 195 396 374 140 141 196 397 374 140 141 197 398 374 140 141 198 399 374 140 141 199 400 374 140 141 200 401 374 140 141 201 402 374 140 141 202 403 374 140 141 203 404 374 140 141 204 405 374 140 141 205 406 51 140 141 206 407 51 140 141 207 408 51 140 141 208 409 51 140 141 209 410 51 140 141 210 411 51 140 141 211 412 51 140 141 212 413 51 140 141 213 414 51 140 141 214 415 51 140 141 215 416 51 140 141 216 417 51 140 141 217 418 51 140 419 147 420 597 320 421 51 140 590 566 567 150 113 51 140 141 321 114 382 140 590 147 141 567 322 115 51 140 590 566 567 151 435 51 140 141 152 436 51 140 141 424 429 51 140 141 425 430 51 140 141 426 431 51 140 440 568 439 438 51 140 440 568 427 432 51 140 141 153 428 51 140 141 154 434 51 140 141 155 437 51 140 141 423 433 51 140 441 218 442 51 140 441 219 458 51 140 441 220 459 51 140 441 221 460 51 140 441 222 461 51 140 441 223 462 51 140 441 224 463 51 140 441 225 464 51 140 441 226 465 51 140 441 227 466 51 140 441 316 467 51 140 441 317 468 51 140 441 318 469 51 140 441 319 470 51 140 441 228 471 51 140 441 229 472 51 140 441 230 473 51 140 441 536 540 51 140 441 231 474 51 140 441 232 475 51 140 441 233 476 51 140 441 234 477 51 140 441 235 478 51 140 591 5 569 236 479 51 140 141 237 480 51 140 141 238 101 51 140 141 239 102 51 140 141 240 103 51 140 141 241 104 51 140 141 242 105 51 140 141 243 106 51 140 141 244 107 51 140 141 245 108 51 140 141 246 109 51 140 141 247 481 382 140 141 248 482 382 140 141 249 483 382 140 141 250 484 382 140 141 251 485 382 140 141 252 486 382 140 141 253 487 382 140 141 254 89 382 140 141 255 488 382 140 141 256 90 382 140 141 257 489 382 140 141 258 92 382 140 141 259 490 382 140 141 260 491 382 140 141 261 492 382 140 141 262 493 382 140 141 263 494 382 140 141 264 495 382 140 141 265 496 382 140 141 266 498 497 570 267 499 382 140 141 268 500 382 140 141 269 501 382 140 141 270 502 382 140 141 271 503 382 140 141 272 504 382 140 141 273 505 382 140 141 274 96 382 140 141 275 97 382 140 141 276 506 382 140 141 277 98 382 140 141 278 507 51 140 592 569 279 508 51 140 592 569 280 509 382 140 141 281 510 382 140 141 282 511 382 140 141 283 512 382 140 141 537 541 382 140 141 538 542 382 140 141 539 543 382 140 141 284 513 382 140 141 285 514 382 140 141 286 515 382 140 141 287 516 382 140 141 288 517 382 140 141 289 518 382 140 141 290 519 51 140 141 291 520 51 140 141 292 521 51 140 141 293 522 51 140 141 294 524 51 140 591 571 295 525 51 140 591 571 296 526 51 140 141 297 527 51 140 141 298 528 51 140 141 299 529 51 140 141 300 530 51 140 141 301 531 51 140 141 302 532 51 140 141 303 533 51 140 534 304 110 51 140 535 10 11 12 18 139 138 139 138 52 51 140 141 53 51 140 141 74 51 140 141 54 51 140 141 75 51 140 141 55 51 140 141 556 51 140 141 56 51 140 141 57 51 140 141 58 51 140 141 76 51 140 141 59 51 140 141 60 51 140 141 61 51 140 141 62 51 140 141 63 51 140 141 64 51 140 141 65 51 140 141 77 51 140 141 66 51 140 141 67 51 140 141 78 140 141 68 140 141 79 51 140 141 80 51 140 141 69 51 140 141 81 51 140 141 70 51 140 141 82 51 140 141 71 51 140 141 72 51 140 141 72 51 140 141 73 51 140 141 83 557 140 593 598 84 51 140 593 598 85 51 140 593 598 86 51 140 593 598 87 51 140 593 598 555 51 140 141 88 557 593 598 21 22 139 138 139 138 113 51 140 141 114 51 140 141 115 51 140 141 13 139 138 139 138 110 382 140 141 111 112 14 139 138 139 138 101 382 140 141 102 382 140 141 103 382 140 141 104 382 140 141 105 382 140 141 106 382 140 141 107 382 140 141 108 382 140 141 109 382 140 141 15 5 16 558 51 140 593 598 559 51 140 593 598 560 51 140 593 598 561 564 140 593 598 562 564 140 593 598 563 564 140 593 598 5 17 89 422 90 91 92 93 94 95 374 140 594 598 96 97 98 5 523 595 599 600

6 9 99 139 138 139 138 146 118 51 140 145 147 141 119 51 140 145 147 141 120 51 140 145 147 141 121 51 140 145 147 141 117 51 140 577 147 141 572 5 122 51 140 577 147 141 572 123 51 140 578 147 141 596 124 51 140 578 147 141 596 125 51 140 578 147 141 596 126 51 140 578 147 141 596 127 51 140 578 147 141 596 5 128 51 140 578 147 141 596 129 51 140 443 147 141 596 130 51 140 579 147 141 596 131 51 142 141 147 141 132 51 142 141 147 141 133 51 142 141 147 141 134 51 142 141 147 141 135 51 142 141 147 141 136 51 142 141 147 141 137 51 142 141 147 141 19 139 138 139 138 23 51 140 141 147 141 24 51 140 141 147 141 143 144 140 141 147 141 25 51 140 141 147 141 26 51 140 141 147 141 27 51 140 141 147 141 28 51 140 141 147 141 29 51 140 141 147 141 30 51 140 141 147 141 31 148 140 580 147 141 32 51 140 580 147 141 33 51 140 141 147 141 34 51 140 141 147 141 35 51 140 141 147 141 36 51 140 141 147 141 37 51 140 141 147 141 38 51 140 141 147 141 39 51 140 141 147 141 20 139 138 139 138 40 41 42 43 51 140 581 573 44 45 51 140 581 573 46 47 51 140 582 574 48 49 51 140 582 574 446 544 444 140 453 545 444 140 454 546 444 140 455 547 444 140 456 548 444 140 447 549 444 140 448 550 444 140 449 551 444 140 450 552 444 140 451 553 444 140 452 554 444 140 149 50 444 140 445 5 100 139 138 139 138 323 148 140 583 573 325 148 140 583 573 326 148 140 583 573 327 148 140 583 573 328 148 140 583 573 324 148 140 332 573 329 148 140 330 575 331 148 140 333 575 159 334 51 140 141 575 160 335 51 140 141 575 161 336 51 140 141 575 337 51 140 141 575 338 51 140 141 575 339 51 140 141 575 340 51 140 141 575 341 51 140 141 575 342 51 140 141 575 343 51 140 141 575 344 51 140 141 575 345 51 140 141 575 346 51 140 141 575 347 51 140 141 575 348 51 140 141 575 162 349 51 140 141 575 163 350 51 140 141 575 164 351 51 140 141 575 156 565 51 140 584 573 157 352 51 140 585 573 158 353 51 140 585 573 165 354 51 140 141 575 166 355 51 140 141 575 167 357 51 140 141 575 168 356 51 140 141 575 169 358 51 140 141 575 170 359 51 140 141 575 171 360 51 140 457 576 172 361 51 140 141 575 601 324 51 140 141 575 311 362 51 140 141 575 305 308 51 140 586 573 173 363 51 140 141 575 309 310 51 140 141 575 312 364 51 140 141 575 313 365 51 140 141 575 314 366 51 140 141 575 306 307 51 140 586 573 315 367 51 140 586 573 174 368 51 140 141 175 369 51 140 587 573 176 177 51 140 587 573 178 370 51 140 587 573 179 371 51 140 587 573 180 372 51 140 587 573 181 373 51 140 141 182 375 382 140 588 573 376 382 140 588 573 377 382 140 588 573 378 382 140 588 573 379 382 140 588 573 380 382 140 588 573 381 382 140 588 573 381 51 140 141 183 383 51 140 141 184 384 51 140 141 185 385 51 140 141 186 386 51 140 141 387 331 51 140 589 573 187 388 51 140 588 573 188 389 51 140 588 573 189 390 51 140 588 573 190 391 51 140 141 191 392 374 140 141 192 393 51 140 141 193 394 382 140 141 194 395 51 140 141 195 396 374 140 141 196 397 374 140 141 197 398 374 140 141 198 399 374 140 141 199 400 374 140 141 200 401 374 140 141 201 402 374 140 141 202 403 374 140 141 203 404 374 140 141 204 405 374 140 141 205 406 51 140 141 206 407 51 140 141 207 408 51 140 141 208 409 51 140 141 209 410 51 140 141 210 411 51 140 141 211 412 51 140 141 212 413 51 140 141 213 414 51 140 141 214 415 51 140 141 215 416 51 140 141 216 417 51 140 141 217 418 51 140 419 147 420 597 320 421 51 140 590 566 567 150 113 51 140 141 321 114 382 140 590 147 141 567 322 115 51 140 590 566 567 151 435 51 140 141 152 436 51 140 141 424 429 51 140 141 425 430 51 140 141 426 431 51 140 440 568 439 438 51 140 440 568 427 432 51 140 141 153 428 51 140 141 154 434 51 140 141 155 437 51 140 141 423 433 51 140 441 218 442 51 140 441 219 458 51 140 441 220 459 51 140 441 221 460 51 140 441 222 461 51 140 441 223 462 51 140 441 224 463 51 140 441 225 464 51 140 441 226 465 51 140 441 227 466 51 140 441 316 467 51 140 441 317 468 51 140 441 318 469 51 140 441 319 470 51 140 441 228 471 51 140 441 229 472 51 140 441 230 473 51 140 441 536 540 51 140 441 231 474 51 140 441 232 475 51 140 441 233 476 51 140 441 234 477 51 140 441 235 478 51 140 591 5 569 236 479 51 140 141 237 480 51 140 141 238 101 51 140 141 239 102 51 140 141 240 103 51 140 141 241 104 51 140 141 242 105 51 140 141 243 106 51 140 141 244 107 51 140 141 245 108 51 140 141 246 109 51 140 141 247 481 382 140 141 248 482 382 140 141 249 483 382 140 141 250 484 382 140 141 251 485 382 140 141 252 486 382 140 141 253 487 382 140 141 254 89 382 140 141 255 488 382 140 141 256 90 382 140 141 257 489 382 140 141 258 92 382 140 141 259 490 382 140 141 260 491 382 140 141 261 492 382 140 141 262 493 382 140 141 263 494 382 140 141 264 495 382 140 141 265 496 382 140 141 266 498 497 570 267 499 382 140 141 268 500 382 140 141 269 501 382 140 141 270 502 382 140 141 271 503 382 140 141 272 504 382 140 141 273 505 382 140 141 274 96 382 140 141 275 97 382 140 141 276 506 382 140 141 277 98 382 140 141 278 507 51 140 592 569 279 508 51 140 592 569 280 509 382 140 141 281 510 382 140 141 282 511 382 140 141 283 512 382 140 141 537 541 382 140 141 538 542 382 140 141 539 543 382 140 141 284 513 382 140 141 285 514 382 140 141 286 515 382 140 141 287 516 382 140 141 288 517 382 140 141 289 518 382 140 141 290 519 51 140 141 291 520 51 140 141 292 521 51 140 141 293 522 51 140 141 294 524 51 140 591 571 295 525 51 140 591 571 296 526 51 140 141 297 527 51 140 141 298 528 51 140 141 299 529 51 140 141 300 530 51 140 141 301 531 51 140 141 302 532 51 140 141 303 533 51 140 534 304 110 51 140 535 10 11 12 18 139 138 139 138 52 51 140 141 53 51 140 141 74 51 140 141 54 51 140 141 75 51 140 141 55 51 140 141 556 51 140 141 56 51 140 141 57 51 140 141 58 51 140 141 76 51 140 141 59 51 140 141 60 51 140 141 61 51 140 141 62 51 140 141 63 51 140 141 64 51 140 141 65 51 140 141 77 51 140 141 66 51 140 141 67 51 140 141 78 140 141 68 140 141 79 51 140 141 80 51 140 141 69 51 140 141 81 51 140 141 70 51 140 141 82 51 140 141 71 51 140 141 72 51 140 141 72 51 140 141 73 51 140 141 83 557 140 593 598 84 51 140 593 598 85 51 140 593 598 86 51 140 593 598 87 51 140 593 598 555 51 140 141 88 557 593 598 21 22 139 138 139 138 113 51 140 141 114 51 140 141 115 51 140 141 13 139 138 139 138 110 382 140 141 111 112 14 139 138 139 138 101 382 140 141 102 382 140 141 103 382 140 141 104 382 140 141 105 382 140 141 106 382 140 141 107 382 140 141 108 382 140 141 109 382 140 141 15 5 16 558 51 140 593 598 559 51 140 593 598 560 51 140 593 598 561 564 140 593 598 562 564 140 593 598 563 564 140 593 598 5 17 89 422 90 91 92 93 94 95 374 140 594 598 96 97 98 5 523 595 599 600

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

6 9 99 139 138 139 138 146 118 51 140 145 147 141 119 51 140 145 147 141 120 51 140 145 147 141 121 51 140 145 147 141 117 51 140 577 147 141 572 5 122 51 140 577 147 141 572 123 51 140 578 147 141 596 124 51 140 578 147 141 596 125 51 140 578 147 141 596 126 51 140 578 147 141 596 127 51 140 578 147 141 596 5 128 51 140 578 147 141 596 129 51 140 443 147 141 596 130 51 140 579 147 141 596 131 51 142 141 147 141 132 51 142 141 147 141 133 51 142 141 147 141 134 51 142 141 147 141 135 51 142 141 147 141 136 51 142 141 147 141 137 51 142 141 147 141 19 139 138 139 138 23 51 140 141 147 141 24 51 140 141 147 141 143 144 140 141 147 141 25 51 140 141 147 141 26 51 140 141 147 141 27 51 140 141 147 141 28 51 140 141 147 141 29 51 140 141 147 141 30 51 140 141 147 141 31 148 140 580 147 141 32 51 140 580 147 141 33 51 140 141 147 141 34 51 140 141 147 141 35 51 140 141 147 141 36 51 140 141 147 141 37 51 140 141 147 141 38 51 140 141 147 141 39 51 140 141 147 141 20 139 138 139 138 40 41 42 43 51 140 581 573 44 45 51 140 581 573 46 47 51 140 582 574 48 49 51 140 582 574 446 544 444 140 453 545 444 140 454 546 444 140 455 547 444 140 456 548 444 140 447 549 444 140 448 550 444 140 449 551 444 140 450 552 444 140 451 553 444 140 452 554 444 140 149 50 444 140 445 5 100 139 138 139 138 323 148 140 583 573 325 148 140 583 573 326 148 140 583 573 327 148 140 583 573 328 148 140 583 573 324 148 140 332 573 329 148 140 330 575 331 148 140 333 575 159 334 51 140 141 575 160 335 51 140 141 575 161 336 51 140 141 575 337 51 140 141 575 338 51 140 141 575 339 51 140 141 575 340 51 140 141 575 341 51 140 141 575 342 51 140 141 575 343 51 140 141 575 344 51 140 141 575 345 51 140 141 575 346 51 140 141 575 347 51 140 141 575 348 51 140 141 575 162 349 51 140 141 575 163 350 51 140 141 575 164 351 51 140 141 575 156 565 51 140 584 573 157 352 51 140 585 573 158 353 51 140 585 573 165 354 51 140 141 575 166 355 51 140 141 575 167 357 51 140 141 575 168 356 51 140 141 575 169 358 51 140 141 575 170 359 51 140 141 575 171 360 51 140 457 576 172 361 51 140 141 575 601 324 51 140 141 575 311 362 51 140 141 575 305 308 51 140 586 573 173 363 51 140 141 575 309 310 51 140 141 575 312 364 51 140 141 575 313 365 51 140 141 575 314 366 51 140 141 575 306 307 51 140 586 573 315 367 51 140 586 573 174 368 51 140 141 175 369 51 140 587 573 176 177 51 140 587 573 178 370 51 140 587 573 179 371 51 140 587 573 180 372 51 140 587 573 181 373 51 140 141 182 375 382 140 588 573 376 382 140 588 573 377 382 140 588 573 378 382 140 588 573 379 382 140 588 573 380 382 140 588 573 381 382 140 588 573 381 51 140 141 183 383 51 140 141 184 384 51 140 141 185 385 51 140 141 186 386 51 140 141 387 331 51 140 589 573 187 388 51 140 588 573 188 389 51 140 588 573 189 390 51 140 588 573 190 391 51 140 141 191 392 374 140 141 192 393 51 140 141 193 394 382 140 141 194 395 51 140 141 195 396 374 140 141 196 397 374 140 141 197 398 374 140 141 198 399 374 140 141 199 400 374 140 141 200 401 374 140 141 201 402 374 140 141 202 403 374 140 141 203 404 374 140 141 204 405 374 140 141 205 406 51 140 141 206 407 51 140 141 207 408 51 140 141 208 409 51 140 141 209 410 51 140 141 210 411 51 140 141 211 412 51 140 141 212 413 51 140 141 213 414 51 140 141 214 415 51 140 141 215 416 51 140 141 216 417 51 140 141 217 418 51 140 419 147 420 597 320 421 51 140 590 566 567 150 113 51 140 141 321 114 382 140 590 147 141 567 322 115 51 140 590 566 567 151 435 51 140 141 152 436 51 140 141 424 429 51 140 141 425 430 51 140 141 426 431 51 140 440 568 439 438 51 140 440 568 427 432 51 140 141 153 428 51 140 141 154 434 51 140 141 155 437 51 140 141 423 433 51 140 441 218 442 51 140 441 219 458 51 140 441 220 459 51 140 441 221 460 51 140 441 222 461 51 140 441 223 462 51 140 441 224 463 51 140 441 225 464 51 140 441 226 465 51 140 441 227 466 51 140 441 316 467 51 140 441 317 468 51 140 441 318 469 51 140 441 319 470 51 140 441 228 471 51 140 441 229 472 51 140 441 230 473 51 140 441 536 540 51 140 441 231 474 51 140 441 232 475 51 140 441 233 476 51 140 441 234 477 51 140 441 235 478 51 140 591 5 569 236 479 51 140 141 237 480 51 140 141 238 101 51 140 141 239 102 51 140 141 240 103 51 140 141 241 104 51 140 141 242 105 51 140 141 243 106 51 140 141 244 107 51 140 141 245 108 51 140 141 246 109 51 140 141 247 481 382 140 141 248 482 382 140 141 249 483 382 140 141 250 484 382 140 141 251 485 382 140 141 252 486 382 140 141 253 487 382 140 141 254 89 382 140 141 255 488 382 140 141 256 90 382 140 141 257 489 382 140 141 258 92 382 140 141 259 490 382 140 141 260 491 382 140 141 261 492 382 140 141 262 493 382 140 141 263 494 382 140 141 264 495 382 140 141 265 496 382 140 141 266 498 497 570 267 499 382 140 141 268 500 382 140 141 269 501 382 140 141 270 502 382 140 141 271 503 382 140 141 272 504 382 140 141 273 505 382 140 141 274 96 382 140 141 275 97 382 140 141 276 506 382 140 141 277 98 382 140 141 278 507 51 140 592 569 279 508 51 140 592 569 280 509 382 140 141 281 510 382 140 141 282 511 382 140 141 283 512 382 140 141 537 541 382 140 141 538 542 382 140 141 539 543 382 140 141 284 513 382 140 141 285 514 382 140 141 286 515 382 140 141 287 516 382 140 141 288 517 382 140 141 289 518 382 140 141 290 519 51 140 141 291 520 51 140 141 292 521 51 140 141 293 522 51 140 141 294 524 51 140 591 571 295 525 51 140 591 571 296 526 51 140 141 297 527 51 140 141 298 528 51 140 141 299 529 51 140 141 300 530 51 140 141 301 531 51 140 141 302 532 51 140 141 303 533 51 140 534 304 110 51 140 535 10 11 12 18 139 138 139 138 52 51 140 141 53 51 140 141 74 51 140 141 54 51 140 141 75 51 140 141 55 51 140 141 556 51 140 141 56 51 140 141 57 51 140 141 58 51 140 141 76 51 140 141 59 51 140 141 60 51 140 141 61 51 140 141 62 51 140 141 63 51 140 141 64 51 140 141 65 51 140 141 77 51 140 141 66 51 140 141 67 51 140 141 78 140 141 68 140 141 79 51 140 141 80 51 140 141 69 51 140 141 81 51 140 141 70 51 140 141 82 51 140 141 71 51 140 141 72 51 140 141 72 51 140 141 73 51 140 141 83 557 140 593 598 84 51 140 593 598 85 51 140 593 598 86 51 140 593 598 87 51 140 593 598 555 51 140 141 88 557 593 598 21 22 139 138 139 138 113 51 140 141 114 51 140 141 115 51 140 141 13 139 138 139 138 110 382 140 141 111 112 14 139 138 139 138 101 382 140 141 102 382 140 141 103 382 140 141 104 382 140 141 105 382 140 141 106 382 140 141 107 382 140 141 108 382 140 141 109 382 140 141 15 5 16 558 51 140 593 598 559 51 140 593 598 560 51 140 593 598 561 564 140 593 598 562 564 140 593 598 563 564 140 593 598 5 17 89 422 90 91 92 93 94 95 374 140 594 598 96 97 98 5 523 595 599 600

6 9 99 139 138 139 138 146 118 51 140 145 147 141 119 51 140 145 147 141 120 51 140 145 147 141 121 51 140 145 147 141 117 51 140 577 147 141 572 5 122 51 140 577 147 141 572 123 51 140 578 147 141 596 124 51 140 578 147 141 596 125 51 140 578 147 141 596 126 51 140 578 147 141 596 127 51 140 578 147 141 596 5 128 51 140 578 147 141 596 129 51 140 443 147 141 596 130 51 140 579 147 141 596 131 51 142 141 147 141 132 51 142 141 147 141 133 51 142 141 147 141 134 51 142 141 147 141 135 51 142 141 147 141 136 51 142 141 147 141 137 51 142 141 147 141 19 139 138 139 138 23 51 140 141 147 141 24 51 140 141 147 141 143 144 140 141 147 141 25 51 140 141 147 141 26 51 140 141 147 141 27 51 140 141 147 141 28 51 140 141 147 141 29 51 140 141 147 141 30 51 140 141 147 141 31 148 140 580 147 141 32 51 140 580 147 141 33 51 140 141 147 141 34 51 140 141 147 141 35 51 140 141 147 141 36 51 140 141 147 141 37 51 140 141 147 141 38 51 140 141 147 141 39 51 140 141 147 141 20 139 138 139 138 40 41 42 43 51 140 581 573 44 45 51 140 581 573 46 47 51 140 582 574 48 49 51 140 582 574 446 544 444 140 453 545 444 140 454 546 444 140 455 547 444 140 456 548 444 140 447 549 444 140 448 550 444 140 449 551 444 140 450 552 444 140 451 553 444 140 452 554 444 140 149 50 444 140 445 5 100 139 138 139 138 323 148 140 583 573 325 148 140 583 573 326 148 140 583 573 327 148 140 583 573 328 148 140 583 573 324 148 140 332 573 329 148 140 330 575 331 148 140 333 575 159 334 51 140 141 575 160 335 51 140 141 575 161 336 51 140 141 575 337 51 140 141 575 338 51 140 141 575 339 51 140 141 575 340 51 140 141 575 341 51 140 141 575 342 51 140 141 575 343 51 140 141 575 344 51 140 141 575 345 51 140 141 575 346 51 140 141 575 347 51 140 141 575 348 51 140 141 575 162 349 51 140 141 575 163 350 51 140 141 575 164 351 51 140 141 575 156 565 51 140 584 573 157 352 51 140 585 573 158 353 51 140 585 573 165 354 51 140 141 575 166 355 51 140 141 575 167 357 51 140 141 575 168 356 51 140 141 575 169 358 51 140 141 575 170 359 51 140 141 575 171 360 51 140 457 576 172 361 51 140 141 575 601 324 51 140 141 575 311 362 51 140 141 575 305 308 51 140 586 573 173 363 51 140 141 575 309 310 51 140 141 575 312 364 51 140 141 575 313 365 51 140 141 575 314 366 51 140 141 575 306 307 51 140 586 573 315 367 51 140 586 573 174 368 51 140 141 175 369 51 140 587 573 176 177 51 140 587 573 178 370 51 140 587 573 179 371 51 140 587 573 180 372 51 140 587 573 181 373 51 140 141 182 375 382 140 588 573 376 382 140 588 573 377 382 140 588 573 378 382 140 588 573 379 382 140 588 573 380 382 140 588 573 381 382 140 588 573 381 51 140 141 183 383 51 140 141 184 384 51 140 141 185 385 51 140 141 186 386 51 140 141 387 331 51 140 589 573 187 388 51 140 588 573 188 389 51 140 588 573 189 390 51 140 588 573 190 391 51 140 141 191 392 374 140 141 192 393 51 140 141 193 394 382 140 141 194 395 51 140 141 195 396 374 140 141 196 397 374 140 141 197 398 374 140 141 198 399 374 140 141 199 400 374 140 141 200 401 374 140 141 201 402 374 140 141 202 403 374 140 141 203 404 374 140 141 204 405 374 140 141 205 406 51 140 141 206 407 51 140 141 207 408 51 140 141 208 409 51 140 141 209 410 51 140 141 210 411 51 140 141 211 412 51 140 141 212 413 51 140 141 213 414 51 140 141 214 415 51 140 141 215 416 51 140 141 216 417 51 140 141 217 418 51 140 419 147 420 597 320 421 51 140 590 566 567 150 113 51 140 141 321 114 382 140 590 147 141 567 322 115 51 140 590 566 567 151 435 51 140 141 152 436 51 140 141 424 429 51 140 141 425 430 51 140 141 426 431 51 140 440 568 439 438 51 140 440 568 427 432 51 140 141 153 428 51 140 141 154 434 51 140 141 155 437 51 140 141 423 433 51 140 441 218 442 51 140 441 219 458 51 140 441 220 459 51 140 441 221 460 51 140 441 222 461 51 140 441 223 462 51 140 441 224 463 51 140 441 225 464 51 140 441 226 465 51 140 441 227 466 51 140 441 316 467 51 140 441 317 468 51 140 441 318 469 51 140 441 319 470 51 140 441 228 471 51 140 441 229 472 51 140 441 230 473 51 140 441 536 540 51 140 441 231 474 51 140 441 232 475 51 140 441 233 476 51 140 441 234 477 51 140 441 235 478 51 140 591 5 569 236 479 51 140 141 237 480 51 140 141 238 101 51 140 141 239 102 51 140 141 240 103 51 140 141 241 104 51 140 141 242 105 51 140 141 243 106 51 140 141 244 107 51 140 141 245 108 51 140 141 246 109 51 140 141 247 481 382 140 141 248 482 382 140 141 249 483 382 140 141 250 484 382 140 141 251 485 382 140 141 252 486 382 140 141 253 487 382 140 141 254 89 382 140 141 255 488 382 140 141 256 90 382 140 141 257 489 382 140 141 258 92 382 140 141 259 490 382 140 141 260 491 382 140 141 261 492 382 140 141 262 493 382 140 141 263 494 382 140 141 264 495 382 140 141 265 496 382 140 141 266 498 497 570 267 499 382 140 141 268 500 382 140 141 269 501 382 140 141 270 502 382 140 141 271 503 382 140 141 272 504 382 140 141 273 505 382 140 141 274 96 382 140 141 275 97 382 140 141 276 506 382 140 141 277 98 382 140 141 278 507 51 140 592 569 279 508 51 140 592 569 280 509 382 140 141 281 510 382 140 141 282 511 382 140 141 283 512 382 140 141 537 541 382 140 141 538 542 382 140 141 539 543 382 140 141 284 513 382 140 141 285 514 382 140 141 286 515 382 140 141 287 516 382 140 141 288 517 382 140 141 289 518 382 140 141 290 519 51 140 141 291 520 51 140 141 292 521 51 140 141 293 522 51 140 141 294 524 51 140 591 571 295 525 51 140 591 571 296 526 51 140 141 297 527 51 140 141 298 528 51 140 141 299 529 51 140 141 300 530 51 140 141 301 531 51 140 141 302 532 51 140 141 303 533 51 140 534 304 110 51 140 535 10 11 12 18 139 138 139 138 52 51 140 141 53 51 140 141 74 51 140 141 54 51 140 141 75 51 140 141 55 51 140 141 556 51 140 141 56 51 140 141 57 51 140 141 58 51 140 141 76 51 140 141 59 51 140 141 60 51 140 141 61 51 140 141 62 51 140 141 63 51 140 141 64 51 140 141 65 51 140 141 77 51 140 141 66 51 140 141 67 51 140 141 78 140 141 68 140 141 79 51 140 141 80 51 140 141 69 51 140 141 81 51 140 141 70 51 140 141 82 51 140 141 71 51 140 141 72 51 140 141 72 51 140 141 73 51 140 141 83 557 140 593 598 84 51 140 593 598 85 51 140 593 598 86 51 140 593 598 87 51 140 593 598 555 51 140 141 88 557 593 598 21 22 139 138 139 138 113 51 140 141 114 51 140 141 115 51 140 141 13 139 138 139 138 110 382 140 141 111 112 14 139 138 139 138 101 382 140 141 102 382 140 141 103 382 140 141 104 382 140 141 105 382 140 141 106 382 140 141 107 382 140 141 108 382 140 141 109 382 140 141 15 5 16 558 51 140 593 598 559 51 140 593 598 560 51 140 593 598 561 564 140 593 598 562 564 140 593 598 563 564 140 593 598 5 17 89 422 90 91 92 93 94 95 374 140 594 598 96 97 98 5 523 595 599 600

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

6 9 99 139 138 139 138 146 118 51 140 145 147 141 119 51 140 145 147 141 120 51 140 145 147 141 121 51 140 145 147 141 117 51 140 577 147 141 572 5 122 51 140 577 147 141 572 123 51 140 578 147 141 596 124 51 140 578 147 141 596 125 51 140 578 147 141 596 126 51 140 578 147 141 596 127 51 140 578 147 141 596 5 128 51 140 578 147 141 596 129 51 140 443 147 141 596 130 51 140 579 147 141 596 131 51 142 141 147 141 132 51 142 141 147 141 133 51 142 141 147 141 134 51 142 141 147 141 135 51 142 141 147 141 136 51 142 141 147 141 137 51 142 141 147 141 19 139 138 139 138 23 51 140 141 147 141 24 51 140 141 147 141 143 144 140 141 147 141 25 51 140 141 147 141 26 51 140 141 147 141 27 51 140 141 147 141 28 51 140 141 147 141 29 51 140 141 147 141 30 51 140 141 147 141 31 148 140 580 147 141 32 51 140 580 147 141 33 51 140 141 147 141 34 51 140 141 147 141 35 51 140 141 147 141 36 51 140 141 147 141 37 51 140 141 147 141 38 51 140 141 147 141 39 51 140 141 147 141 20 139 138 139 138 40 41 42 43 51 140 581 573 44 45 51 140 581 573 46 47 51 140 582 574 48 49 51 140 582 574 446 544 444 140 453 545 444 140 454 546 444 140 455 547 444 140 456 548 444 140 447 549 444 140 448 550 444 140 449 551 444 140 450 552 444 140 451 553 444 140 452 554 444 140 149 50 444 140 445 5 100 139 138 139 138 323 148 140 583 573 325 148 140 583 573 326 148 140 583 573 327 148 140 583 573 328 148 140 583 573 324 148 140 332 573 329 148 140 330 575 331 148 140 333 575 159 334 51 140 141 575 160 335 51 140 141 575 161 336 51 140 141 575 337 51 140 141 575 338 51 140 141 575 339 51 140 141 575 340 51 140 141 575 341 51 140 141 575 342 51 140 141 575 343 51 140 141 575 344 51 140 141 575 345 51 140 141 575 346 51 140 141 575 347 51 140 141 575 348 51 140 141 575 162 349 51 140 141 575 163 350 51 140 141 575 164 351 51 140 141 575 156 565 51 140 584 573 157 352 51 140 585 573 158 353 51 140 585 573 165 354 51 140 141 575 166 355 51 140 141 575 167 357 51 140 141 575 168 356 51 140 141 575 169 358 51 140 141 575 170 359 51 140 141 575 171 360 51 140 457 576 172 361 51 140 141 575 601 324 51 140 141 575 311 362 51 140 141 575 305 308 51 140 586 573 173 363 51 140 141 575 309 310 51 140 141 575 312 364 51 140 141 575 313 365 51 140 141 575 314 366 51 140 141 575 306 307 51 140 586 573 315 367 51 140 586 573 174 368 51 140 141 175 369 51 140 587 573 176 177 51 140 587 573 178 370 51 140 587 573 179 371 51 140 587 573 180 372 51 140 587 573 181 373 51 140 141 182 375 382 140 588 573 376 382 140 588 573 377 382 140 588 573 378 382 140 588 573 379 382 140 588 573 380 382 140 588 573 381 382 140 588 573 381 51 140 141 183 383 51 140 141 184 384 51 140 141 185 385 51 140 141 186 386 51 140 141 387 331 51 140 589 573 187 388 51 140 588 573 188 389 51 140 588 573 189 390 51 140 588 573 190 391 51 140 141 191 392 374 140 141 192 393 51 140 141 193 394 382 140 141 194 395 51 140 141 195 396 374 140 141 196 397 374 140 141 197 398 374 140 141 198 399 374 140 141 199 400 374 140 141 200 401 374 140 141 201 402 374 140 141 202 403 374 140 141 203 404 374 140 141 204 405 374 140 141 205 406 51 140 141 206 407 51 140 141 207 408 51 140 141 208 409 51 140 141 209 410 51 140 141 210 411 51 140 141 211 412 51 140 141 212 413 51 140 141 213 414 51 140 141 214 415 51 140 141 215 416 51 140 141 216 417 51 140 141 217 418 51 140 419 147 420 597 320 421 51 140 590 566 567 150 113 51 140 141 321 114 382 140 590 147 141 567 322 115 51 140 590 566 567 151 435 51 140 141 152 436 51 140 141 424 429 51 140 141 425 430 51 140 141 426 431 51 140 440 568 439 438 51 140 440 568 427 432 51 140 141 153 428 51 140 141 154 434 51 140 141 155 437 51 140 141 423 433 51 140 441 218 442 51 140 441 219 458 51 140 441 220 459 51 140 441 221 460 51 140 441 222 461 51 140 441 223 462 51 140 441 224 463 51 140 441 225 464 51 140 441 226 465 51 140 441 227 466 51 140 441 316 467 51 140 441 317 468 51 140 441 318 469 51 140 441 319 470 51 140 441 228 471 51 140 441 229 472 51 140 441 230 473 51 140 441 536 540 51 140 441 231 474 51 140 441 232 475 51 140 441 233 476 51 140 441 234 477 51 140 441 235 478 51 140 591 5 569 236 479 51 140 141 237 480 51 140 141 238 101 51 140 141 239 102 51 140 141 240 103 51 140 141 241 104 51 140 141 242 105 51 140 141 243 106 51 140 141 244 107 51 140 141 245 108 51 140 141 246 109 51 140 141 247 481 382 140 141 248 482 382 140 141 249 483 382 140 141 250 484 382 140 141 251 485 382 140 141 252 486 382 140 141 253 487 382 140 141 254 89 382 140 141 255 488 382 140 141 256 90 382 140 141 257 489 382 140 141 258 92 382 140 141 259 490 382 140 141 260 491 382 140 141 261 492 382 140 141 262 493 382 140 141 263 494 382 140 141 264 495 382 140 141 265 496 382 140 141 266 498 497 570 267 499 382 140 141 268 500 382 140 141 269 501 382 140 141 270 502 382 140 141 271 503 382 140 141 272 504 382 140 141 273 505 382 140 141 274 96 382 140 141 275 97 382 140 141 276 506 382 140 141 277 98 382 140 141 278 507 51 140 592 569 279 508 51 140 592 569 280 509 382 140 141 281 510 382 140 141 282 511 382 140 141 283 512 382 140 141 537 541 382 140 141 538 542 382 140 141 539 543 382 140 141 284 513 382 140 141 285 514 382 140 141 286 515 382 140 141 287 516 382 140 141 288 517 382 140 141 289 518 382 140 141 290 519 51 140 141 291 520 51 140 141 292 521 51 140 141 293 522 51 140 141 294 524 51 140 591 571 295 525 51 140 591 571 296 526 51 140 141 297 527 51 140 141 298 528 51 140 141 299 529 51 140 141 300 530 51 140 141 301 531 51 140 141 302 532 51 140 141 303 533 51 140 534 304 110 51 140 535 10 11 12 18 139 138 139 138 52 51 140 141 53 51 140 141 74 51 140 141 54 51 140 141 75 51 140 141 55 51 140 141 556 51 140 141 56 51 140 141 57 51 140 141 58 51 140 141 76 51 140 141 59 51 140 141 60 51 140 141 61 51 140 141 62 51 140 141 63 51 140 141 64 51 140 141 65 51 140 141 77 51 140 141 66 51 140 141 67 51 140 141 78 140 141 68 140 141 79 51 140 141 80 51 140 141 69 51 140 141 81 51 140 141 70 51 140 141 82 51 140 141 71 51 140 141 72 51 140 141 72 51 140 141 73 51 140 141 83 557 140 593 598 84 51 140 593 598 85 51 140 593 598 86 51 140 593 598 87 51 140 593 598 555 51 140 141 88 557 593 598 21 22 139 138 139 138 113 51 140 141 114 51 140 141 115 51 140 141 13 139 138 139 138 110 382 140 141 111 112 14 139 138 139 138 101 382 140 141 102 382 140 141 103 382 140 141 104 382 140 141 105 382 140 141 106 382 140 141 107 382 140 141 108 382 140 141 109 382 140 141 15 5 16 558 51 140 593 598 559 51 140 593 598 560 51 140 593 598 561 564 140 593 598 562 564 140 593 598 563 564 140 593 598 5 17 89 422 90 91 92 93 94 95 374 140 594 598 96 97 98 5 523 595 599 600

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

607 661 660 604 602 603 606 138 146 610 620 611 621 612 622 613 623 614 624 615 625 616 626 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 617 627 618 628 633 634 635 636 637 634 638 639 640 641 642 143 619 651 650 649 648 609 647 646 645 644 643 652 653 654 655 656 657 658 659 331 388 388 390

607 661 660 604 602 603 606 138 146 610 620 611 621 612 622 613 623 614 624 615 625 616 626 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 617 627 618 628 633 634 635 636 637 634 638 639 640 641 642 143 619 651 650 649 648 609 647 646 645 644 643 652 653 654 655 656 657 658 659 331 388 388 390

607 661 660 604 602 603 606 138 146 610 620 611 621 612 622 613 623 614 624 615 625 616 626 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 617 627 618 628 633 634 635 636 637 634 638 639 640 641 642 143 619 651 650 649 648 609 647 646 645 644 643 652 653 654 655 656 657 658 659 331 388 388 390

607 661 660 604 602 603 606 138 146 610 620 611 621 612 622 613 623 614 624 615 625 616 626 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 617 627 618 628 633 634 635 636 637 634 638 639 640 641 642 143 619 651 650 649 648 609 647 646 645 644 643 652 653 654 655 656 657 658 659 331 388 388 390

607 661 660 604 602 603 606 138 146 610 620 611 621 612 622 613 623 614 624 615 625 616 626 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 617 627 618 628 633 634 635 636 637 634 638 639 640 641 642 143 619 651 650 649 648 609 647 646 645 644 643 652 653 654 655 656 657 658 659 331 388 388 390

607 661 660 604 602 603 606 138 146 610 620 611 621 612 622 613 623 614 624 615 625 616 626 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 617 627 618 628 633 634 635 636 637 634 638 639 640 641 642 143 619 651 650 649 648 609 647 646 645 644 643 652 653 654 655 656 657 658 659 331 388 388 390

607 661 660 604 602 603 606 138 146 610 620 611 621 612 622 613 623 614 624 615 625 616 626 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 617 627 618 628 633 634 635 636 637 634 638 639 640 641 642 143 619 651 650 649 648 609 647 646 645 644 643 652 653 654 655 656 657 658 659 331 388 388 390

607 661 660 604 602 603 606 138 146 610 620 611 621 612 622 613 623 614 624 615 625 616 626 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 617 627 618 628 633 634 635 636 637 634 638 639 640 641 642 143 619 651 650 649 648 609 647 646 645 644 643 652 653 654 655 656 657 658 659 331 388 388 390

6 9 99 139 138 139 138 146 118 51 140 145 147 141 119 51 140 145 147 141 120 51 140 145 147 141 121 51 140 145 147 141 117 51 140 577 147 141 572 5 122 51 140 577 147 141 572 123 51 140 578 147 141 596 124 51 140 578 147 141 596 125 51 140 578 147 141 596 126 51 140 578 147 141 596 127 51 140 578 147 141 596 5 128 51 140 578 147 141 596 129 51 140 443 147 141 596 130 51 140 579 147 141 596 131 51 142 141 147 141 132 51 142 141 147 141 133 51 142 141 147 141 134 51 142 141 147 141 135 51 142 141 147 141 136 51 142 141 147 141 137 51 142 141 147 141 19 139 138 139 138 23 51 140 141 147 141 24 51 140 141 147 141 143 144 140 141 147 141 25 51 140 141 147 141 26 51 140 141 147 141 27 51 140 141 147 141 28 51 140 141 147 141 29 51 140 141 147 141 30 51 140 141 147 141 31 148 140 580 147 141 32 51 140 580 147 141 33 51 140 141 147 141 34 51 140 141 147 141 35 51 140 141 147 141 36 51 140 141 147 141 37 51 140 141 147 141 38 51 140 141 147 141 39 51 140 141 147 141 20 139 138 139 138 40 41 42 43 51 140 581 573 44 45 51 140 581 573 46 47 51 140 582 574 48 49 51 140 582 574 446 544 444 140 453 545 444 140 454 546 444 140 455 547 444 140 456 548 444 140 447 549 444 140 448 550 444 140 449 551 444 140 450 552 444 140 451 553 444 140 452 554 444 140 149 50 444 140 445 5 100 139 138 139 138 323 148 140 583 573 325 148 140 583 573 326 148 140 583 573 327 148 140 583 573 328 148 140 583 573 324 148 140 332 573 329 148 140 330 575 331 148 140 333 575 159 334 51 140 141 575 160 335 51 140 141 575 161 336 51 140 141 575 337 51 140 141 575 338 51 140 141 575 339 51 140 141 575 340 51 140 141 575 341 51 140 141 575 342 51 140 141 575 343 51 140 141 575 344 51 140 141 575 345 51 140 141 575 346 51 140 141 575 347 51 140 141 575 348 51 140 141 575 162 349 51 140 141 575 163 350 51 140 141 575 164 351 51 140 141 575 156 565 51 140 584 573 157 352 51 140 585 573 158 353 51 140 585 573 165 354 51 140 141 575 166 355 51 140 141 575 167 357 51 140 141 575 168 356 51 140 141 575 169 358 51 140 141 575 170 359 51 140 141 575 171 360 51 140 457 576 172 361 51 140 141 575 601 324 51 140 141 575 311 362 51 140 141 575 305 308 51 140 586 573 173 363 51 140 141 575 309 310 51 140 141 575 312 364 51 140 141 575 313 365 51 140 141 575 314 366 51 140 141 575 306 307 51 140 586 573 315 367 51 140 586 573 174 368 51 140 141 175 369 51 140 587 573 176 177 51 140 587 573 178 370 51 140 587 573 179 371 51 140 587 573 180 372 51 140 587 573 181 373 51 140 141 182 375 382 140 588 573 376 382 140 588 573 377 382 140 588 573 378 382 140 588 573 379 382 140 588 573 380 382 140 588 573 381 382 140 588 573 381 51 140 141 183 383 51 140 141 184 384 51 140 141 185 385 51 140 141 186 386 51 140 141 387 331 51 140 589 573 187 388 51 140 588 573 188 389 51 140 588 573 189 390 51 140 588 573 190 391 51 140 141 191 392 374 140 141 192 393 51 140 141 193 394 382 140 141 194 395 51 140 141 195 396 374 140 141 196 397 374 140 141 197 398 374 140 141 198 399 374 140 141 199 400 374 140 141 200 401 374 140 141 201 402 374 140 141 202 403 374 140 141 203 404 374 140 141 204 405 374 140 141 205 406 51 140 141 206 407 51 140 141 207 408 51 140 141 208 409 51 140 141 209 410 51 140 141 210 411 51 140 141 211 412 51 140 141 212 413 51 140 141 213 414 51 140 141 214 415 51 140 141 215 416 51 140 141 216 417 51 140 141 217 418 51 140 419 147 420 597 320 421 51 140 590 566 567 150 113 51 140 141 321 114 382 140 590 147 141 567 322 115 51 140 590 566 567 151 435 51 140 141 152 436 51 140 141 424 429 51 140 141 425 430 51 140 141 426 431 51 140 440 568 439 438 51 140 440 568 427 432 51 140 141 153 428 51 140 141 154 434 51 140 141 155 437 51 140 141 423 433 51 140 441 218 442 51 140 441 219 458 51 140 441 220 459 51 140 441 221 460 51 140 441 222 461 51 140 441 223 462 51 140 441 224 463 51 140 441 225 464 51 140 441 226 465 51 140 441 227 466 51 140 441 316 467 51 140 441 317 468 51 140 441 318 469 51 140 441 319 470 51 140 441 228 471 51 140 441 229 472 51 140 441 230 473 51 140 441 536 540 51 140 441 231 474 51 140 441 232 475 51 140 441 233 476 51 140 441 234 477 51 140 441 235 478 51 140 591 5 569 236 479 51 140 141 237 480 51 140 141 238 101 51 140 141 239 102 51 140 141 240 103 51 140 141 241 104 51 140 141 242 105 51 140 141 243 106 51 140 141 244 107 51 140 141 245 108 51 140 141 246 109 51 140 141 247 481 382 140 141 248 482 382 140 141 249 483 382 140 141 250 484 382 140 141 251 485 382 140 141 252 486 382 140 141 253 487 382 140 141 254 89 382 140 141 255 488 382 140 141 256 90 382 140 141 257 489 382 140 141 258 92 382 140 141 259 490 382 140 141 260 491 382 140 141 261 492 382 140 141 262 493 382 140 141 263 494 382 140 141 264 495 382 140 141 265 496 382 140 141 266 498 497 570 267 499 382 140 141 268 500 382 140 141 269 501 382 140 141 270 502 382 140 141 271 503 382 140 141 272 504 382 140 141 273 505 382 140 141 274 96 382 140 141 275 97 382 140 141 276 506 382 140 141 277 98 382 140 141 278 507 51 140 592 569 279 508 51 140 592 569 280 509 382 140 141 281 510 382 140 141 282 511 382 140 141 283 512 382 140 141 537 541 382 140 141 538 542 382 140 141 539 543 382 140 141 284 513 382 140 141 285 514 382 140 141 286 515 382 140 141 287 516 382 140 141 288 517 382 140 141 289 518 382 140 141 290 519 51 140 141 291 520 51 140 141 292 521 51 140 141 293 522 51 140 141 294 524 51 140 591 571 295 525 51 140 591 571 296 526 51 140 141 297 527 51 140 141 298 528 51 140 141 299 529 51 140 141 300 530 51 140 141 301 531 51 140 141 302 532 51 140 141 303 533 51 140 534 304 110 51 140 535 10 11 12 18 139 138 139 138 52 51 140 141 53 51 140 141 74 51 140 141 54 51 140 141 75 51 140 141 55 51 140 141 556 51 140 141 56 51 140 141 57 51 140 141 58 51 140 141 76 51 140 141 59 51 140 141 60 51 140 141 61 51 140 141 62 51 140 141 63 51 140 141 64 51 140 141 65 51 140 141 77 51 140 141 66 51 140 141 67 51 140 141 78 140 141 68 140 141 79 51 140 141 80 51 140 141 69 51 140 141 81 51 140 141 70 51 140 141 82 51 140 141 71 51 140 141 72 51 140 141 72 51 140 141 73 51 140 141 83 557 140 593 598 84 51 140 593 598 85 51 140 593 598 86 51 140 593 598 87 51 140 593 598 555 51 140 141 88 557 593 598 21 22 139 138 139 138 113 51 140 141 114 51 140 141 115 51 140 141 13 139 138 139 138 110 382 140 141 111 112 14 139 138 139 138 101 382 140 141 102 382 140 141 103 382 140 141 104 382 140 141 105 382 140 141 106 382 140 141 107 382 140 141 108 382 140 141 109 382 140 141 15 5 16 558 51 140 593 598 559 51 140 593 598 560 51 140 593 598 561 564 140 593 598 562 564 140 593 598 563 564 140 593 598 5 17 89 422 90 91 92 93 94 95 374 140 594 598 96 97 98 5 523 595 599 600

6 9 99 139 138 139 138 146 118 51 140 145 147 141 119 51 140 145 147 141 120 51 140 145 147 141 121 51 140 145 147 141 117 51 140 577 147 141 572 5 122 51 140 577 147 141 572 123 51 140 578 147 141 596 124 51 140 578 147 141 596 125 51 140 578 147 141 596 126 51 140 578 147 141 596 127 51 140 578 147 141 596 5 128 51 140 578 147 141 596 129 51 140 443 147 141 596 130 51 140 579 147 141 596 131 51 142 141 147 141 132 51 142 141 147 141 133 51 142 141 147 141 134 51 142 141 147 141 135 51 142 141 147 141 136 51 142 141 147 141 137 51 142 141 147 141 19 139 138 139 138 23 51 140 141 147 141 24 51 140 141 147 141 143 144 140 141 147 141 25 51 140 141 147 141 26 51 140 141 147 141 27 51 140 141 147 141 28 51 140 141 147 141 29 51 140 141 147 141 30 51 140 141 147 141 31 148 140 580 147 141 32 51 140 580 147 141 33 51 140 141 147 141 34 51 140 141 147 141 35 51 140 141 147 141 36 51 140 141 147 141 37 51 140 141 147 141 38 51 140 141 147 141 39 51 140 141 147 141 20 139 138 139 138 40 41 42 43 51 140 581 573 44 45 51 140 581 573 46 47 51 140 582 574 48 49 51 140 582 574 446 544 444 140 453 545 444 140 454 546 444 140 455 547 444 140 456 548 444 140 447 549 444 140 448 550 444 140 449 551 444 140 450 552 444 140 451 553 444 140 452 554 444 140 149 50 444 140 445 5 100 139 138 139 138 323 148 140 583 573 325 148 140 583 573 326 148 140 583 573 327 148 140 583 573 328 148 140 583 573 324 148 140 332 573 329 148 140 330 575 331 148 140 333 575 159 334 51 140 141 575 160 335 51 140 141 575 161 336 51 140 141 575 337 51 140 141 575 338 51 140 141 575 339 51 140 141 575 340 51 140 141 575 341 51 140 141 575 342 51 140 141 575 343 51 140 141 575 344 51 140 141 575 345 51 140 141 575 346 51 140 141 575 347 51 140 141 575 348 51 140 141 575 162 349 51 140 141 575 163 350 51 140 141 575 164 351 51 140 141 575 156 565 51 140 584 573 157 352 51 140 585 573 158 353 51 140 585 573 165 354 51 140 141 575 166 355 51 140 141 575 167 357 51 140 141 575 168 356 51 140 141 575 169 358 51 140 141 575 170 359 51 140 141 575 171 360 51 140 457 576 172 361 51 140 141 575 601 324 51 140 141 575 311 362 51 140 141 575 305 308 51 140 586 573 173 363 51 140 141 575 309 310 51 140 141 575 312 364 51 140 141 575 313 365 51 140 141 575 314 366 51 140 141 575 306 307 51 140 586 573 315 367 51 140 586 573 174 368 51 140 141 175 369 51 140 587 573 176 177 51 140 587 573 178 370 51 140 587 573 179 371 51 140 587 573 180 372 51 140 587 573 181 373 51 140 141 182 375 382 140 588 573 376 382 140 588 573 377 382 140 588 573 378 382 140 588 573 379 382 140 588 573 380 382 140 588 573 381 382 140 588 573 381 51 140 141 183 383 51 140 141 184 384 51 140 141 185 385 51 140 141 186 386 51 140 141 387 331 51 140 589 573 187 388 51 140 588 573 188 389 51 140 588 573 189 390 51 140 588 573 190 391 51 140 141 191 392 374 140 141 192 393 51 140 141 193 394 382 140 141 194 395 51 140 141 195 396 374 140 141 196 397 374 140 141 197 398 374 140 141 198 399 374 140 141 199 400 374 140 141 200 401 374 140 141 201 402 374 140 141 202 403 374 140 141 203 404 374 140 141 204 405 374 140 141 205 406 51 140 141 206 407 51 140 141 207 408 51 140 141 208 409 51 140 141 209 410 51 140 141 210 411 51 140 141 211 412 51 140 141 212 413 51 140 141 213 414 51 140 141 214 415 51 140 141 215 416 51 140 141 216 417 51 140 141 217 418 51 140 419 147 420 597 320 421 51 140 590 566 567 150 113 51 140 141 321 114 382 140 590 147 141 567 322 115 51 140 590 566 567 151 435 51 140 141 152 436 51 140 141 424 429 51 140 141 425 430 51 140 141 426 431 51 140 440 568 439 438 51 140 440 568 427 432 51 140 141 153 428 51 140 141 154 434 51 140 141 155 437 51 140 141 423 433 51 140 441 218 442 51 140 441 219 458 51 140 441 220 459 51 140 441 221 460 51 140 441 222 461 51 140 441 223 462 51 140 441 224 463 51 140 441 225 464 51 140 441 226 465 51 140 441 227 466 51 140 441 316 467 51 140 441 317 468 51 140 441 318 469 51 140 441 319 470 51 140 441 228 471 51 140 441 229 472 51 140 441 230 473 51 140 441 536 540 51 140 441 231 474 51 140 441 232 475 51 140 441 233 476 51 140 441 234 477 51 140 441 235 478 51 140 591 5 569 236 479 51 140 141 237 480 51 140 141 238 101 51 140 141 239 102 51 140 141 240 103 51 140 141 241 104 51 140 141 242 105 51 140 141 243 106 51 140 141 244 107 51 140 141 245 108 51 140 141 246 109 51 140 141 247 481 382 140 141 248 482 382 140 141 249 483 382 140 141 250 484 382 140 141 251 485 382 140 141 252 486 382 140 141 253 487 382 140 141 254 89 382 140 141 255 488 382 140 141 256 90 382 140 141 257 489 382 140 141 258 92 382 140 141 259 490 382 140 141 260 491 382 140 141 261 492 382 140 141 262 493 382 140 141 263 494 382 140 141 264 495 382 140 141 265 496 382 140 141 266 498 497 570 267 499 382 140 141 268 500 382 140 141 269 501 382 140 141 270 502 382 140 141 271 503 382 140 141 272 504 382 140 141 273 505 382 140 141 274 96 382 140 141 275 97 382 140 141 276 506 382 140 141 277 98 382 140 141 278 507 51 140 592 569 279 508 51 140 592 569 280 509 382 140 141 281 510 382 140 141 282 511 382 140 141 283 512 382 140 141 537 541 382 140 141 538 542 382 140 141 539 543 382 140 141 284 513 382 140 141 285 514 382 140 141 286 515 382 140 141 287 516 382 140 141 288 517 382 140 141 289 518 382 140 141 290 519 51 140 141 291 520 51 140 141 292 521 51 140 141 293 522 51 140 141 294 524 51 140 591 571 295 525 51 140 591 571 296 526 51 140 141 297 527 51 140 141 298 528 51 140 141 299 529 51 140 141 300 530 51 140 141 301 531 51 140 141 302 532 51 140 141 303 533 51 140 534 304 110 51 140 535 10 11 12 18 139 138 139 138 52 51 140 141 53 51 140 141 74 51 140 141 54 51 140 141 75 51 140 141 55 51 140 141 556 51 140 141 56 51 140 141 57 51 140 141 58 51 140 141 76 51 140 141 59 51 140 141 60 51 140 141 61 51 140 141 62 51 140 141 63 51 140 141 64 51 140 141 65 51 140 141 77 51 140 141 66 51 140 141 67 51 140 141 78 140 141 68 140 141 79 51 140 141 80 51 140 141 69 51 140 141 81 51 140 141 70 51 140 141 82 51 140 141 71 51 140 141 72 51 140 141 72 51 140 141 73 51 140 141 83 557 140 593 598 84 51 140 593 598 85 51 140 593 598 86 51 140 593 598 87 51 140 593 598 555 51 140 141 88 557 593 598 21 22 139 138 139 138 113 51 140 141 114 51 140 141 115 51 140 141 13 139 138 139 138 110 382 140 141 111 112 14 139 138 139 138 101 382 140 141 102 382 140 141 103 382 140 141 104 382 140 141 105 382 140 141 106 382 140 141 107 382 140 141 108 382 140 141 109 382 140 141 15 5 16 558 51 140 593 598 559 51 140 593 598 560 51 140 593 598 561 564 140 593 598 562 564 140 593 598 563 564 140 593 598 5 17 89 422 90 91 92 93 94 95 374 140 594 598 96 97 98 5 523 595 599 600

6 9 99 139 138 139 138 146 118 51 140 145 147 141 119 51 140 145 147 141 120 51 140 145 147 141 121 51 140 145 147 141 117 51 140 577 147 141 572 5 122 51 140 577 147 141 572 123 51 140 578 147 141 596 124 51 140 578 147 141 596 125 51 140 578 147 141 596 126 51 140 578 147 141 596 127 51 140 578 147 141 596 5 128 51 140 578 147 141 596 129 51 140 443 147 141 596 130 51 140 579 147 141 596 131 51 142 141 147 141 132 51 142 141 147 141 133 51 142 141 147 141 134 51 142 141 147 141 135 51 142 141 147 141 136 51 142 141 147 141 137 51 142 141 147 141 19 139 138 139 138 23 51 140 141 147 141 24 51 140 141 147 141 143 144 140 141 147 141 25 51 140 141 147 141 26 51 140 141 147 141 27 51 140 141 147 141 28 51 140 141 147 141 29 51 140 141 147 141 30 51 140 141 147 141 31 148 140 580 147 141 32 51 140 580 147 141 33 51 140 141 147 141 34 51 140 141 147 141 35 51 140 141 147 141 36 51 140 141 147 141 37 51 140 141 147 141 38 51 140 141 147 141 39 51 140 141 147 141 20 139 138 139 138 40 41 42 43 51 140 581 573 44 45 51 140 581 573 46 47 51 140 582 574 48 49 51 140 582 574 446 544 444 140 453 545 444 140 454 546 444 140 455 547 444 140 456 548 444 140 447 549 444 140 448 550 444 140 449 551 444 140 450 552 444 140 451 553 444 140 452 554 444 140 149 50 444 140 445 5 100 139 138 139 138 323 148 140 583 573 325 148 140 583 573 326 148 140 583 573 327 148 140 583 573 328 148 140 583 573 324 148 140 332 573 329 148 140 330 575 331 148 140 333 575 159 334 51 140 141 575 160 335 51 140 141 575 161 336 51 140 141 575 337 51 140 141 575 338 51 140 141 575 339 51 140 141 575 340 51 140 141 575 341 51 140 141 575 342 51 140 141 575 343 51 140 141 575 344 51 140 141 575 345 51 140 141 575 346 51 140 141 575 347 51 140 141 575 348 51 140 141 575 162 349 51 140 141 575 163 350 51 140 141 575 164 351 51 140 141 575 156 565 51 140 584 573 157 352 51 140 585 573 158 353 51 140 585 573 165 354 51 140 141 575 166 355 51 140 141 575 167 357 51 140 141 575 168 356 51 140 141 575 169 358 51 140 141 575 170 359 51 140 141 575 171 360 51 140 457 576 172 361 51 140 141 575 601 324 51 140 141 575 311 362 51 140 141 575 305 308 51 140 586 573 173 363 51 140 141 575 309 310 51 140 141 575 312 364 51 140 141 575 313 365 51 140 141 575 314 366 51 140 141 575 306 307 51 140 586 573 315 367 51 140 586 573 174 368 51 140 141 175 369 51 140 587 573 176 177 51 140 587 573 178 370 51 140 587 573 179 371 51 140 587 573 180 372 51 140 587 573 181 373 51 140 141 182 375 382 140 588 573 376 382 140 588 573 377 382 140 588 573 378 382 140 588 573 379 382 140 588 573 380 382 140 588 573 381 382 140 588 573 381 51 140 141 183 383 51 140 141 184 384 51 140 141 185 385 51 140 141 186 386 51 140 141 387 331 51 140 589 573 187 388 51 140 588 573 188 389 51 140 588 573 189 390 51 140 588 573 190 391 51 140 141 191 392 374 140 141 192 393 51 140 141 193 394 382 140 141 194 395 51 140 141 195 396 374 140 141 196 397 374 140 141 197 398 374 140 141 198 399 374 140 141 199 400 374 140 141 200 401 374 140 141 201 402 374 140 141 202 403 374 140 141 203 404 374 140 141 204 405 374 140 141 205 406 51 140 141 206 407 51 140 141 207 408 51 140 141 208 409 51 140 141 209 410 51 140 141 210 411 51 140 141 211 412 51 140 141 212 413 51 140 141 213 414 51 140 141 214 415 51 140 141 215 416 51 140 141 216 417 51 140 141 217 418 51 140 419 147 420 597 320 421 51 140 590 566 567 150 113 51 140 141 321 114 382 140 590 147 141 567 322 115 51 140 590 566 567 151 435 51 140 141 152 436 51 140 141 424 429 51 140 141 425 430 51 140 141 426 431 51 140 440 568 439 438 51 140 440 568 427 432 51 140 141 153 428 51 140 141 154 434 51 140 141 155 437 51 140 141 423 433 51 140 441 218 442 51 140 441 219 458 51 140 441 220 459 51 140 441 221 460 51 140 441 222 461 51 140 441 223 462 51 140 441 224 463 51 140 441 225 464 51 140 441 226 465 51 140 441 227 466 51 140 441 316 467 51 140 441 317 468 51 140 441 318 469 51 140 441 319 470 51 140 441 228 471 51 140 441 229 472 51 140 441 230 473 51 140 441 536 540 51 140 441 231 474 51 140 441 232 475 51 140 441 233 476 51 140 441 234 477 51 140 441 235 478 51 140 591 5 569 236 479 51 140 141 237 480 51 140 141 238 101 51 140 141 239 102 51 140 141 240 103 51 140 141 241 104 51 140 141 242 105 51 140 141 243 106 51 140 141 244 107 51 140 141 245 108 51 140 141 246 109 51 140 141 247 481 382 140 141 248 482 382 140 141 249 483 382 140 141 250 484 382 140 141 251 485 382 140 141 252 486 382 140 141 253 487 382 140 141 254 89 382 140 141 255 488 382 140 141 256 90 382 140 141 257 489 382 140 141 258 92 382 140 141 259 490 382 140 141 260 491 382 140 141 261 492 382 140 141 262 493 382 140 141 263 494 382 140 141 264 495 382 140 141 265 496 382 140 141 266 498 497 570 267 499 382 140 141 268 500 382 140 141 269 501 382 140 141 270 502 382 140 141 271 503 382 140 141 272 504 382 140 141 273 505 382 140 141 274 96 382 140 141 275 97 382 140 141 276 506 382 140 141 277 98 382 140 141 278 507 51 140 592 569 279 508 51 140 592 569 280 509 382 140 141 281 510 382 140 141 282 511 382 140 141 283 512 382 140 141 537 541 382 140 141 538 542 382 140 141 539 543 382 140 141 284 513 382 140 141 285 514 382 140 141 286 515 382 140 141 287 516 382 140 141 288 517 382 140 141 289 518 382 140 141 290 519 51 140 141 291 520 51 140 141 292 521 51 140 141 293 522 51 140 141 294 524 51 140 591 571 295 525 51 140 591 571 296 526 51 140 141 297 527 51 140 141 298 528 51 140 141 299 529 51 140 141 300 530 51 140 141 301 531 51 140 141 302 532 51 140 141 303 533 51 140 534 304 110 51 140 535 10 11 12 18 139 138 139 138 52 51 140 141 53 51 140 141 74 51 140 141 54 51 140 141 75 51 140 141 55 51 140 141 556 51 140 141 56 51 140 141 57 51 140 141 58 51 140 141 76 51 140 141 59 51 140 141 60 51 140 141 61 51 140 141 62 51 140 141 63 51 140 141 64 51 140 141 65 51 140 141 77 51 140 141 66 51 140 141 67 51 140 141 78 140 141 68 140 141 79 51 140 141 80 51 140 141 69 51 140 141 81 51 140 141 70 51 140 141 82 51 140 141 71 51 140 141 72 51 140 141 72 51 140 141 73 51 140 141 83 557 140 593 598 84 51 140 593 598 85 51 140 593 598 86 51 140 593 598 87 51 140 593 598 555 51 140 141 88 557 593 598 21 22 139 138 139 138 113 51 140 141 114 51 140 141 115 51 140 141 13 139 138 139 138 110 382 140 141 111 112 14 139 138 139 138 101 382 140 141 102 382 140 141 103 382 140 141 104 382 140 141 105 382 140 141 106 382 140 141 107 382 140 141 108 382 140 141 109 382 140 141 15 5 16 558 51 140 593 598 559 51 140 593 598 560 51 140 593 598 561 564 140 593 598 562 564 140 593 598 563 564 140 593 598 5 17 89 422 90 91 92 93 94 95 374 140 594 598 96 97 98 5 523 595 599 600

6 9 99 139 138 139 138 146 118 51 140 145 147 141 119 51 140 145 147 141 120 51 140 145 147 141 121 51 140 145 147 141 117 51 140 577 147 141 572 5 122 51 140 577 147 141 572 123 51 140 578 147 141 596 124 51 140 578 147 141 596 125 51 140 578 147 141 596 126 51 140 578 147 141 596 127 51 140 578 147 141 596 5 128 51 140 578 147 141 596 129 51 140 443 147 141 596 130 51 140 579 147 141 596 131 51 142 141 147 141 132 51 142 141 147 141 133 51 142 141 147 141 134 51 142 141 147 141 135 51 142 141 147 141 136 51 142 141 147 141 137 51 142 141 147 141 19 139 138 139 138 23 51 140 141 147 141 24 51 140 141 147 141 143 144 140 141 147 141 25 51 140 141 147 141 26 51 140 141 147 141 27 51 140 141 147 141 28 51 140 141 147 141 29 51 140 141 147 141 30 51 140 141 147 141 31 148 140 580 147 141 32 51 140 580 147 141 33 51 140 141 147 141 34 51 140 141 147 141 35 51 140 141 147 141 36 51 140 141 147 141 37 51 140 141 147 141 38 51 140 141 147 141 39 51 140 141 147 141 20 139 138 139 138 40 41 42 43 51 140 581 573 44 45 51 140 581 573 46 47 51 140 582 574 48 49 51 140 582 574 446 544 444 140 453 545 444 140 454 546 444 140 455 547 444 140 456 548 444 140 447 549 444 140 448 550 444 140 449 551 444 140 450 552 444 140 451 553 444 140 452 554 444 140 149 50 444 140 445 5 100 139 138 139 138 323 148 140 583 573 325 148 140 583 573 326 148 140 583 573 327 148 140 583 573 328 148 140 583 573 324 148 140 332 573 329 148 140 330 575 331 148 140 333 575 159 334 51 140 141 575 160 335 51 140 141 575 161 336 51 140 141 575 337 51 140 141 575 338 51 140 141 575 339 51 140 141 575 340 51 140 141 575 341 51 140 141 575 342 51 140 141 575 343 51 140 141 575 344 51 140 141 575 345 51 140 141 575 346 51 140 141 575 347 51 140 141 575 348 51 140 141 575 162 349 51 140 141 575 163 350 51 140 141 575 164 351 51 140 141 575 156 565 51 140 584 573 157 352 51 140 585 573 158 353 51 140 585 573 165 354 51 140 141 575 166 355 51 140 141 575 167 357 51 140 141 575 168 356 51 140 141 575 169 358 51 140 141 575 170 359 51 140 141 575 171 360 51 140 457 576 172 361 51 140 141 575 601 324 51 140 141 575 311 362 51 140 141 575 305 308 51 140 586 573 173 363 51 140 141 575 309 310 51 140 141 575 312 364 51 140 141 575 313 365 51 140 141 575 314 366 51 140 141 575 306 307 51 140 586 573 315 367 51 140 586 573 174 368 51 140 141 175 369 51 140 587 573 176 177 51 140 587 573 178 370 51 140 587 573 179 371 51 140 587 573 180 372 51 140 587 573 181 373 51 140 141 182 375 382 140 588 573 376 382 140 588 573 377 382 140 588 573 378 382 140 588 573 379 382 140 588 573 380 382 140 588 573 381 382 140 588 573 381 51 140 141 183 383 51 140 141 184 384 51 140 141 185 385 51 140 141 186 386 51 140 141 387 331 51 140 589 573 187 388 51 140 588 573 188 389 51 140 588 573 189 390 51 140 588 573 190 391 51 140 141 191 392 374 140 141 192 393 51 140 141 193 394 382 140 141 194 395 51 140 141 195 396 374 140 141 196 397 374 140 141 197 398 374 140 141 198 399 374 140 141 199 400 374 140 141 200 401 374 140 141 201 402 374 140 141 202 403 374 140 141 203 404 374 140 141 204 405 374 140 141 205 406 51 140 141 206 407 51 140 141 207 408 51 140 141 208 409 51 140 141 209 410 51 140 141 210 411 51 140 141 211 412 51 140 141 212 413 51 140 141 213 414 51 140 141 214 415 51 140 141 215 416 51 140 141 216 417 51 140 141 217 418 51 140 419 147 420 597 320 421 51 140 590 566 567 150 113 51 140 141 321 114 382 140 590 147 141 567 322 115 51 140 590 566 567 151 435 51 140 141 152 436 51 140 141 424 429 51 140 141 425 430 51 140 141 426 431 51 140 440 568 439 438 51 140 440 568 427 432 51 140 141 153 428 51 140 141 154 434 51 140 141 155 437 51 140 141 423 433 51 140 441 218 442 51 140 441 219 458 51 140 441 220 459 51 140 441 221 460 51 140 441 222 461 51 140 441 223 462 51 140 441 224 463 51 140 441 225 464 51 140 441 226 465 51 140 441 227 466 51 140 441 316 467 51 140 441 317 468 51 140 441 318 469 51 140 441 319 470 51 140 441 228 471 51 140 441 229 472 51 140 441 230 473 51 140 441 536 540 51 140 441 231 474 51 140 441 232 475 51 140 441 233 476 51 140 441 234 477 51 140 441 235 478 51 140 591 5 569 236 479 51 140 141 237 480 51 140 141 238 101 51 140 141 239 102 51 140 141 240 103 51 140 141 241 104 51 140 141 242 105 51 140 141 243 106 51 140 141 244 107 51 140 141 245 108 51 140 141 246 109 51 140 141 247 481 382 140 141 248 482 382 140 141 249 483 382 140 141 250 484 382 140 141 251 485 382 140 141 252 486 382 140 141 253 487 382 140 141 254 89 382 140 141 255 488 382 140 141 256 90 382 140 141 257 489 382 140 141 258 92 382 140 141 259 490 382 140 141 260 491 382 140 141 261 492 382 140 141 262 493 382 140 141 263 494 382 140 141 264 495 382 140 141 265 496 382 140 141 266 498 497 570 267 499 382 140 141 268 500 382 140 141 269 501 382 140 141 270 502 382 140 141 271 503 382 140 141 272 504 382 140 141 273 505 382 140 141 274 96 382 140 141 275 97 382 140 141 276 506 382 140 141 277 98 382 140 141 278 507 51 140 592 569 279 508 51 140 592 569 280 509 382 140 141 281 510 382 140 141 282 511 382 140 141 283 512 382 140 141 537 541 382 140 141 538 542 382 140 141 539 543 382 140 141 284 513 382 140 141 285 514 382 140 141 286 515 382 140 141 287 516 382 140 141 288 517 382 140 141 289 518 382 140 141 290 519 51 140 141 291 520 51 140 141 292 521 51 140 141 293 522 51 140 141 294 524 51 140 591 571 295 525 51 140 591 571 296 526 51 140 141 297 527 51 140 141 298 528 51 140 141 299 529 51 140 141 300 530 51 140 141 301 531 51 140 141 302 532 51 140 141 303 533 51 140 534 304 110 51 140 535 10 11 12 18 139 138 139 138 52 51 140 141 53 51 140 141 74 51 140 141 54 51 140 141 75 51 140 141 55 51 140 141 556 51 140 141 56 51 140 141 57 51 140 141 58 51 140 141 76 51 140 141 59 51 140 141 60 51 140 141 61 51 140 141 62 51 140 141 63 51 140 141 64 51 140 141 65 51 140 141 77 51 140 141 66 51 140 141 67 51 140 141 78 140 141 68 140 141 79 51 140 141 80 51 140 141 69 51 140 141 81 51 140 141 70 51 140 141 82 51 140 141 71 51 140 141 72 51 140 141 72 51 140 141 73 51 140 141 83 557 140 593 598 84 51 140 593 598 85 51 140 593 598 86 51 140 593 598 87 51 140 593 598 555 51 140 141 88 557 593 598 21 22 139 138 139 138 113 51 140 141 114 51 140 141 115 51 140 141 13 139 138 139 138 110 382 140 141 111 112 14 139 138 139 138 101 382 140 141 102 382 140 141 103 382 140 141 104 382 140 141 105 382 140 141 106 382 140 141 107 382 140 141 108 382 140 141 109 382 140 141 15 5 16 558 51 140 593 598 559 51 140 593 598 560 51 140 593 598 561 564 140 593 598 562 564 140 593 598 563 564 140 593 598 5 17 89 422 90 91 92 93 94 95 374 140 594 598 96 97 98 5 523 595 599 600

6 9 99 139 138 139 138 146 118 51 140 145 147 141 119 51 140 145 147 141 120 51 140 145 147 141 121 51 140 145 147 141 117 51 140 577 147 141 572 5 122 51 140 577 147 141 572 123 51 140 578 147 141 596 124 51 140 578 147 141 596 125 51 140 578 147 141 596 126 51 140 578 147 141 596 127 51 140 578 147 141 596 5 128 51 140 578 147 141 596 129 51 140 443 147 141 596 130 51 140 579 147 141 596 131 51 142 141 147 141 132 51 142 141 147 141 133 51 142 141 147 141 134 51 142 141 147 141 135 51 142 141 147 141 136 51 142 141 147 141 137 51 142 141 147 141 19 139 138 139 138 23 51 140 141 147 141 24 51 140 141 147 141 143 144 140 141 147 141 25 51 140 141 147 141 26 51 140 141 147 141 27 51 140 141 147 141 28 51 140 141 147 141 29 51 140 141 147 141 30 51 140 141 147 141 31 148 140 580 147 141 32 51 140 580 147 141 33 51 140 141 147 141 34 51 140 141 147 141 35 51 140 141 147 141 36 51 140 141 147 141 37 51 140 141 147 141 38 51 140 141 147 141 39 51 140 141 147 141 20 139 138 139 138 40 41 42 43 51 140 581 573 44 45 51 140 581 573 46 47 51 140 582 574 48 49 51 140 582 574 446 544 444 140 453 545 444 140 454 546 444 140 455 547 444 140 456 548 444 140 447 549 444 140 448 550 444 140 449 551 444 140 450 552 444 140 451 553 444 140 452 554 444 140 149 50 444 140 445 5 100 139 138 139 138 323 148 140 583 573 325 148 140 583 573 326 148 140 583 573 327 148 140 583 573 328 148 140 583 573 324 148 140 332 573 329 148 140 330 575 331 148 140 333 575 159 334 51 140 141 575 160 335 51 140 141 575 161 336 51 140 141 575 337 51 140 141 575 338 51 140 141 575 339 51 140 141 575 340 51 140 141 575 341 51 140 141 575 342 51 140 141 575 343 51 140 141 575 344 51 140 141 575 345 51 140 141 575 346 51 140 141 575 347 51 140 141 575 348 51 140 141 575 162 349 51 140 141 575 163 350 51 140 141 575 164 351 51 140 141 575 156 565 51 140 584 573 157 352 51 140 585 573 158 353 51 140 585 573 165 354 51 140 141 575 166 355 51 140 141 575 167 357 51 140 141 575 168 356 51 140 141 575 169 358 51 140 141 575 170 359 51 140 141 575 171 360 51 140 457 576 172 361 51 140 141 575 601 324 51 140 141 575 311 362 51 140 141 575 305 308 51 140 586 573 173 363 51 140 141 575 309 310 51 140 141 575 312 364 51 140 141 575 313 365 51 140 141 575 314 366 51 140 141 575 306 307 51 140 586 573 315 367 51 140 586 573 174 368 51 140 141 175 369 51 140 587 573 176 177 51 140 587 573 178 370 51 140 587 573 179 371 51 140 587 573 180 372 51 140 587 573 181 373 51 140 141 182 375 382 140 588 573 376 382 140 588 573 377 382 140 588 573 378 382 140 588 573 379 382 140 588 573 380 382 140 588 573 381 382 140 588 573 381 51 140 141 183 383 51 140 141 184 384 51 140 141 185 385 51 140 141 186 386 51 140 141 387 331 51 140 589 573 187 388 51 140 588 573 188 389 51 140 588 573 189 390 51 140 588 573 190 391 51 140 141 191 392 374 140 141 192 393 51 140 141 193 394 382 140 141 194 395 51 140 141 195 396 374 140 141 196 397 374 140 141 197 398 374 140 141 198 399 374 140 141 199 400 374 140 141 200 401 374 140 141 201 402 374 140 141 202 403 374 140 141 203 404 374 140 141 204 405 374 140 141 205 406 51 140 141 206 407 51 140 141 207 408 51 140 141 208 409 51 140 141 209 410 51 140 141 210 411 51 140 141 211 412 51 140 141 212 413 51 140 141 213 414 51 140 141 214 415 51 140 141 215 416 51 140 141 216 417 51 140 141 217 418 51 140 419 147 420 597 320 421 51 140 590 566 567 150 113 51 140 141 321 114 382 140 590 147 141 567 322 115 51 140 590 566 567 151 435 51 140 141 152 436 51 140 141 424 429 51 140 141 425 430 51 140 141 426 431 51 140 440 568 439 438 51 140 440 568 427 432 51 140 141 153 428 51 140 141 154 434 51 140 141 155 437 51 140 141 423 433 51 140 441 218 442 51 140 441 219 458 51 140 441 220 459 51 140 441 221 460 51 140 441 222 461 51 140 441 223 462 51 140 441 224 463 51 140 441 225 464 51 140 441 226 465 51 140 441 227 466 51 140 441 316 467 51 140 441 317 468 51 140 441 318 469 51 140 441 319 470 51 140 441 228 471 51 140 441 229 472 51 140 441 230 473 51 140 441 536 540 51 140 441 231 474 51 140 441 232 475 51 140 441 233 476 51 140 441 234 477 51 140 441 235 478 51 140 591 5 569 236 479 51 140 141 237 480 51 140 141 238 101 51 140 141 239 102 51 140 141 240 103 51 140 141 241 104 51 140 141 242 105 51 140 141 243 106 51 140 141 244 107 51 140 141 245 108 51 140 141 246 109 51 140 141 247 481 382 140 141 248 482 382 140 141 249 483 382 140 141 250 484 382 140 141 251 485 382 140 141 252 486 382 140 141 253 487 382 140 141 254 89 382 140 141 255 488 382 140 141 256 90 382 140 141 257 489 382 140 141 258 92 382 140 141 259 490 382 140 141 260 491 382 140 141 261 492 382 140 141 262 493 382 140 141 263 494 382 140 141 264 495 382 140 141 265 496 382 140 141 266 498 497 570 267 499 382 140 141 268 500 382 140 141 269 501 382 140 141 270 502 382 140 141 271 503 382 140 141 272 504 382 140 141 273 505 382 140 141 274 96 382 140 141 275 97 382 140 141 276 506 382 140 141 277 98 382 140 141 278 507 51 140 592 569 279 508 51 140 592 569 280 509 382 140 141 281 510 382 140 141 282 511 382 140 141 283 512 382 140 141 537 541 382 140 141 538 542 382 140 141 539 543 382 140 141 284 513 382 140 141 285 514 382 140 141 286 515 382 140 141 287 516 382 140 141 288 517 382 140 141 289 518 382 140 141 290 519 51 140 141 291 520 51 140 141 292 521 51 140 141 293 522 51 140 141 294 524 51 140 591 571 295 525 51 140 591 571 296 526 51 140 141 297 527 51 140 141 298 528 51 140 141 299 529 51 140 141 300 530 51 140 141 301 531 51 140 141 302 532 51 140 141 303 533 51 140 534 304 110 51 140 535 10 11 12 18 139 138 139 138 52 51 140 141 53 51 140 141 74 51 140 141 54 51 140 141 75 51 140 141 55 51 140 141 556 51 140 141 56 51 140 141 57 51 140 141 58 51 140 141 76 51 140 141 59 51 140 141 60 51 140 141 61 51 140 141 62 51 140 141 63 51 140 141 64 51 140 141 65 51 140 141 77 51 140 141 66 51 140 141 67 51 140 141 78 140 141 68 140 141 79 51 140 141 80 51 140 141 69 51 140 141 81 51 140 141 70 51 140 141 82 51 140 141 71 51 140 141 72 51 140 141 72 51 140 141 73 51 140 141 83 557 140 593 598 84 51 140 593 598 85 51 140 593 598 86 51 140 593 598 87 51 140 593 598 555 51 140 141 88 557 593 598 21 22 139 138 139 138 113 51 140 141 114 51 140 141 115 51 140 141 13 139 138 139 138 110 382 140 141 111 112 14 139 138 139 138 101 382 140 141 102 382 140 141 103 382 140 141 104 382 140 141 105 382 140 141 106 382 140 141 107 382 140 141 108 382 140 141 109 382 140 141 15 5 16 558 51 140 593 598 559 51 140 593 598 560 51 140 593 598 561 564 140 593 598 562 564 140 593 598 563 564 140 593 598 5 17 89 422 90 91 92 93 94 95 374 140 594 598 96 97 98 5 523 595 599 600

6 9 99 139 138 139 138 146 118 51 140 145 147 141 119 51 140 145 147 141 120 51 140 145 147 141 121 51 140 145 147 141 117 51 140 577 147 141 572 5 122 51 140 577 147 141 572 123 51 140 578 147 141 596 124 51 140 578 147 141 596 125 51 140 578 147 141 596 126 51 140 578 147 141 596 127 51 140 578 147 141 596 5 128 51 140 578 147 141 596 129 51 140 443 147 141 596 130 51 140 579 147 141 596 131 51 142 141 147 141 132 51 142 141 147 141 133 51 142 141 147 141 134 51 142 141 147 141 135 51 142 141 147 141 136 51 142 141 147 141 137 51 142 141 147 141 19 139 138 139 138 23 51 140 141 147 141 24 51 140 141 147 141 143 144 140 141 147 141 25 51 140 141 147 141 26 51 140 141 147 141 27 51 140 141 147 141 28 51 140 141 147 141 29 51 140 141 147 141 30 51 140 141 147 141 31 148 140 580 147 141 32 51 140 580 147 141 33 51 140 141 147 141 34 51 140 141 147 141 35 51 140 141 147 141 36 51 140 141 147 141 37 51 140 141 147 141 38 51 140 141 147 141 39 51 140 141 147 141 20 139 138 139 138 40 41 42 43 51 140 581 573 44 45 51 140 581 573 46 47 51 140 582 574 48 49 51 140 582 574 446 544 444 140 453 545 444 140 454 546 444 140 455 547 444 140 456 548 444 140 447 549 444 140 448 550 444 140 449 551 444 140 450 552 444 140 451 553 444 140 452 554 444 140 149 50 444 140 445 5 100 139 138 139 138 323 148 140 583 573 325 148 140 583 573 326 148 140 583 573 327 148 140 583 573 328 148 140 583 573 324 148 140 332 573 329 148 140 330 575 331 148 140 333 575 159 334 51 140 141 575 160 335 51 140 141 575 161 336 51 140 141 575 337 51 140 141 575 338 51 140 141 575 339 51 140 141 575 340 51 140 141 575 341 51 140 141 575 342 51 140 141 575 343 51 140 141 575 344 51 140 141 575 345 51 140 141 575 346 51 140 141 575 347 51 140 141 575 348 51 140 141 575 162 349 51 140 141 575 163 350 51 140 141 575 164 351 51 140 141 575 156 565 51 140 584 573 157 352 51 140 585 573 158 353 51 140 585 573 165 354 51 140 141 575 166 355 51 140 141 575 167 357 51 140 141 575 168 356 51 140 141 575 169 358 51 140 141 575 170 359 51 140 141 575 171 360 51 140 457 576 172 361 51 140 141 575 601 324 51 140 141 575 311 362 51 140 141 575 305 308 51 140 586 573 173 363 51 140 141 575 309 310 51 140 141 575 312 364 51 140 141 575 313 365 51 140 141 575 314 366 51 140 141 575 306 307 51 140 586 573 315 367 51 140 586 573 174 368 51 140 141 175 369 51 140 587 573 176 177 51 140 587 573 178 370 51 140 587 573 179 371 51 140 587 573 180 372 51 140 587 573 181 373 51 140 141 182 375 382 140 588 573 376 382 140 588 573 377 382 140 588 573 378 382 140 588 573 379 382 140 588 573 380 382 140 588 573 381 382 140 588 573 381 51 140 141 183 383 51 140 141 184 384 51 140 141 185 385 51 140 141 186 386 51 140 141 387 331 51 140 589 573 187 388 51 140 588 573 188 389 51 140 588 573 189 390 51 140 588 573 190 391 51 140 141 191 392 374 140 141 192 393 51 140 141 193 394 382 140 141 194 395 51 140 141 195 396 374 140 141 196 397 374 140 141 197 398 374 140 141 198 399 374 140 141 199 400 374 140 141 200 401 374 140 141 201 402 374 140 141 202 403 374 140 141 203 404 374 140 141 204 405 374 140 141 205 406 51 140 141 206 407 51 140 141 207 408 51 140 141 208 409 51 140 141 209 410 51 140 141 210 411 51 140 141 211 412 51 140 141 212 413 51 140 141 213 414 51 140 141 214 415 51 140 141 215 416 51 140 141 216 417 51 140 141 217 418 51 140 419 147 420 597 320 421 51 140 590 566 567 150 113 51 140 141 321 114 382 140 590 147 141 567 322 115 51 140 590 566 567 151 435 51 140 141 152 436 51 140 141 424 429 51 140 141 425 430 51 140 141 426 431 51 140 440 568 439 438 51 140 440 568 427 432 51 140 141 153 428 51 140 141 154 434 51 140 141 155 437 51 140 141 423 433 51 140 441 218 442 51 140 441 219 458 51 140 441 220 459 51 140 441 221 460 51 140 441 222 461 51 140 441 223 462 51 140 441 224 463 51 140 441 225 464 51 140 441 226 465 51 140 441 227 466 51 140 441 316 467 51 140 441 317 468 51 140 441 318 469 51 140 441 319 470 51 140 441 228 471 51 140 441 229 472 51 140 441 230 473 51 140 441 536 540 51 140 441 231 474 51 140 441 232 475 51 140 441 233 476 51 140 441 234 477 51 140 441 235 478 51 140 591 5 569 236 479 51 140 141 237 480 51 140 141 238 101 51 140 141 239 102 51 140 141 240 103 51 140 141 241 104 51 140 141 242 105 51 140 141 243 106 51 140 141 244 107 51 140 141 245 108 51 140 141 246 109 51 140 141 247 481 382 140 141 248 482 382 140 141 249 483 382 140 141 250 484 382 140 141 251 485 382 140 141 252 486 382 140 141 253 487 382 140 141 254 89 382 140 141 255 488 382 140 141 256 90 382 140 141 257 489 382 140 141 258 92 382 140 141 259 490 382 140 141 260 491 382 140 141 261 492 382 140 141 262 493 382 140 141 263 494 382 140 141 264 495 382 140 141 265 496 382 140 141 266 498 497 570 267 499 382 140 141 268 500 382 140 141 269 501 382 140 141 270 502 382 140 141 271 503 382 140 141 272 504 382 140 141 273 505 382 140 141 274 96 382 140 141 275 97 382 140 141 276 506 382 140 141 277 98 382 140 141 278 507 51 140 592 569 279 508 51 140 592 569 280 509 382 140 141 281 510 382 140 141 282 511 382 140 141 283 512 382 140 141 537 541 382 140 141 538 542 382 140 141 539 543 382 140 141 284 513 382 140 141 285 514 382 140 141 286 515 382 140 141 287 516 382 140 141 288 517 382 140 141 289 518 382 140 141 290 519 51 140 141 291 520 51 140 141 292 521 51 140 141 293 522 51 140 141 294 524 51 140 591 571 295 525 51 140 591 571 296 526 51 140 141 297 527 51 140 141 298 528 51 140 141 299 529 51 140 141 300 530 51 140 141 301 531 51 140 141 302 532 51 140 141 303 533 51 140 534 304 110 51 140 535 10 11 12 18 139 138 139 138 52 51 140 141 53 51 140 141 74 51 140 141 54 51 140 141 75 51 140 141 55 51 140 141 556 51 140 141 56 51 140 141 57 51 140 141 58 51 140 141 76 51 140 141 59 51 140 141 60 51 140 141 61 51 140 141 62 51 140 141 63 51 140 141 64 51 140 141 65 51 140 141 77 51 140 141 66 51 140 141 67 51 140 141 78 140 141 68 140 141 79 51 140 141 80 51 140 141 69 51 140 141 81 51 140 141 70 51 140 141 82 51 140 141 71 51 140 141 72 51 140 141 72 51 140 141 73 51 140 141 83 557 140 593 598 84 51 140 593 598 85 51 140 593 598 86 51 140 593 598 87 51 140 593 598 555 51 140 141 88 557 593 598 21 22 139 138 139 138 113 51 140 141 114 51 140 141 115 51 140 141 13 139 138 139 138 110 382 140 141 111 112 14 139 138 139 138 101 382 140 141 102 382 140 141 103 382 140 141 104 382 140 141 105 382 140 141 106 382 140 141 107 382 140 141 108 382 140 141 109 382 140 141 15 5 16 558 51 140 593 598 559 51 140 593 598 560 51 140 593 598 561 564 140 593 598 562 564 140 593 598 563 564 140 593 598 5 17 89 422 90 91 92 93 94 95 374 140 594 598 96 97 98 5 523 595 599 600

6 9 99 139 138 139 138 146 118 51 140 145 147 141 119 51 140 145 147 141 120 51 140 145 147 141 121 51 140 145 147 141 117 51 140 577 147 141 572 5 122 51 140 577 147 141 572 123 51 140 578 147 141 596 124 51 140 578 147 141 596 125 51 140 578 147 141 596 126 51 140 578 147 141 596 127 51 140 578 147 141 596 5 128 51 140 578 147 141 596 129 51 140 443 147 141 596 130 51 140 579 147 141 596 131 51 142 141 147 141 132 51 142 141 147 141 133 51 142 141 147 141 134 51 142 141 147 141 135 51 142 141 147 141 136 51 142 141 147 141 137 51 142 141 147 141 19 139 138 139 138 23 51 140 141 147 141 24 51 140 141 147 141 143 144 140 141 147 141 25 51 140 141 147 141 26 51 140 141 147 141 27 51 140 141 147 141 28 51 140 141 147 141 29 51 140 141 147 141 30 51 140 141 147 141 31 148 140 580 147 141 32 51 140 580 147 141 33 51 140 141 147 141 34 51 140 141 147 141 35 51 140 141 147 141 36 51 140 141 147 141 37 51 140 141 147 141 38 51 140 141 147 141 39 51 140 141 147 141 20 139 138 139 138 40 41 42 43 51 140 581 573 44 45 51 140 581 573 46 47 51 140 582 574 48 49 51 140 582 574 446 544 444 140 453 545 444 140 454 546 444 140 455 547 444 140 456 548 444 140 447 549 444 140 448 550 444 140 449 551 444 140 450 552 444 140 451 553 444 140 452 554 444 140 149 50 444 140 445 5 100 139 138 139 138 323 148 140 583 573 325 148 140 583 573 326 148 140 583 573 327 148 140 583 573 328 148 140 583 573 324 148 140 332 573 329 148 140 330 575 331 148 140 333 575 159 334 51 140 141 575 160 335 51 140 141 575 161 336 51 140 141 575 337 51 140 141 575 338 51 140 141 575 339 51 140 141 575 340 51 140 141 575 341 51 140 141 575 342 51 140 141 575 343 51 140 141 575 344 51 140 141 575 345 51 140 141 575 346 51 140 141 575 347 51 140 141 575 348 51 140 141 575 162 349 51 140 141 575 163 350 51 140 141 575 164 351 51 140 141 575 156 565 51 140 584 573 157 352 51 140 585 573 158 353 51 140 585 573 165 354 51 140 141 575 166 355 51 140 141 575 167 357 51 140 141 575 168 356 51 140 141 575 169 358 51 140 141 575 170 359 51 140 141 575 171 360 51 140 457 576 172 361 51 140 141 575 601 324 51 140 141 575 311 362 51 140 141 575 305 308 51 140 586 573 173 363 51 140 141 575 309 310 51 140 141 575 312 364 51 140 141 575 313 365 51 140 141 575 314 366 51 140 141 575 306 307 51 140 586 573 315 367 51 140 586 573 174 368 51 140 141 175 369 51 140 587 573 176 177 51 140 587 573 178 370 51 140 587 573 179 371 51 140 587 573 180 372 51 140 587 573 181 373 51 140 141 182 375 382 140 588 573 376 382 140 588 573 377 382 140 588 573 378 382 140 588 573 379 382 140 588 573 380 382 140 588 573 381 382 140 588 573 381 51 140 141 183 383 51 140 141 184 384 51 140 141 185 385 51 140 141 186 386 51 140 141 387 331 51 140 589 573 187 388 51 140 588 573 188 389 51 140 588 573 189 390 51 140 588 573 190 391 51 140 141 191 392 374 140 141 192 393 51 140 141 193 394 382 140 141 194 395 51 140 141 195 396 374 140 141 196 397 374 140 141 197 398 374 140 141 198 399 374 140 141 199 400 374 140 141 200 401 374 140 141 201 402 374 140 141 202 403 374 140 141 203 404 374 140 141 204 405 374 140 141 205 406 51 140 141 206 407 51 140 141 207 408 51 140 141 208 409 51 140 141 209 410 51 140 141 210 411 51 140 141 211 412 51 140 141 212 413 51 140 141 213 414 51 140 141 214 415 51 140 141 215 416 51 140 141 216 417 51 140 141 217 418 51 140 419 147 420 597 320 421 51 140 590 566 567 150 113 51 140 141 321 114 382 140 590 147 141 567 322 115 51 140 590 566 567 151 435 51 140 141 152 436 51 140 141 424 429 51 140 141 425 430 51 140 141 426 431 51 140 440 568 439 438 51 140 440 568 427 432 51 140 141 153 428 51 140 141 154 434 51 140 141 155 437 51 140 141 423 433 51 140 441 218 442 51 140 441 219 458 51 140 441 220 459 51 140 441 221 460 51 140 441 222 461 51 140 441 223 462 51 140 441 224 463 51 140 441 225 464 51 140 441 226 465 51 140 441 227 466 51 140 441 316 467 51 140 441 317 468 51 140 441 318 469 51 140 441 319 470 51 140 441 228 471 51 140 441 229 472 51 140 441 230 473 51 140 441 536 540 51 140 441 231 474 51 140 441 232 475 51 140 441 233 476 51 140 441 234 477 51 140 441 235 478 51 140 591 5 569 236 479 51 140 141 237 480 51 140 141 238 101 51 140 141 239 102 51 140 141 240 103 51 140 141 241 104 51 140 141 242 105 51 140 141 243 106 51 140 141 244 107 51 140 141 245 108 51 140 141 246 109 51 140 141 247 481 382 140 141 248 482 382 140 141 249 483 382 140 141 250 484 382 140 141 251 485 382 140 141 252 486 382 140 141 253 487 382 140 141 254 89 382 140 141 255 488 382 140 141 256 90 382 140 141 257 489 382 140 141 258 92 382 140 141 259 490 382 140 141 260 491 382 140 141 261 492 382 140 141 262 493 382 140 141 263 494 382 140 141 264 495 382 140 141 265 496 382 140 141 266 498 497 570 267 499 382 140 141 268 500 382 140 141 269 501 382 140 141 270 502 382 140 141 271 503 382 140 141 272 504 382 140 141 273 505 382 140 141 274 96 382 140 141 275 97 382 140 141 276 506 382 140 141 277 98 382 140 141 278 507 51 140 592 569 279 508 51 140 592 569 280 509 382 140 141 281 510 382 140 141 282 511 382 140 141 283 512 382 140 141 537 541 382 140 141 538 542 382 140 141 539 543 382 140 141 284 513 382 140 141 285 514 382 140 141 286 515 382 140 141 287 516 382 140 141 288 517 382 140 141 289 518 382 140 141 290 519 51 140 141 291 520 51 140 141 292 521 51 140 141 293 522 51 140 141 294 524 51 140 591 571 295 525 51 140 591 571 296 526 51 140 141 297 527 51 140 141 298 528 51 140 141 299 529 51 140 141 300 530 51 140 141 301 531 51 140 141 302 532 51 140 141 303 533 51 140 534 304 110 51 140 535 10 11 12 18 139 138 139 138 52 51 140 141 53 51 140 141 74 51 140 141 54 51 140 141 75 51 140 141 55 51 140 141 556 51 140 141 56 51 140 141 57 51 140 141 58 51 140 141 76 51 140 141 59 51 140 141 60 51 140 141 61 51 140 141 62 51 140 141 63 51 140 141 64 51 140 141 65 51 140 141 77 51 140 141 66 51 140 141 67 51 140 141 78 140 141 68 140 141 79 51 140 141 80 51 140 141 69 51 140 141 81 51 140 141 70 51 140 141 82 51 140 141 71 51 140 141 72 51 140 141 72 51 140 141 73 51 140 141 83 557 140 593 598 84 51 140 593 598 85 51 140 593 598 86 51 140 593 598 87 51 140 593 598 555 51 140 141 88 557 593 598 21 22 139 138 139 138 113 51 140 141 114 51 140 141 115 51 140 141 13 139 138 139 138 110 382 140 141 111 112 14 139 138 139 138 101 382 140 141 102 382 140 141 103 382 140 141 104 382 140 141 105 382 140 141 106 382 140 141 107 382 140 141 108 382 140 141 109 382 140 141 15 5 16 558 51 140 593 598 559 51 140 593 598 560 51 140 593 598 561 564 140 593 598 562 564 140 593 598 563 564 140 593 598 5 17 89 422 90 91 92 93 94 95 374 140 594 598 96 97 98 5 523 595 599 600

6 9 99 139 138 139 138 146 118 51 140 145 147 141 119 51 140 145 147 141 120 51 140 145 147 141 121 51 140 145 147 141 117 51 140 577 147 141 572 5 122 51 140 577 147 141 572 123 51 140 578 147 141 596 124 51 140 578 147 141 596 125 51 140 578 147 141 596 126 51 140 578 147 141 596 127 51 140 578 147 141 596 5 128 51 140 578 147 141 596 129 51 140 443 147 141 596 130 51 140 579 147 141 596 131 51 142 141 147 141 132 51 142 141 147 141 133 51 142 141 147 141 134 51 142 141 147 141 135 51 142 141 147 141 136 51 142 141 147 141 137 51 142 141 147 141 19 139 138 139 138 23 51 140 141 147 141 24 51 140 141 147 141 143 144 140 141 147 141 25 51 140 141 147 141 26 51 140 141 147 141 27 51 140 141 147 141 28 51 140 141 147 141 29 51 140 141 147 141 30 51 140 141 147 141 31 148 140 580 147 141 32 51 140 580 147 141 33 51 140 141 147 141 34 51 140 141 147 141 35 51 140 141 147 141 36 51 140 141 147 141 37 51 140 141 147 141 38 51 140 141 147 141 39 51 140 141 147 141 20 139 138 139 138 40 41 42 43 51 140 581 573 44 45 51 140 581 573 46 47 51 140 582 574 48 49 51 140 582 574 446 544 444 140 453 545 444 140 454 546 444 140 455 547 444 140 456 548 444 140 447 549 444 140 448 550 444 140 449 551 444 140 450 552 444 140 451 553 444 140 452 554 444 140 149 50 444 140 445 5 100 139 138 139 138 323 148 140 583 573 325 148 140 583 573 326 148 140 583 573 327 148 140 583 573 328 148 140 583 573 324 148 140 332 573 329 148 140 330 575 331 148 140 333 575 159 334 51 140 141 575 160 335 51 140 141 575 161 336 51 140 141 575 337 51 140 141 575 338 51 140 141 575 339 51 140 141 575 340 51 140 141 575 341 51 140 141 575 342 51 140 141 575 343 51 140 141 575 344 51 140 141 575 345 51 140 141 575 346 51 140 141 575 347 51 140 141 575 348 51 140 141 575 162 349 51 140 141 575 163 350 51 140 141 575 164 351 51 140 141 575 156 565 51 140 584 573 157 352 51 140 585 573 158 353 51 140 585 573 165 354 51 140 141 575 166 355 51 140 141 575 167 357 51 140 141 575 168 356 51 140 141 575 169 358 51 140 141 575 170 359 51 140 141 575 171 360 51 140 457 576 172 361 51 140 141 575 601 324 51 140 141 575 311 362 51 140 141 575 305 308 51 140 586 573 173 363 51 140 141 575 309 310 51 140 141 575 312 364 51 140 141 575 313 365 51 140 141 575 314 366 51 140 141 575 306 307 51 140 586 573 315 367 51 140 586 573 174 368 51 140 141 175 369 51 140 587 573 176 177 51 140 587 573 178 370 51 140 587 573 179 371 51 140 587 573 180 372 51 140 587 573 181 373 51 140 141 182 375 382 140 588 573 376 382 140 588 573 377 382 140 588 573 378 382 140 588 573 379 382 140 588 573 380 382 140 588 573 381 382 140 588 573 381 51 140 141 183 383 51 140 141 184 384 51 140 141 185 385 51 140 141 186 386 51 140 141 387 331 51 140 589 573 187 388 51 140 588 573 188 389 51 140 588 573 189 390 51 140 588 573 190 391 51 140 141 191 392 374 140 141 192 393 51 140 141 193 394 382 140 141 194 395 51 140 141 195 396 374 140 141 196 397 374 140 141 197 398 374 140 141 198 399 374 140 141 199 400 374 140 141 200 401 374 140 141 201 402 374 140 141 202 403 374 140 141 203 404 374 140 141 204 405 374 140 141 205 406 51 140 141 206 407 51 140 141 207 408 51 140 141 208 409 51 140 141 209 410 51 140 141 210 411 51 140 141 211 412 51 140 141 212 413 51 140 141 213 414 51 140 141 214 415 51 140 141 215 416 51 140 141 216 417 51 140 141 217 418 51 140 419 147 420 597 320 421 51 140 590 566 567 150 113 51 140 141 321 114 382 140 590 147 141 567 322 115 51 140 590 566 567 151 435 51 140 141 152 436 51 140 141 424 429 51 140 141 425 430 51 140 141 426 431 51 140 440 568 439 438 51 140 440 568 427 432 51 140 141 153 428 51 140 141 154 434 51 140 141 155 437 51 140 141 423 433 51 140 441 218 442 51 140 441 219 458 51 140 441 220 459 51 140 441 221 460 51 140 441 222 461 51 140 441 223 462 51 140 441 224 463 51 140 441 225 464 51 140 441 226 465 51 140 441 227 466 51 140 441 316 467 51 140 441 317 468 51 140 441 318 469 51 140 441 319 470 51 140 441 228 471 51 140 441 229 472 51 140 441 230 473 51 140 441 536 540 51 140 441 231 474 51 140 441 232 475 51 140 441 233 476 51 140 441 234 477 51 140 441 235 478 51 140 591 5 569 236 479 51 140 141 237 480 51 140 141 238 101 51 140 141 239 102 51 140 141 240 103 51 140 141 241 104 51 140 141 242 105 51 140 141 243 106 51 140 141 244 107 51 140 141 245 108 51 140 141 246 109 51 140 141 247 481 382 140 141 248 482 382 140 141 249 483 382 140 141 250 484 382 140 141 251 485 382 140 141 252 486 382 140 141 253 487 382 140 141 254 89 382 140 141 255 488 382 140 141 256 90 382 140 141 257 489 382 140 141 258 92 382 140 141 259 490 382 140 141 260 491 382 140 141 261 492 382 140 141 262 493 382 140 141 263 494 382 140 141 264 495 382 140 141 265 496 382 140 141 266 498 497 570 267 499 382 140 141 268 500 382 140 141 269 501 382 140 141 270 502 382 140 141 271 503 382 140 141 272 504 382 140 141 273 505 382 140 141 274 96 382 140 141 275 97 382 140 141 276 506 382 140 141 277 98 382 140 141 278 507 51 140 592 569 279 508 51 140 592 569 280 509 382 140 141 281 510 382 140 141 282 511 382 140 141 283 512 382 140 141 537 541 382 140 141 538 542 382 140 141 539 543 382 140 141 284 513 382 140 141 285 514 382 140 141 286 515 382 140 141 287 516 382 140 141 288 517 382 140 141 289 518 382 140 141 290 519 51 140 141 291 520 51 140 141 292 521 51 140 141 293 522 51 140 141 294 524 51 140 591 571 295 525 51 140 591 571 296 526 51 140 141 297 527 51 140 141 298 528 51 140 141 299 529 51 140 141 300 530 51 140 141 301 531 51 140 141 302 532 51 140 141 303 533 51 140 534 304 110 51 140 535 10 11 12 18 139 138 139 138 52 51 140 141 53 51 140 141 74 51 140 141 54 51 140 141 75 51 140 141 55 51 140 141 556 51 140 141 56 51 140 141 57 51 140 141 58 51 140 141 76 51 140 141 59 51 140 141 60 51 140 141 61 51 140 141 62 51 140 141 63 51 140 141 64 51 140 141 65 51 140 141 77 51 140 141 66 51 140 141 67 51 140 141 78 140 141 68 140 141 79 51 140 141 80 51 140 141 69 51 140 141 81 51 140 141 70 51 140 141 82 51 140 141 71 51 140 141 72 51 140 141 72 51 140 141 73 51 140 141 83 557 140 593 598 84 51 140 593 598 85 51 140 593 598 86 51 140 593 598 87 51 140 593 598 555 51 140 141 88 557 593 598 21 22 139 138 139 138 113 51 140 141 114 51 140 141 115 51 140 141 13 139 138 139 138 110 382 140 141 111 112 14 139 138 139 138 101 382 140 141 102 382 140 141 103 382 140 141 104 382 140 141 105 382 140 141 106 382 140 141 107 382 140 141 108 382 140 141 109 382 140 141 15 5 16 558 51 140 593 598 559 51 140 593 598 560 51 140 593 598 561 564 140 593 598 562 564 140 593 598 563 564 140 593 598 5 17 89 422 90 91 92 93 94 95 374 140 594 598 96 97 98 5 523 595 599 600

6 9 99 139 138 139 138 146 118 51 140 145 147 141 119 51 140 145 147 141 120 51 140 145 147 141 121 51 140 145 147 141 117 51 140 577 147 141 572 5 122 51 140 577 147 141 572 123 51 140 578 147 141 596 124 51 140 578 147 141 596 125 51 140 578 147 141 596 126 51 140 578 147 141 596 127 51 140 578 147 141 596 5 128 51 140 578 147 141 596 129 51 140 443 147 141 596 130 51 140 579 147 141 596 131 51 142 141 147 141 132 51 142 141 147 141 133 51 142 141 147 141 134 51 142 141 147 141 135 51 142 141 147 141 136 51 142 141 147 141 137 51 142 141 147 141 19 139 138 139 138 23 51 140 141 147 141 24 51 140 141 147 141 143 144 140 141 147 141 25 51 140 141 147 141 26 51 140 141 147 141 27 51 140 141 147 141 28 51 140 141 147 141 29 51 140 141 147 141 30 51 140 141 147 141 31 148 140 580 147 141 32 51 140 580 147 141 33 51 140 141 147 141 34 51 140 141 147 141 35 51 140 141 147 141 36 51 140 141 147 141 37 51 140 141 147 141 38 51 140 141 147 141 39 51 140 141 147 141 20 139 138 139 138 40 41 42 43 51 140 581 573 44 45 51 140 581 573 46 47 51 140 582 574 48 49 51 140 582 574 446 544 444 140 453 545 444 140 454 546 444 140 455 547 444 140 456 548 444 140 447 549 444 140 448 550 444 140 449 551 444 140 450 552 444 140 451 553 444 140 452 554 444 140 149 50 444 140 445 5 100 139 138 139 138 323 148 140 583 573 325 148 140 583 573 326 148 140 583 573 327 148 140 583 573 328 148 140 583 573 324 148 140 332 573 329 148 140 330 575 331 148 140 333 575 159 334 51 140 141 575 160 335 51 140 141 575 161 336 51 140 141 575 337 51 140 141 575 338 51 140 141 575 339 51 140 141 575 340 51 140 141 575 341 51 140 141 575 342 51 140 141 575 343 51 140 141 575 344 51 140 141 575 345 51 140 141 575 346 51 140 141 575 347 51 140 141 575 348 51 140 141 575 162 349 51 140 141 575 163 350 51 140 141 575 164 351 51 140 141 575 156 565 51 140 584 573 157 352 51 140 585 573 158 353 51 140 585 573 165 354 51 140 141 575 166 355 51 140 141 575 167 357 51 140 141 575 168 356 51 140 141 575 169 358 51 140 141 575 170 359 51 140 141 575 171 360 51 140 457 576 172 361 51 140 141 575 601 324 51 140 141 575 311 362 51 140 141 575 305 308 51 140 586 573 173 363 51 140 141 575 309 310 51 140 141 575 312 364 51 140 141 575 313 365 51 140 141 575 314 366 51 140 141 575 306 307 51 140 586 573 315 367 51 140 586 573 174 368 51 140 141 175 369 51 140 587 573 176 177 51 140 587 573 178 370 51 140 587 573 179 371 51 140 587 573 180 372 51 140 587 573 181 373 51 140 141 182 375 382 140 588 573 376 382 140 588 573 377 382 140 588 573 378 382 140 588 573 379 382 140 588 573 380 382 140 588 573 381 382 140 588 573 381 51 140 141 183 383 51 140 141 184 384 51 140 141 185 385 51 140 141 186 386 51 140 141 387 331 51 140 589 573 187 388 51 140 588 573 188 389 51 140 588 573 189 390 51 140 588 573 190 391 51 140 141 191 392 374 140 141 192 393 51 140 141 193 394 382 140 141 194 395 51 140 141 195 396 374 140 141 196 397 374 140 141 197 398 374 140 141 198 399 374 140 141 199 400 374 140 141 200 401 374 140 141 201 402 374 140 141 202 403 374 140 141 203 404 374 140 141 204 405 374 140 141 205 406 51 140 141 206 407 51 140 141 207 408 51 140 141 208 409 51 140 141 209 410 51 140 141 210 411 51 140 141 211 412 51 140 141 212 413 51 140 141 213 414 51 140 141 214 415 51 140 141 215 416 51 140 141 216 417 51 140 141 217 418 51 140 419 147 420 597 320 421 51 140 590 566 567 150 113 51 140 141 321 114 382 140 590 147 141 567 322 115 51 140 590 566 567 151 435 51 140 141 152 436 51 140 141 424 429 51 140 141 425 430 51 140 141 426 431 51 140 440 568 439 438 51 140 440 568 427 432 51 140 141 153 428 51 140 141 154 434 51 140 141 155 437 51 140 141 423 433 51 140 441 218 442 51 140 441 219 458 51 140 441 220 459 51 140 441 221 460 51 140 441 222 461 51 140 441 223 462 51 140 441 224 463 51 140 441 225 464 51 140 441 226 465 51 140 441 227 466 51 140 441 316 467 51 140 441 317 468 51 140 441 318 469 51 140 441 319 470 51 140 441 228 471 51 140 441 229 472 51 140 441 230 473 51 140 441 536 540 51 140 441 231 474 51 140 441 232 475 51 140 441 233 476 51 140 441 234 477 51 140 441 235 478 51 140 591 5 569 236 479 51 140 141 237 480 51 140 141 238 101 51 140 141 239 102 51 140 141 240 103 51 140 141 241 104 51 140 141 242 105 51 140 141 243 106 51 140 141 244 107 51 140 141 245 108 51 140 141 246 109 51 140 141 247 481 382 140 141 248 482 382 140 141 249 483 382 140 141 250 484 382 140 141 251 485 382 140 141 252 486 382 140 141 253 487 382 140 141 254 89 382 140 141 255 488 382 140 141 256 90 382 140 141 257 489 382 140 141 258 92 382 140 141 259 490 382 140 141 260 491 382 140 141 261 492 382 140 141 262 493 382 140 141 263 494 382 140 141 264 495 382 140 141 265 496 382 140 141 266 498 497 570 267 499 382 140 141 268 500 382 140 141 269 501 382 140 141 270 502 382 140 141 271 503 382 140 141 272 504 382 140 141 273 505 382 140 141 274 96 382 140 141 275 97 382 140 141 276 506 382 140 141 277 98 382 140 141 278 507 51 140 592 569 279 508 51 140 592 569 280 509 382 140 141 281 510 382 140 141 282 511 382 140 141 283 512 382 140 141 537 541 382 140 141 538 542 382 140 141 539 543 382 140 141 284 513 382 140 141 285 514 382 140 141 286 515 382 140 141 287 516 382 140 141 288 517 382 140 141 289 518 382 140 141 290 519 51 140 141 291 520 51 140 141 292 521 51 140 141 293 522 51 140 141 294 524 51 140 591 571 295 525 51 140 591 571 296 526 51 140 141 297 527 51 140 141 298 528 51 140 141 299 529 51 140 141 300 530 51 140 141 301 531 51 140 141 302 532 51 140 141 303 533 51 140 534 304 110 51 140 535 10 11 12 18 139 138 139 138 52 51 140 141 53 51 140 141 74 51 140 141 54 51 140 141 75 51 140 141 55 51 140 141 556 51 140 141 56 51 140 141 57 51 140 141 58 51 140 141 76 51 140 141 59 51 140 141 60 51 140 141 61 51 140 141 62 51 140 141 63 51 140 141 64 51 140 141 65 51 140 141 77 51 140 141 66 51 140 141 67 51 140 141 78 140 141 68 140 141 79 51 140 141 80 51 140 141 69 51 140 141 81 51 140 141 70 51 140 141 82 51 140 141 71 51 140 141 72 51 140 141 72 51 140 141 73 51 140 141 83 557 140 593 598 84 51 140 593 598 85 51 140 593 598 86 51 140 593 598 87 51 140 593 598 555 51 140 141 88 557 593 598 21 22 139 138 139 138 113 51 140 141 114 51 140 141 115 51 140 141 13 139 138 139 138 110 382 140 141 111 112 14 139 138 139 138 101 382 140 141 102 382 140 141 103 382 140 141 104 382 140 141 105 382 140 141 106 382 140 141 107 382 140 141 108 382 140 141 109 382 140 141 15 5 16 558 51 140 593 598 559 51 140 593 598 560 51 140 593 598 561 564 140 593 598 562 564 140 593 598 563 564 140 593 598 5 17 89 422 90 91 92 93 94 95 374 140 594 598 96 97 98 5 523 595 599 600

6 9 99 139 138 139 138 146 118 51 140 145 147 141 119 51 140 145 147 141 120 51 140 145 147 141 121 51 140 145 147 141 117 51 140 577 147 141 572 5 122 51 140 577 147 141 572 123 51 140 578 147 141 596 124 51 140 578 147 141 596 125 51 140 578 147 141 596 126 51 140 578 147 141 596 127 51 140 578 147 141 596 5 128 51 140 578 147 141 596 129 51 140 443 147 141 596 130 51 140 579 147 141 596 131 51 142 141 147 141 132 51 142 141 147 141 133 51 142 141 147 141 134 51 142 141 147 141 135 51 142 141 147 141 136 51 142 141 147 141 137 51 142 141 147 141 19 139 138 139 138 23 51 140 141 147 141 24 51 140 141 147 141 143 144 140 141 147 141 25 51 140 141 147 141 26 51 140 141 147 141 27 51 140 141 147 141 28 51 140 141 147 141 29 51 140 141 147 141 30 51 140 141 147 141 31 148 140 580 147 141 32 51 140 580 147 141 33 51 140 141 147 141 34 51 140 141 147 141 35 51 140 141 147 141 36 51 140 141 147 141 37 51 140 141 147 141 38 51 140 141 147 141 39 51 140 141 147 141 20 139 138 139 138 40 41 42 43 51 140 581 573 44 45 51 140 581 573 46 47 51 140 582 574 48 49 51 140 582 574 446 544 444 140 453 545 444 140 454 546 444 140 455 547 444 140 456 548 444 140 447 549 444 140 448 550 444 140 449 551 444 140 450 552 444 140 451 553 444 140 452 554 444 140 149 50 444 140 445 5 100 139 138 139 138 323 148 140 583 573 325 148 140 583 573 326 148 140 583 573 327 148 140 583 573 328 148 140 583 573 324 148 140 332 573 329 148 140 330 575 331 148 140 333 575 159 334 51 140 141 575 160 335 51 140 141 575 161 336 51 140 141 575 337 51 140 141 575 338 51 140 141 575 339 51 140 141 575 340 51 140 141 575 341 51 140 141 575 342 51 140 141 575 343 51 140 141 575 344 51 140 141 575 345 51 140 141 575 346 51 140 141 575 347 51 140 141 575 348 51 140 141 575 162 349 51 140 141 575 163 350 51 140 141 575 164 351 51 140 141 575 156 565 51 140 584 573 157 352 51 140 585 573 158 353 51 140 585 573 165 354 51 140 141 575 166 355 51 140 141 575 167 357 51 140 141 575 168 356 51 140 141 575 169 358 51 140 141 575 170 359 51 140 141 575 171 360 51 140 457 576 172 361 51 140 141 575 601 324 51 140 141 575 311 362 51 140 141 575 305 308 51 140 586 573 173 363 51 140 141 575 309 310 51 140 141 575 312 364 51 140 141 575 313 365 51 140 141 575 314 366 51 140 141 575 306 307 51 140 586 573 315 367 51 140 586 573 174 368 51 140 141 175 369 51 140 587 573 176 177 51 140 587 573 178 370 51 140 587 573 179 371 51 140 587 573 180 372 51 140 587 573 181 373 51 140 141 182 375 382 140 588 573 376 382 140 588 573 377 382 140 588 573 378 382 140 588 573 379 382 140 588 573 380 382 140 588 573 381 382 140 588 573 381 51 140 141 183 383 51 140 141 184 384 51 140 141 185 385 51 140 141 186 386 51 140 141 387 331 51 140 589 573 187 388 51 140 588 573 188 389 51 140 588 573 189 390 51 140 588 573 190 391 51 140 141 191 392 374 140 141 192 393 51 140 141 193 394 382 140 141 194 395 51 140 141 195 396 374 140 141 196 397 374 140 141 197 398 374 140 141 198 399 374 140 141 199 400 374 140 141 200 401 374 140 141 201 402 374 140 141 202 403 374 140 141 203 404 374 140 141 204 405 374 140 141 205 406 51 140 141 206 407 51 140 141 207 408 51 140 141 208 409 51 140 141 209 410 51 140 141 210 411 51 140 141 211 412 51 140 141 212 413 51 140 141 213 414 51 140 141 214 415 51 140 141 215 416 51 140 141 216 417 51 140 141 217 418 51 140 419 147 420 597 320 421 51 140 590 566 567 150 113 51 140 141 321 114 382 140 590 147 141 567 322 115 51 140 590 566 567 151 435 51 140 141 152 436 51 140 141 424 429 51 140 141 425 430 51 140 141 426 431 51 140 440 568 439 438 51 140 440 568 427 432 51 140 141 153 428 51 140 141 154 434 51 140 141 155 437 51 140 141 423 433 51 140 441 218 442 51 140 441 219 458 51 140 441 220 459 51 140 441 221 460 51 140 441 222 461 51 140 441 223 462 51 140 441 224 463 51 140 441 225 464 51 140 441 226 465 51 140 441 227 466 51 140 441 316 467 51 140 441 317 468 51 140 441 318 469 51 140 441 319 470 51 140 441 228 471 51 140 441 229 472 51 140 441 230 473 51 140 441 536 540 51 140 441 231 474 51 140 441 232 475 51 140 441 233 476 51 140 441 234 477 51 140 441 235 478 51 140 591 5 569 236 479 51 140 141 237 480 51 140 141 238 101 51 140 141 239 102 51 140 141 240 103 51 140 141 241 104 51 140 141 242 105 51 140 141 243 106 51 140 141 244 107 51 140 141 245 108 51 140 141 246 109 51 140 141 247 481 382 140 141 248 482 382 140 141 249 483 382 140 141 250 484 382 140 141 251 485 382 140 141 252 486 382 140 141 253 487 382 140 141 254 89 382 140 141 255 488 382 140 141 256 90 382 140 141 257 489 382 140 141 258 92 382 140 141 259 490 382 140 141 260 491 382 140 141 261 492 382 140 141 262 493 382 140 141 263 494 382 140 141 264 495 382 140 141 265 496 382 140 141 266 498 497 570 267 499 382 140 141 268 500 382 140 141 269 501 382 140 141 270 502 382 140 141 271 503 382 140 141 272 504 382 140 141 273 505 382 140 141 274 96 382 140 141 275 97 382 140 141 276 506 382 140 141 277 98 382 140 141 278 507 51 140 592 569 279 508 51 140 592 569 280 509 382 140 141 281 510 382 140 141 282 511 382 140 141 283 512 382 140 141 537 541 382 140 141 538 542 382 140 141 539 543 382 140 141 284 513 382 140 141 285 514 382 140 141 286 515 382 140 141 287 516 382 140 141 288 517 382 140 141 289 518 382 140 141 290 519 51 140 141 291 520 51 140 141 292 521 51 140 141 293 522 51 140 141 294 524 51 140 591 571 295 525 51 140 591 571 296 526 51 140 141 297 527 51 140 141 298 528 51 140 141 299 529 51 140 141 300 530 51 140 141 301 531 51 140 141 302 532 51 140 141 303 533 51 140 534 304 110 51 140 535 10 11 12 18 139 138 139 138 52 51 140 141 53 51 140 141 74 51 140 141 54 51 140 141 75 51 140 141 55 51 140 141 556 51 140 141 56 51 140 141 57 51 140 141 58 51 140 141 76 51 140 141 59 51 140 141 60 51 140 141 61 51 140 141 62 51 140 141 63 51 140 141 64 51 140 141 65 51 140 141 77 51 140 141 66 51 140 141 67 51 140 141 78 140 141 68 140 141 79 51 140 141 80 51 140 141 69 51 140 141 81 51 140 141 70 51 140 141 82 51 140 141 71 51 140 141 72 51 140 141 72 51 140 141 73 51 140 141 83 557 140 593 598 84 51 140 593 598 85 51 140 593 598 86 51 140 593 598 87 51 140 593 598 555 51 140 141 88 557 593 598 21 22 139 138 139 138 113 51 140 141 114 51 140 141 115 51 140 141 13 139 138 139 138 110 382 140 141 111 112 14 139 138 139 138 101 382 140 141 102 382 140 141 103 382 140 141 104 382 140 141 105 382 140 141 106 382 140 141 107 382 140 141 108 382 140 141 109 382 140 141 15 5 16 558 51 140 593 598 559 51 140 593 598 560 51 140 593 598 561 564 140 593 598 562 564 140 593 598 563 564 140 593 598 5 17 89 422 90 91 92 93 94 95 374 140 594 598 96 97 98 5 523 595 599 600

6 9 99 139 138 139 138 146 118 51 140 145 147 141 119 51 140 145 147 141 120 51 140 145 147 141 121 51 140 145 147 141 117 51 140 577 147 141 572 5 122 51 140 577 147 141 572 123 51 140 578 147 141 596 124 51 140 578 147 141 596 125 51 140 578 147 141 596 126 51 140 578 147 141 596 127 51 140 578 147 141 596 5 128 51 140 578 147 141 596 129 51 140 443 147 141 596 130 51 140 579 147 141 596 131 51 142 141 147 141 132 51 142 141 147 141 133 51 142 141 147 141 134 51 142 141 147 141 135 51 142 141 147 141 136 51 142 141 147 141 137 51 142 141 147 141 19 139 138 139 138 23 51 140 141 147 141 24 51 140 141 147 141 143 144 140 141 147 141 25 51 140 141 147 141 26 51 140 141 147 141 27 51 140 141 147 141 28 51 140 141 147 141 29 51 140 141 147 141 30 51 140 141 147 141 31 148 140 580 147 141 32 51 140 580 147 141 33 51 140 141 147 141 34 51 140 141 147 141 35 51 140 141 147 141 36 51 140 141 147 141 37 51 140 141 147 141 38 51 140 141 147 141 39 51 140 141 147 141 20 139 138 139 138 40 41 42 43 51 140 581 573 44 45 51 140 581 573 46 47 51 140 582 574 48 49 51 140 582 574 446 544 444 140 453 545 444 140 454 546 444 140 455 547 444 140 456 548 444 140 447 549 444 140 448 550 444 140 449 551 444 140 450 552 444 140 451 553 444 140 452 554 444 140 149 50 444 140 445 5 100 139 138 139 138 323 148 140 583 573 325 148 140 583 573 326 148 140 583 573 327 148 140 583 573 328 148 140 583 573 324 148 140 332 573 329 148 140 330 575 331 148 140 333 575 159 334 51 140 141 575 160 335 51 140 141 575 161 336 51 140 141 575 337 51 140 141 575 338 51 140 141 575 339 51 140 141 575 340 51 140 141 575 341 51 140 141 575 342 51 140 141 575 343 51 140 141 575 344 51 140 141 575 345 51 140 141 575 346 51 140 141 575 347 51 140 141 575 348 51 140 141 575 162 349 51 140 141 575 163 350 51 140 141 575 164 351 51 140 141 575 156 565 51 140 584 573 157 352 51 140 585 573 158 353 51 140 585 573 165 354 51 140 141 575 166 355 51 140 141 575 167 357 51 140 141 575 168 356 51 140 141 575 169 358 51 140 141 575 170 359 51 140 141 575 171 360 51 140 457 576 172 361 51 140 141 575 601 324 51 140 141 575 311 362 51 140 141 575 305 308 51 140 586 573 173 363 51 140 141 575 309 310 51 140 141 575 312 364 51 140 141 575 313 365 51 140 141 575 314 366 51 140 141 575 306 307 51 140 586 573 315 367 51 140 586 573 174 368 51 140 141 175 369 51 140 587 573 176 177 51 140 587 573 178 370 51 140 587 573 179 371 51 140 587 573 180 372 51 140 587 573 181 373 51 140 141 182 375 382 140 588 573 376 382 140 588 573 377 382 140 588 573 378 382 140 588 573 379 382 140 588 573 380 382 140 588 573 381 382 140 588 573 381 51 140 141 183 383 51 140 141 184 384 51 140 141 185 385 51 140 141 186 386 51 140 141 387 331 51 140 589 573 187 388 51 140 588 573 188 389 51 140 588 573 189 390 51 140 588 573 190 391 51 140 141 191 392 374 140 141 192 393 51 140 141 193 394 382 140 141 194 395 51 140 141 195 396 374 140 141 196 397 374 140 141 197 398 374 140 141 198 399 374 140 141 199 400 374 140 141 200 401 374 140 141 201 402 374 140 141 202 403 374 140 141 203 404 374 140 141 204 405 374 140 141 205 406 51 140 141 206 407 51 140 141 207 408 51 140 141 208 409 51 140 141 209 410 51 140 141 210 411 51 140 141 211 412 51 140 141 212 413 51 140 141 213 414 51 140 141 214 415 51 140 141 215 416 51 140 141 216 417 51 140 141 217 418 51 140 419 147 420 597 320 421 51 140 590 566 567 150 113 51 140 141 321 114 382 140 590 147 141 567 322 115 51 140 590 566 567 151 435 51 140 141 152 436 51 140 141 424 429 51 140 141 425 430 51 140 141 426 431 51 140 440 568 439 438 51 140 440 568 427 432 51 140 141 153 428 51 140 141 154 434 51 140 141 155 437 51 140 141 423 433 51 140 441 218 442 51 140 441 219 458 51 140 441 220 459 51 140 441 221 460 51 140 441 222 461 51 140 441 223 462 51 140 441 224 463 51 140 441 225 464 51 140 441 226 465 51 140 441 227 466 51 140 441 316 467 51 140 441 317 468 51 140 441 318 469 51 140 441 319 470 51 140 441 228 471 51 140 441 229 472 51 140 441 230 473 51 140 441 536 540 51 140 441 231 474 51 140 441 232 475 51 140 441 233 476 51 140 441 234 477 51 140 441 235 478 51 140 591 5 569 236 479 51 140 141 237 480 51 140 141 238 101 51 140 141 239 102 51 140 141 240 103 51 140 141 241 104 51 140 141 242 105 51 140 141 243 106 51 140 141 244 107 51 140 141 245 108 51 140 141 246 109 51 140 141 247 481 382 140 141 248 482 382 140 141 249 483 382 140 141 250 484 382 140 141 251 485 382 140 141 252 486 382 140 141 253 487 382 140 141 254 89 382 140 141 255 488 382 140 141 256 90 382 140 141 257 489 382 140 141 258 92 382 140 141 259 490 382 140 141 260 491 382 140 141 261 492 382 140 141 262 493 382 140 141 263 494 382 140 141 264 495 382 140 141 265 496 382 140 141 266 498 497 570 267 499 382 140 141 268 500 382 140 141 269 501 382 140 141 270 502 382 140 141 271 503 382 140 141 272 504 382 140 141 273 505 382 140 141 274 96 382 140 141 275 97 382 140 141 276 506 382 140 141 277 98 382 140 141 278 507 51 140 592 569 279 508 51 140 592 569 280 509 382 140 141 281 510 382 140 141 282 511 382 140 141 283 512 382 140 141 537 541 382 140 141 538 542 382 140 141 539 543 382 140 141 284 513 382 140 141 285 514 382 140 141 286 515 382 140 141 287 516 382 140 141 288 517 382 140 141 289 518 382 140 141 290 519 51 140 141 291 520 51 140 141 292 521 51 140 141 293 522 51 140 141 294 524 51 140 591 571 295 525 51 140 591 571 296 526 51 140 141 297 527 51 140 141 298 528 51 140 141 299 529 51 140 141 300 530 51 140 141 301 531 51 140 141 302 532 51 140 141 303 533 51 140 534 304 110 51 140 535 10 11 12 18 139 138 139 138 52 51 140 141 53 51 140 141 74 51 140 141 54 51 140 141 75 51 140 141 55 51 140 141 556 51 140 141 56 51 140 141 57 51 140 141 58 51 140 141 76 51 140 141 59 51 140 141 60 51 140 141 61 51 140 141 62 51 140 141 63 51 140 141 64 51 140 141 65 51 140 141 77 51 140 141 66 51 140 141 67 51 140 141 78 140 141 68 140 141 79 51 140 141 80 51 140 141 69 51 140 141 81 51 140 141 70 51 140 141 82 51 140 141 71 51 140 141 72 51 140 141 72 51 140 141 73 51 140 141 83 557 140 593 598 84 51 140 593 598 85 51 140 593 598 86 51 140 593 598 87 51 140 593 598 555 51 140 141 88 557 593 598 21 22 139 138 139 138 113 51 140 141 114 51 140 141 115 51 140 141 13 139 138 139 138 110 382 140 141 111 112 14 139 138 139 138 101 382 140 141 102 382 140 141 103 382 140 141 104 382 140 141 105 382 140 141 106 382 140 141 107 382 140 141 108 382 140 141 109 382 140 141 15 5 16 558 51 140 593 598 559 51 140 593 598 560 51 140 593 598 561 564 140 593 598 562 564 140 593 598 563 564 140 593 598 5 17 89 422 90 91 92 93 94 95 374 140 594 598 96 97 98 5 523 595 599 600

6 9 99 139 138 139 138 146 118 51 140 145 147 141 119 51 140 145 147 141 120 51 140 145 147 141 121 51 140 145 147 141 117 51 140 577 147 141 572 5 122 51 140 577 147 141 572 123 51 140 578 147 141 596 124 51 140 578 147 141 596 125 51 140 578 147 141 596 126 51 140 578 147 141 596 127 51 140 578 147 141 596 5 128 51 140 578 147 141 596 129 51 140 443 147 141 596 130 51 140 579 147 141 596 131 51 142 141 147 141 132 51 142 141 147 141 133 51 142 141 147 141 134 51 142 141 147 141 135 51 142 141 147 141 136 51 142 141 147 141 137 51 142 141 147 141 19 139 138 139 138 23 51 140 141 147 141 24 51 140 141 147 141 143 144 140 141 147 141 25 51 140 141 147 141 26 51 140 141 147 141 27 51 140 141 147 141 28 51 140 141 147 141 29 51 140 141 147 141 30 51 140 141 147 141 31 148 140 580 147 141 32 51 140 580 147 141 33 51 140 141 147 141 34 51 140 141 147 141 35 51 140 141 147 141 36 51 140 141 147 141 37 51 140 141 147 141 38 51 140 141 147 141 39 51 140 141 147 141 20 139 138 139 138 40 41 42 43 51 140 581 573 44 45 51 140 581 573 46 47 51 140 582 574 48 49 51 140 582 574 446 544 444 140 453 545 444 140 454 546 444 140 455 547 444 140 456 548 444 140 447 549 444 140 448 550 444 140 449 551 444 140 450 552 444 140 451 553 444 140 452 554 444 140 149 50 444 140 445 5 100 139 138 139 138 323 148 140 583 573 325 148 140 583 573 326 148 140 583 573 327 148 140 583 573 328 148 140 583 573 324 148 140 332 573 329 148 140 330 575 331 148 140 333 575 159 334 51 140 141 575 160 335 51 140 141 575 161 336 51 140 141 575 337 51 140 141 575 338 51 140 141 575 339 51 140 141 575 340 51 140 141 575 341 51 140 141 575 342 51 140 141 575 343 51 140 141 575 344 51 140 141 575 345 51 140 141 575 346 51 140 141 575 347 51 140 141 575 348 51 140 141 575 162 349 51 140 141 575 163 350 51 140 141 575 164 351 51 140 141 575 156 565 51 140 584 573 157 352 51 140 585 573 158 353 51 140 585 573 165 354 51 140 141 575 166 355 51 140 141 575 167 357 51 140 141 575 168 356 51 140 141 575 169 358 51 140 141 575 170 359 51 140 141 575 171 360 51 140 457 576 172 361 51 140 141 575 601 324 51 140 141 575 311 362 51 140 141 575 305 308 51 140 586 573 173 363 51 140 141 575 309 310 51 140 141 575 312 364 51 140 141 575 313 365 51 140 141 575 314 366 51 140 141 575 306 307 51 140 586 573 315 367 51 140 586 573 174 368 51 140 141 175 369 51 140 587 573 176 177 51 140 587 573 178 370 51 140 587 573 179 371 51 140 587 573 180 372 51 140 587 573 181 373 51 140 141 182 375 382 140 588 573 376 382 140 588 573 377 382 140 588 573 378 382 140 588 573 379 382 140 588 573 380 382 140 588 573 381 382 140 588 573 381 51 140 141 183 383 51 140 141 184 384 51 140 141 185 385 51 140 141 186 386 51 140 141 387 331 51 140 589 573 187 388 51 140 588 573 188 389 51 140 588 573 189 390 51 140 588 573 190 391 51 140 141 191 392 374 140 141 192 393 51 140 141 193 394 382 140 141 194 395 51 140 141 195 396 374 140 141 196 397 374 140 141 197 398 374 140 141 198 399 374 140 141 199 400 374 140 141 200 401 374 140 141 201 402 374 140 141 202 403 374 140 141 203 404 374 140 141 204 405 374 140 141 205 406 51 140 141 206 407 51 140 141 207 408 51 140 141 208 409 51 140 141 209 410 51 140 141 210 411 51 140 141 211 412 51 140 141 212 413 51 140 141 213 414 51 140 141 214 415 51 140 141 215 416 51 140 141 216 417 51 140 141 217 418 51 140 419 147 420 597 320 421 51 140 590 566 567 150 113 51 140 141 321 114 382 140 590 147 141 567 322 115 51 140 590 566 567 151 435 51 140 141 152 436 51 140 141 424 429 51 140 141 425 430 51 140 141 426 431 51 140 440 568 439 438 51 140 440 568 427 432 51 140 141 153 428 51 140 141 154 434 51 140 141 155 437 51 140 141 423 433 51 140 441 218 442 51 140 441 219 458 51 140 441 220 459 51 140 441 221 460 51 140 441 222 461 51 140 441 223 462 51 140 441 224 463 51 140 441 225 464 51 140 441 226 465 51 140 441 227 466 51 140 441 316 467 51 140 441 317 468 51 140 441 318 469 51 140 441 319 470 51 140 441 228 471 51 140 441 229 472 51 140 441 230 473 51 140 441 536 540 51 140 441 231 474 51 140 441 232 475 51 140 441 233 476 51 140 441 234 477 51 140 441 235 478 51 140 591 5 569 236 479 51 140 141 237 480 51 140 141 238 101 51 140 141 239 102 51 140 141 240 103 51 140 141 241 104 51 140 141 242 105 51 140 141 243 106 51 140 141 244 107 51 140 141 245 108 51 140 141 246 109 51 140 141 247 481 382 140 141 248 482 382 140 141 249 483 382 140 141 250 484 382 140 141 251 485 382 140 141 252 486 382 140 141 253 487 382 140 141 254 89 382 140 141 255 488 382 140 141 256 90 382 140 141 257 489 382 140 141 258 92 382 140 141 259 490 382 140 141 260 491 382 140 141 261 492 382 140 141 262 493 382 140 141 263 494 382 140 141 264 495 382 140 141 265 496 382 140 141 266 498 497 570 267 499 382 140 141 268 500 382 140 141 269 501 382 140 141 270 502 382 140 141 271 503 382 140 141 272 504 382 140 141 273 505 382 140 141 274 96 382 140 141 275 97 382 140 141 276 506 382 140 141 277 98 382 140 141 278 507 51 140 592 569 279 508 51 140 592 569 280 509 382 140 141 281 510 382 140 141 282 511 382 140 141 283 512 382 140 141 537 541 382 140 141 538 542 382 140 141 539 543 382 140 141 284 513 382 140 141 285 514 382 140 141 286 515 382 140 141 287 516 382 140 141 288 517 382 140 141 289 518 382 140 141 290 519 51 140 141 291 520 51 140 141 292 521 51 140 141 293 522 51 140 141 294 524 51 140 591 571 295 525 51 140 591 571 296 526 51 140 141 297 527 51 140 141 298 528 51 140 141 299 529 51 140 141 300 530 51 140 141 301 531 51 140 141 302 532 51 140 141 303 533 51 140 534 304 110 51 140 535 10 11 12 18 139 138 139 138 52 51 140 141 53 51 140 141 74 51 140 141 54 51 140 141 75 51 140 141 55 51 140 141 556 51 140 141 56 51 140 141 57 51 140 141 58 51 140 141 76 51 140 141 59 51 140 141 60 51 140 141 61 51 140 141 62 51 140 141 63 51 140 141 64 51 140 141 65 51 140 141 77 51 140 141 66 51 140 141 67 51 140 141 78 140 141 68 140 141 79 51 140 141 80 51 140 141 69 51 140 141 81 51 140 141 70 51 140 141 82 51 140 141 71 51 140 141 72 51 140 141 72 51 140 141 73 51 140 141 83 557 140 593 598 84 51 140 593 598 85 51 140 593 598 86 51 140 593 598 87 51 140 593 598 555 51 140 141 88 557 593 598 21 22 139 138 139 138 113 51 140 141 114 51 140 141 115 51 140 141 13 139 138 139 138 110 382 140 141 111 112 14 139 138 139 138 101 382 140 141 102 382 140 141 103 382 140 141 104 382 140 141 105 382 140 141 106 382 140 141 107 382 140 141 108 382 140 141 109 382 140 141 15 5 16 558 51 140 593 598 559 51 140 593 598 560 51 140 593 598 561 564 140 593 598 562 564 140 593 598 563 564 140 593 598 5 17 89 422 90 91 92 93 94 95 374 140 594 598 96 97 98 5 523 595 599 600

6 9 99 139 138 139 138 146 118 51 140 145 147 141 119 51 140 145 147 141 120 51 140 145 147 141 121 51 140 145 147 141 117 51 140 577 147 141 572 5 122 51 140 577 147 141 572 123 51 140 578 147 141 596 124 51 140 578 147 141 596 125 51 140 578 147 141 596 126 51 140 578 147 141 596 127 51 140 578 147 141 596 5 128 51 140 578 147 141 596 129 51 140 443 147 141 596 130 51 140 579 147 141 596 131 51 142 141 147 141 132 51 142 141 147 141 133 51 142 141 147 141 134 51 142 141 147 141 135 51 142 141 147 141 136 51 142 141 147 141 137 51 142 141 147 141 19 139 138 139 138 23 51 140 141 147 141 24 51 140 141 147 141 143 144 140 141 147 141 25 51 140 141 147 141 26 51 140 141 147 141 27 51 140 141 147 141 28 51 140 141 147 141 29 51 140 141 147 141 30 51 140 141 147 141 31 148 140 580 147 141 32 51 140 580 147 141 33 51 140 141 147 141 34 51 140 141 147 141 35 51 140 141 147 141 36 51 140 141 147 141 37 51 140 141 147 141 38 51 140 141 147 141 39 51 140 141 147 141 20 139 138 139 138 40 41 42 43 51 140 581 573 44 45 51 140 581 573 46 47 51 140 582 574 48 49 51 140 582 574 446 544 444 140 453 545 444 140 454 546 444 140 455 547 444 140 456 548 444 140 447 549 444 140 448 550 444 140 449 551 444 140 450 552 444 140 451 553 444 140 452 554 444 140 149 50 444 140 445 5 100 139 138 139 138 323 148 140 583 573 325 148 140 583 573 326 148 140 583 573 327 148 140 583 573 328 148 140 583 573 324 148 140 332 573 329 148 140 330 575 331 148 140 333 575 159 334 51 140 141 575 160 335 51 140 141 575 161 336 51 140 141 575 337 51 140 141 575 338 51 140 141 575 339 51 140 141 575 340 51 140 141 575 341 51 140 141 575 342 51 140 141 575 343 51 140 141 575 344 51 140 141 575 345 51 140 141 575 346 51 140 141 575 347 51 140 141 575 348 51 140 141 575 162 349 51 140 141 575 163 350 51 140 141 575 164 351 51 140 141 575 156 565 51 140 584 573 157 352 51 140 585 573 158 353 51 140 585 573 165 354 51 140 141 575 166 355 51 140 141 575 167 357 51 140 141 575 168 356 51 140 141 575 169 358 51 140 141 575 170 359 51 140 141 575 171 360 51 140 457 576 172 361 51 140 141 575 601 324 51 140 141 575 311 362 51 140 141 575 305 308 51 140 586 573 173 363 51 140 141 575 309 310 51 140 141 575 312 364 51 140 141 575 313 365 51 140 141 575 314 366 51 140 141 575 306 307 51 140 586 573 315 367 51 140 586 573 174 368 51 140 141 175 369 51 140 587 573 176 177 51 140 587 573 178 370 51 140 587 573 179 371 51 140 587 573 180 372 51 140 587 573 181 373 51 140 141 182 375 382 140 588 573 376 382 140 588 573 377 382 140 588 573 378 382 140 588 573 379 382 140 588 573 380 382 140 588 573 381 382 140 588 573 381 51 140 141 183 383 51 140 141 184 384 51 140 141 185 385 51 140 141 186 386 51 140 141 387 331 51 140 589 573 187 388 51 140 588 573 188 389 51 140 588 573 189 390 51 140 588 573 190 391 51 140 141 191 392 374 140 141 192 393 51 140 141 193 394 382 140 141 194 395 51 140 141 195 396 374 140 141 196 397 374 140 141 197 398 374 140 141 198 399 374 140 141 199 400 374 140 141 200 401 374 140 141 201 402 374 140 141 202 403 374 140 141 203 404 374 140 141 204 405 374 140 141 205 406 51 140 141 206 407 51 140 141 207 408 51 140 141 208 409 51 140 141 209 410 51 140 141 210 411 51 140 141 211 412 51 140 141 212 413 51 140 141 213 414 51 140 141 214 415 51 140 141 215 416 51 140 141 216 417 51 140 141 217 418 51 140 419 147 420 597 320 421 51 140 590 566 567 150 113 51 140 141 321 114 382 140 590 147 141 567 322 115 51 140 590 566 567 151 435 51 140 141 152 436 51 140 141 424 429 51 140 141 425 430 51 140 141 426 431 51 140 440 568 439 438 51 140 440 568 427 432 51 140 141 153 428 51 140 141 154 434 51 140 141 155 437 51 140 141 423 433 51 140 441 218 442 51 140 441 219 458 51 140 441 220 459 51 140 441 221 460 51 140 441 222 461 51 140 441 223 462 51 140 441 224 463 51 140 441 225 464 51 140 441 226 465 51 140 441 227 466 51 140 441 316 467 51 140 441 317 468 51 140 441 318 469 51 140 441 319 470 51 140 441 228 471 51 140 441 229 472 51 140 441 230 473 51 140 441 536 540 51 140 441 231 474 51 140 441 232 475 51 140 441 233 476 51 140 441 234 477 51 140 441 235 478 51 140 591 5 569 236 479 51 140 141 237 480 51 140 141 238 101 51 140 141 239 102 51 140 141 240 103 51 140 141 241 104 51 140 141 242 105 51 140 141 243 106 51 140 141 244 107 51 140 141 245 108 51 140 141 246 109 51 140 141 247 481 382 140 141 248 482 382 140 141 249 483 382 140 141 250 484 382 140 141 251 485 382 140 141 252 486 382 140 141 253 487 382 140 141 254 89 382 140 141 255 488 382 140 141 256 90 382 140 141 257 489 382 140 141 258 92 382 140 141 259 490 382 140 141 260 491 382 140 141 261 492 382 140 141 262 493 382 140 141 263 494 382 140 141 264 495 382 140 141 265 496 382 140 141 266 498 497 570 267 499 382 140 141 268 500 382 140 141 269 501 382 140 141 270 502 382 140 141 271 503 382 140 141 272 504 382 140 141 273 505 382 140 141 274 96 382 140 141 275 97 382 140 141 276 506 382 140 141 277 98 382 140 141 278 507 51 140 592 569 279 508 51 140 592 569 280 509 382 140 141 281 510 382 140 141 282 511 382 140 141 283 512 382 140 141 537 541 382 140 141 538 542 382 140 141 539 543 382 140 141 284 513 382 140 141 285 514 382 140 141 286 515 382 140 141 287 516 382 140 141 288 517 382 140 141 289 518 382 140 141 290 519 51 140 141 291 520 51 140 141 292 521 51 140 141 293 522 51 140 141 294 524 51 140 591 571 295 525 51 140 591 571 296 526 51 140 141 297 527 51 140 141 298 528 51 140 141 299 529 51 140 141 300 530 51 140 141 301 531 51 140 141 302 532 51 140 141 303 533 51 140 534 304 110 51 140 535 10 11 12 18 139 138 139 138 52 51 140 141 53 51 140 141 74 51 140 141 54 51 140 141 75 51 140 141 55 51 140 141 556 51 140 141 56 51 140 141 57 51 140 141 58 51 140 141 76 51 140 141 59 51 140 141 60 51 140 141 61 51 140 141 62 51 140 141 63 51 140 141 64 51 140 141 65 51 140 141 77 51 140 141 66 51 140 141 67 51 140 141 78 140 141 68 140 141 79 51 140 141 80 51 140 141 69 51 140 141 81 51 140 141 70 51 140 141 82 51 140 141 71 51 140 141 72 51 140 141 72 51 140 141 73 51 140 141 83 557 140 593 598 84 51 140 593 598 85 51 140 593 598 86 51 140 593 598 87 51 140 593 598 555 51 140 141 88 557 593 598 21 22 139 138 139 138 113 51 140 141 114 51 140 141 115 51 140 141 13 139 138 139 138 110 382 140 141 111 112 14 139 138 139 138 101 382 140 141 102 382 140 141 103 382 140 141 104 382 140 141 105 382 140 141 106 382 140 141 107 382 140 141 108 382 140 141 109 382 140 141 15 5 16 558 51 140 593 598 559 51 140 593 598 560 51 140 593 598 561 564 140 593 598 562 564 140 593 598 563 564 140 593 598 5 17 89 422 90 91 92 93 94 95 374 140 594 598 96 97 98 5 523 595 599 600

6 9 99 139 138 139 138 146 118 51 140 145 147 141 119 51 140 145 147 141 120 51 140 145 147 141 121 51 140 145 147 141 117 51 140 577 147 141 572 5 122 51 140 577 147 141 572 123 51 140 578 147 141 596 124 51 140 578 147 141 596 125 51 140 578 147 141 596 126 51 140 578 147 141 596 127 51 140 578 147 141 596 5 128 51 140 578 147 141 596 129 51 140 443 147 141 596 130 51 140 579 147 141 596 131 51 142 141 147 141 132 51 142 141 147 141 133 51 142 141 147 141 134 51 142 141 147 141 135 51 142 141 147 141 136 51 142 141 147 141 137 51 142 141 147 141 19 139 138 139 138 23 51 140 141 147 141 24 51 140 141 147 141 143 144 140 141 147 141 25 51 140 141 147 141 26 51 140 141 147 141 27 51 140 141 147 141 28 51 140 141 147 141 29 51 140 141 147 141 30 51 140 141 147 141 31 148 140 580 147 141 32 51 140 580 147 141 33 51 140 141 147 141 34 51 140 141 147 141 35 51 140 141 147 141 36 51 140 141 147 141 37 51 140 141 147 141 38 51 140 141 147 141 39 51 140 141 147 141 20 139 138 139 138 40 41 42 43 51 140 581 573 44 45 51 140 581 573 46 47 51 140 582 574 48 49 51 140 582 574 446 544 444 140 453 545 444 140 454 546 444 140 455 547 444 140 456 548 444 140 447 549 444 140 448 550 444 140 449 551 444 140 450 552 444 140 451 553 444 140 452 554 444 140 149 50 444 140 445 5 100 139 138 139 138 323 148 140 583 573 325 148 140 583 573 326 148 140 583 573 327 148 140 583 573 328 148 140 583 573 324 148 140 332 573 329 148 140 330 575 331 148 140 333 575 159 334 51 140 141 575 160 335 51 140 141 575 161 336 51 140 141 575 337 51 140 141 575 338 51 140 141 575 339 51 140 141 575 340 51 140 141 575 341 51 140 141 575 342 51 140 141 575 343 51 140 141 575 344 51 140 141 575 345 51 140 141 575 346 51 140 141 575 347 51 140 141 575 348 51 140 141 575 162 349 51 140 141 575 163 350 51 140 141 575 164 351 51 140 141 575 156 565 51 140 584 573 157 352 51 140 585 573 158 353 51 140 585 573 165 354 51 140 141 575 166 355 51 140 141 575 167 357 51 140 141 575 168 356 51 140 141 575 169 358 51 140 141 575 170 359 51 140 141 575 171 360 51 140 457 576 172 361 51 140 141 575 601 324 51 140 141 575 311 362 51 140 141 575 305 308 51 140 586 573 173 363 51 140 141 575 309 310 51 140 141 575 312 364 51 140 141 575 313 365 51 140 141 575 314 366 51 140 141 575 306 307 51 140 586 573 315 367 51 140 586 573 174 368 51 140 141 175 369 51 140 587 573 176 177 51 140 587 573 178 370 51 140 587 573 179 371 51 140 587 573 180 372 51 140 587 573 181 373 51 140 141 182 375 382 140 588 573 376 382 140 588 573 377 382 140 588 573 378 382 140 588 573 379 382 140 588 573 380 382 140 588 573 381 382 140 588 573 381 51 140 141 183 383 51 140 141 184 384 51 140 141 185 385 51 140 141 186 386 51 140 141 387 331 51 140 589 573 187 388 51 140 588 573 188 389 51 140 588 573 189 390 51 140 588 573 190 391 51 140 141 191 392 374 140 141 192 393 51 140 141 193 394 382 140 141 194 395 51 140 141 195 396 374 140 141 196 397 374 140 141 197 398 374 140 141 198 399 374 140 141 199 400 374 140 141 200 401 374 140 141 201 402 374 140 141 202 403 374 140 141 203 404 374 140 141 204 405 374 140 141 205 406 51 140 141 206 407 51 140 141 207 408 51 140 141 208 409 51 140 141 209 410 51 140 141 210 411 51 140 141 211 412 51 140 141 212 413 51 140 141 213 414 51 140 141 214 415 51 140 141 215 416 51 140 141 216 417 51 140 141 217 418 51 140 419 147 420 597 320 421 51 140 590 566 567 150 113 51 140 141 321 114 382 140 590 147 141 567 322 115 51 140 590 566 567 151 435 51 140 141 152 436 51 140 141 424 429 51 140 141 425 430 51 140 141 426 431 51 140 440 568 439 438 51 140 440 568 427 432 51 140 141 153 428 51 140 141 154 434 51 140 141 155 437 51 140 141 423 433 51 140 441 218 442 51 140 441 219 458 51 140 441 220 459 51 140 441 221 460 51 140 441 222 461 51 140 441 223 462 51 140 441 224 463 51 140 441 225 464 51 140 441 226 465 51 140 441 227 466 51 140 441 316 467 51 140 441 317 468 51 140 441 318 469 51 140 441 319 470 51 140 441 228 471 51 140 441 229 472 51 140 441 230 473 51 140 441 536 540 51 140 441 231 474 51 140 441 232 475 51 140 441 233 476 51 140 441 234 477 51 140 441 235 478 51 140 591 5 569 236 479 51 140 141 237 480 51 140 141 238 101 51 140 141 239 102 51 140 141 240 103 51 140 141 241 104 51 140 141 242 105 51 140 141 243 106 51 140 141 244 107 51 140 141 245 108 51 140 141 246 109 51 140 141 247 481 382 140 141 248 482 382 140 141 249 483 382 140 141 250 484 382 140 141 251 485 382 140 141 252 486 382 140 141 253 487 382 140 141 254 89 382 140 141 255 488 382 140 141 256 90 382 140 141 257 489 382 140 141 258 92 382 140 141 259 490 382 140 141 260 491 382 140 141 261 492 382 140 141 262 493 382 140 141 263 494 382 140 141 264 495 382 140 141 265 496 382 140 141 266 498 497 570 267 499 382 140 141 268 500 382 140 141 269 501 382 140 141 270 502 382 140 141 271 503 382 140 141 272 504 382 140 141 273 505 382 140 141 274 96 382 140 141 275 97 382 140 141 276 506 382 140 141 277 98 382 140 141 278 507 51 140 592 569 279 508 51 140 592 569 280 509 382 140 141 281 510 382 140 141 282 511 382 140 141 283 512 382 140 141 537 541 382 140 141 538 542 382 140 141 539 543 382 140 141 284 513 382 140 141 285 514 382 140 141 286 515 382 140 141 287 516 382 140 141 288 517 382 140 141 289 518 382 140 141 290 519 51 140 141 291 520 51 140 141 292 521 51 140 141 293 522 51 140 141 294 524 51 140 591 571 295 525 51 140 591 571 296 526 51 140 141 297 527 51 140 141 298 528 51 140 141 299 529 51 140 141 300 530 51 140 141 301 531 51 140 141 302 532 51 140 141 303 533 51 140 534 304 110 51 140 535 10 11 12 18 139 138 139 138 52 51 140 141 53 51 140 141 74 51 140 141 54 51 140 141 75 51 140 141 55 51 140 141 556 51 140 141 56 51 140 141 57 51 140 141 58 51 140 141 76 51 140 141 59 51 140 141 60 51 140 141 61 51 140 141 62 51 140 141 63 51 140 141 64 51 140 141 65 51 140 141 77 51 140 141 66 51 140 141 67 51 140 141 78 140 141 68 140 141 79 51 140 141 80 51 140 141 69 51 140 141 81 51 140 141 70 51 140 141 82 51 140 141 71 51 140 141 72 51 140 141 72 51 140 141 73 51 140 141 83 557 140 593 598 84 51 140 593 598 85 51 140 593 598 86 51 140 593 598 87 51 140 593 598 555 51 140 141 88 557 593 598 21 22 139 138 139 138 113 51 140 141 114 51 140 141 115 51 140 141 13 139 138 139 138 110 382 140 141 111 112 14 139 138 139 138 101 382 140 141 102 382 140 141 103 382 140 141 104 382 140 141 105 382 140 141 106 382 140 141 107 382 140 141 108 382 140 141 109 382 140 141 15 5 16 558 51 140 593 598 559 51 140 593 598 560 51 140 593 598 561 564 140 593 598 562 564 140 593 598 563 564 140 593 598 5 17 89 422 90 91 92 93 94 95 374 140 594 598 96 97 98 5 523 595 599 600

6 9 99 139 138 139 138 146 118 51 140 145 147 141 119 51 140 145 147 141 120 51 140 145 147 141 121 51 140 145 147 141 117 51 140 577 147 141 572 5 122 51 140 577 147 141 572 123 51 140 578 147 141 596 124 51 140 578 147 141 596 125 51 140 578 147 141 596 126 51 140 578 147 141 596 127 51 140 578 147 141 596 5 128 51 140 578 147 141 596 129 51 140 443 147 141 596 130 51 140 579 147 141 596 131 51 142 141 147 141 132 51 142 141 147 141 133 51 142 141 147 141 134 51 142 141 147 141 135 51 142 141 147 141 136 51 142 141 147 141 137 51 142 141 147 141 19 139 138 139 138 23 51 140 141 147 141 24 51 140 141 147 141 143 144 140 141 147 141 25 51 140 141 147 141 26 51 140 141 147 141 27 51 140 141 147 141 28 51 140 141 147 141 29 51 140 141 147 141 30 51 140 141 147 141 31 148 140 580 147 141 32 51 140 580 147 141 33 51 140 141 147 141 34 51 140 141 147 141 35 51 140 141 147 141 36 51 140 141 147 141 37 51 140 141 147 141 38 51 140 141 147 141 39 51 140 141 147 141 20 139 138 139 138 40 41 42 43 51 140 581 573 44 45 51 140 581 573 46 47 51 140 582 574 48 49 51 140 582 574 446 544 444 140 453 545 444 140 454 546 444 140 455 547 444 140 456 548 444 140 447 549 444 140 448 550 444 140 449 551 444 140 450 552 444 140 451 553 444 140 452 554 444 140 149 50 444 140 445 5 100 139 138 139 138 323 148 140 583 573 325 148 140 583 573 326 148 140 583 573 327 148 140 583 573 328 148 140 583 573 324 148 140 332 573 329 148 140 330 575 331 148 140 333 575 159 334 51 140 141 575 160 335 51 140 141 575 161 336 51 140 141 575 337 51 140 141 575 338 51 140 141 575 339 51 140 141 575 340 51 140 141 575 341 51 140 141 575 342 51 140 141 575 343 51 140 141 575 344 51 140 141 575 345 51 140 141 575 346 51 140 141 575 347 51 140 141 575 348 51 140 141 575 162 349 51 140 141 575 163 350 51 140 141 575 164 351 51 140 141 575 156 565 51 140 584 573 157 352 51 140 585 573 158 353 51 140 585 573 165 354 51 140 141 575 166 355 51 140 141 575 167 357 51 140 141 575 168 356 51 140 141 575 169 358 51 140 141 575 170 359 51 140 141 575 171 360 51 140 457 576 172 361 51 140 141 575 601 324 51 140 141 575 311 362 51 140 141 575 305 308 51 140 586 573 173 363 51 140 141 575 309 310 51 140 141 575 312 364 51 140 141 575 313 365 51 140 141 575 314 366 51 140 141 575 306 307 51 140 586 573 315 367 51 140 586 573 174 368 51 140 141 175 369 51 140 587 573 176 177 51 140 587 573 178 370 51 140 587 573 179 371 51 140 587 573 180 372 51 140 587 573 181 373 51 140 141 182 375 382 140 588 573 376 382 140 588 573 377 382 140 588 573 378 382 140 588 573 379 382 140 588 573 380 382 140 588 573 381 382 140 588 573 381 51 140 141 183 383 51 140 141 184 384 51 140 141 185 385 51 140 141 186 386 51 140 141 387 331 51 140 589 573 187 388 51 140 588 573 188 389 51 140 588 573 189 390 51 140 588 573 190 391 51 140 141 191 392 374 140 141 192 393 51 140 141 193 394 382 140 141 194 395 51 140 141 195 396 374 140 141 196 397 374 140 141 197 398 374 140 141 198 399 374 140 141 199 400 374 140 141 200 401 374 140 141 201 402 374 140 141 202 403 374 140 141 203 404 374 140 141 204 405 374 140 141 205 406 51 140 141 206 407 51 140 141 207 408 51 140 141 208 409 51 140 141 209 410 51 140 141 210 411 51 140 141 211 412 51 140 141 212 413 51 140 141 213 414 51 140 141 214 415 51 140 141 215 416 51 140 141 216 417 51 140 141 217 418 51 140 419 147 420 597 320 421 51 140 590 566 567 150 113 51 140 141 321 114 382 140 590 147 141 567 322 115 51 140 590 566 567 151 435 51 140 141 152 436 51 140 141 424 429 51 140 141 425 430 51 140 141 426 431 51 140 440 568 439 438 51 140 440 568 427 432 51 140 141 153 428 51 140 141 154 434 51 140 141 155 437 51 140 141 423 433 51 140 441 218 442 51 140 441 219 458 51 140 441 220 459 51 140 441 221 460 51 140 441 222 461 51 140 441 223 462 51 140 441 224 463 51 140 441 225 464 51 140 441 226 465 51 140 441 227 466 51 140 441 316 467 51 140 441 317 468 51 140 441 318 469 51 140 441 319 470 51 140 441 228 471 51 140 441 229 472 51 140 441 230 473 51 140 441 536 540 51 140 441 231 474 51 140 441 232 475 51 140 441 233 476 51 140 441 234 477 51 140 441 235 478 51 140 591 5 569 236 479 51 140 141 237 480 51 140 141 238 101 51 140 141 239 102 51 140 141 240 103 51 140 141 241 104 51 140 141 242 105 51 140 141 243 106 51 140 141 244 107 51 140 141 245 108 51 140 141 246 109 51 140 141 247 481 382 140 141 248 482 382 140 141 249 483 382 140 141 250 484 382 140 141 251 485 382 140 141 252 486 382 140 141 253 487 382 140 141 254 89 382 140 141 255 488 382 140 141 256 90 382 140 141 257 489 382 140 141 258 92 382 140 141 259 490 382 140 141 260 491 382 140 141 261 492 382 140 141 262 493 382 140 141 263 494 382 140 141 264 495 382 140 141 265 496 382 140 141 266 498 497 570 267 499 382 140 141 268 500 382 140 141 269 501 382 140 141 270 502 382 140 141 271 503 382 140 141 272 504 382 140 141 273 505 382 140 141 274 96 382 140 141 275 97 382 140 141 276 506 382 140 141 277 98 382 140 141 278 507 51 140 592 569 279 508 51 140 592 569 280 509 382 140 141 281 510 382 140 141 282 511 382 140 141 283 512 382 140 141 537 541 382 140 141 538 542 382 140 141 539 543 382 140 141 284 513 382 140 141 285 514 382 140 141 286 515 382 140 141 287 516 382 140 141 288 517 382 140 141 289 518 382 140 141 290 519 51 140 141 291 520 51 140 141 292 521 51 140 141 293 522 51 140 141 294 524 51 140 591 571 295 525 51 140 591 571 296 526 51 140 141 297 527 51 140 141 298 528 51 140 141 299 529 51 140 141 300 530 51 140 141 301 531 51 140 141 302 532 51 140 141 303 533 51 140 534 304 110 51 140 535 10 11 12 18 139 138 139 138 52 51 140 141 53 51 140 141 74 51 140 141 54 51 140 141 75 51 140 141 55 51 140 141 556 51 140 141 56 51 140 141 57 51 140 141 58 51 140 141 76 51 140 141 59 51 140 141 60 51 140 141 61 51 140 141 62 51 140 141 63 51 140 141 64 51 140 141 65 51 140 141 77 51 140 141 66 51 140 141 67 51 140 141 78 140 141 68 140 141 79 51 140 141 80 51 140 141 69 51 140 141 81 51 140 141 70 51 140 141 82 51 140 141 71 51 140 141 72 51 140 141 72 51 140 141 73 51 140 141 83 557 140 593 598 84 51 140 593 598 85 51 140 593 598 86 51 140 593 598 87 51 140 593 598 555 51 140 141 88 557 593 598 21 22 139 138 139 138 113 51 140 141 114 51 140 141 115 51 140 141 13 139 138 139 138 110 382 140 141 111 112 14 139 138 139 138 101 382 140 141 102 382 140 141 103 382 140 141 104 382 140 141 105 382 140 141 106 382 140 141 107 382 140 141 108 382 140 141 109 382 140 141 15 5 16 558 51 140 593 598 559 51 140 593 598 560 51 140 593 598 561 564 140 593 598 562 564 140 593 598 563 564 140 593 598 5 17 89 422 90 91 92 93 94 95 374 140 594 598 96 97 98 5 523 595 599 600

6 9 99 139 138 139 138 146 118 51 140 145 147 141 119 51 140 145 147 141 120 51 140 145 147 141 121 51 140 145 147 141 117 51 140 577 147 141 572 5 122 51 140 577 147 141 572 123 51 140 578 147 141 596 124 51 140 578 147 141 596 125 51 140 578 147 141 596 126 51 140 578 147 141 596 127 51 140 578 147 141 596 5 128 51 140 578 147 141 596 129 51 140 443 147 141 596 130 51 140 579 147 141 596 131 51 142 141 147 141 132 51 142 141 147 141 133 51 142 141 147 141 134 51 142 141 147 141 135 51 142 141 147 141 136 51 142 141 147 141 137 51 142 141 147 141 19 139 138 139 138 23 51 140 141 147 141 24 51 140 141 147 141 143 144 140 141 147 141 25 51 140 141 147 141 26 51 140 141 147 141 27 51 140 141 147 141 28 51 140 141 147 141 29 51 140 141 147 141 30 51 140 141 147 141 31 148 140 580 147 141 32 51 140 580 147 141 33 51 140 141 147 141 34 51 140 141 147 141 35 51 140 141 147 141 36 51 140 141 147 141 37 51 140 141 147 141 38 51 140 141 147 141 39 51 140 141 147 141 20 139 138 139 138 40 41 42 43 51 140 581 573 44 45 51 140 581 573 46 47 51 140 582 574 48 49 51 140 582 574 446 544 444 140 453 545 444 140 454 546 444 140 455 547 444 140 456 548 444 140 447 549 444 140 448 550 444 140 449 551 444 140 450 552 444 140 451 553 444 140 452 554 444 140 149 50 444 140 445 5 100 139 138 139 138 323 148 140 583 573 325 148 140 583 573 326 148 140 583 573 327 148 140 583 573 328 148 140 583 573 324 148 140 332 573 329 148 140 330 575 331 148 140 333 575 159 334 51 140 141 575 160 335 51 140 141 575 161 336 51 140 141 575 337 51 140 141 575 338 51 140 141 575 339 51 140 141 575 340 51 140 141 575 341 51 140 141 575 342 51 140 141 575 343 51 140 141 575 344 51 140 141 575 345 51 140 141 575 346 51 140 141 575 347 51 140 141 575 348 51 140 141 575 162 349 51 140 141 575 163 350 51 140 141 575 164 351 51 140 141 575 156 565 51 140 584 573 157 352 51 140 585 573 158 353 51 140 585 573 165 354 51 140 141 575 166 355 51 140 141 575 167 357 51 140 141 575 168 356 51 140 141 575 169 358 51 140 141 575 170 359 51 140 141 575 171 360 51 140 457 576 172 361 51 140 141 575 601 324 51 140 141 575 311 362 51 140 141 575 305 308 51 140 586 573 173 363 51 140 141 575 309 310 51 140 141 575 312 364 51 140 141 575 313 365 51 140 141 575 314 366 51 140 141 575 306 307 51 140 586 573 315 367 51 140 586 573 174 368 51 140 141 175 369 51 140 587 573 176 177 51 140 587 573 178 370 51 140 587 573 179 371 51 140 587 573 180 372 51 140 587 573 181 373 51 140 141 182 375 382 140 588 573 376 382 140 588 573 377 382 140 588 573 378 382 140 588 573 379 382 140 588 573 380 382 140 588 573 381 382 140 588 573 381 51 140 141 183 383 51 140 141 184 384 51 140 141 185 385 51 140 141 186 386 51 140 141 387 331 51 140 589 573 187 388 51 140 588 573 188 389 51 140 588 573 189 390 51 140 588 573 190 391 51 140 141 191 392 374 140 141 192 393 51 140 141 193 394 382 140 141 194 395 51 140 141 195 396 374 140 141 196 397 374 140 141 197 398 374 140 141 198 399 374 140 141 199 400 374 140 141 200 401 374 140 141 201 402 374 140 141 202 403 374 140 141 203 404 374 140 141 204 405 374 140 141 205 406 51 140 141 206 407 51 140 141 207 408 51 140 141 208 409 51 140 141 209 410 51 140 141 210 411 51 140 141 211 412 51 140 141 212 413 51 140 141 213 414 51 140 141 214 415 51 140 141 215 416 51 140 141 216 417 51 140 141 217 418 51 140 419 147 420 597 320 421 51 140 590 566 567 150 113 51 140 141 321 114 382 140 590 147 141 567 322 115 51 140 590 566 567 151 435 51 140 141 152 436 51 140 141 424 429 51 140 141 425 430 51 140 141 426 431 51 140 440 568 439 438 51 140 440 568 427 432 51 140 141 153 428 51 140 141 154 434 51 140 141 155 437 51 140 141 423 433 51 140 441 218 442 51 140 441 219 458 51 140 441 220 459 51 140 441 221 460 51 140 441 222 461 51 140 441 223 462 51 140 441 224 463 51 140 441 225 464 51 140 441 226 465 51 140 441 227 466 51 140 441 316 467 51 140 441 317 468 51 140 441 318 469 51 140 441 319 470 51 140 441 228 471 51 140 441 229 472 51 140 441 230 473 51 140 441 536 540 51 140 441 231 474 51 140 441 232 475 51 140 441 233 476 51 140 441 234 477 51 140 441 235 478 51 140 591 5 569 236 479 51 140 141 237 480 51 140 141 238 101 51 140 141 239 102 51 140 141 240 103 51 140 141 241 104 51 140 141 242 105 51 140 141 243 106 51 140 141 244 107 51 140 141 245 108 51 140 141 246 109 51 140 141 247 481 382 140 141 248 482 382 140 141 249 483 382 140 141 250 484 382 140 141 251 485 382 140 141 252 486 382 140 141 253 487 382 140 141 254 89 382 140 141 255 488 382 140 141 256 90 382 140 141 257 489 382 140 141 258 92 382 140 141 259 490 382 140 141 260 491 382 140 141 261 492 382 140 141 262 493 382 140 141 263 494 382 140 141 264 495 382 140 141 265 496 382 140 141 266 498 497 570 267 499 382 140 141 268 500 382 140 141 269 501 382 140 141 270 502 382 140 141 271 503 382 140 141 272 504 382 140 141 273 505 382 140 141 274 96 382 140 141 275 97 382 140 141 276 506 382 140 141 277 98 382 140 141 278 507 51 140 592 569 279 508 51 140 592 569 280 509 382 140 141 281 510 382 140 141 282 511 382 140 141 283 512 382 140 141 537 541 382 140 141 538 542 382 140 141 539 543 382 140 141 284 513 382 140 141 285 514 382 140 141 286 515 382 140 141 287 516 382 140 141 288 517 382 140 141 289 518 382 140 141 290 519 51 140 141 291 520 51 140 141 292 521 51 140 141 293 522 51 140 141 294 524 51 140 591 571 295 525 51 140 591 571 296 526 51 140 141 297 527 51 140 141 298 528 51 140 141 299 529 51 140 141 300 530 51 140 141 301 531 51 140 141 302 532 51 140 141 303 533 51 140 534 304 110 51 140 535 10 11 12 18 139 138 139 138 52 51 140 141 53 51 140 141 74 51 140 141 54 51 140 141 75 51 140 141 55 51 140 141 556 51 140 141 56 51 140 141 57 51 140 141 58 51 140 141 76 51 140 141 59 51 140 141 60 51 140 141 61 51 140 141 62 51 140 141 63 51 140 141 64 51 140 141 65 51 140 141 77 51 140 141 66 51 140 141 67 51 140 141 78 140 141 68 140 141 79 51 140 141 80 51 140 141 69 51 140 141 81 51 140 141 70 51 140 141 82 51 140 141 71 51 140 141 72 51 140 141 72 51 140 141 73 51 140 141 83 557 140 593 598 84 51 140 593 598 85 51 140 593 598 86 51 140 593 598 87 51 140 593 598 555 51 140 141 88 557 593 598 21 22 139 138 139 138 113 51 140 141 114 51 140 141 115 51 140 141 13 139 138 139 138 110 382 140 141 111 112 14 139 138 139 138 101 382 140 141 102 382 140 141 103 382 140 141 104 382 140 141 105 382 140 141 106 382 140 141 107 382 140 141 108 382 140 141 109 382 140 141 15 5 16 558 51 140 593 598 559 51 140 593 598 560 51 140 593 598 561 564 140 593 598 562 564 140 593 598 563 564 140 593 598 5 17 89 422 90 91 92 93 94 95 374 140 594 598 96 97 98 5 523 595 599 600

6 9 99 139 138 139 138 146 118 51 140 145 147 141 119 51 140 145 147 141 120 51 140 145 147 141 121 51 140 145 147 141 117 51 140 577 147 141 572 5 122 51 140 577 147 141 572 123 51 140 578 147 141 596 124 51 140 578 147 141 596 125 51 140 578 147 141 596 126 51 140 578 147 141 596 127 51 140 578 147 141 596 5 128 51 140 578 147 141 596 129 51 140 443 147 141 596 130 51 140 579 147 141 596 131 51 142 141 147 141 132 51 142 141 147 141 133 51 142 141 147 141 134 51 142 141 147 141 135 51 142 141 147 141 136 51 142 141 147 141 137 51 142 141 147 141 19 139 138 139 138 23 51 140 141 147 141 24 51 140 141 147 141 143 144 140 141 147 141 25 51 140 141 147 141 26 51 140 141 147 141 27 51 140 141 147 141 28 51 140 141 147 141 29 51 140 141 147 141 30 51 140 141 147 141 31 148 140 580 147 141 32 51 140 580 147 141 33 51 140 141 147 141 34 51 140 141 147 141 35 51 140 141 147 141 36 51 140 141 147 141 37 51 140 141 147 141 38 51 140 141 147 141 39 51 140 141 147 141 20 139 138 139 138 40 41 42 43 51 140 581 573 44 45 51 140 581 573 46 47 51 140 582 574 48 49 51 140 582 574 446 544 444 140 453 545 444 140 454 546 444 140 455 547 444 140 456 548 444 140 447 549 444 140 448 550 444 140 449 551 444 140 450 552 444 140 451 553 444 140 452 554 444 140 149 50 444 140 445 5 100 139 138 139 138 323 148 140 583 573 325 148 140 583 573 326 148 140 583 573 327 148 140 583 573 328 148 140 583 573 324 148 140 332 573 329 148 140 330 575 331 148 140 333 575 159 334 51 140 141 575 160 335 51 140 141 575 161 336 51 140 141 575 337 51 140 141 575 338 51 140 141 575 339 51 140 141 575 340 51 140 141 575 341 51 140 141 575 342 51 140 141 575 343 51 140 141 575 344 51 140 141 575 345 51 140 141 575 346 51 140 141 575 347 51 140 141 575 348 51 140 141 575 162 349 51 140 141 575 163 350 51 140 141 575 164 351 51 140 141 575 156 565 51 140 584 573 157 352 51 140 585 573 158 353 51 140 585 573 165 354 51 140 141 575 166 355 51 140 141 575 167 357 51 140 141 575 168 356 51 140 141 575 169 358 51 140 141 575 170 359 51 140 141 575 171 360 51 140 457 576 172 361 51 140 141 575 601 324 51 140 141 575 311 362 51 140 141 575 305 308 51 140 586 573 173 363 51 140 141 575 309 310 51 140 141 575 312 364 51 140 141 575 313 365 51 140 141 575 314 366 51 140 141 575 306 307 51 140 586 573 315 367 51 140 586 573 174 368 51 140 141 175 369 51 140 587 573 176 177 51 140 587 573 178 370 51 140 587 573 179 371 51 140 587 573 180 372 51 140 587 573 181 373 51 140 141 182 375 382 140 588 573 376 382 140 588 573 377 382 140 588 573 378 382 140 588 573 379 382 140 588 573 380 382 140 588 573 381 382 140 588 573 381 51 140 141 183 383 51 140 141 184 384 51 140 141 185 385 51 140 141 186 386 51 140 141 387 331 51 140 589 573 187 388 51 140 588 573 188 389 51 140 588 573 189 390 51 140 588 573 190 391 51 140 141 191 392 374 140 141 192 393 51 140 141 193 394 382 140 141 194 395 51 140 141 195 396 374 140 141 196 397 374 140 141 197 398 374 140 141 198 399 374 140 141 199 400 374 140 141 200 401 374 140 141 201 402 374 140 141 202 403 374 140 141 203 404 374 140 141 204 405 374 140 141 205 406 51 140 141 206 407 51 140 141 207 408 51 140 141 208 409 51 140 141 209 410 51 140 141 210 411 51 140 141 211 412 51 140 141 212 413 51 140 141 213 414 51 140 141 214 415 51 140 141 215 416 51 140 141 216 417 51 140 141 217 418 51 140 419 147 420 597 320 421 51 140 590 566 567 150 113 51 140 141 321 114 382 140 590 147 141 567 322 115 51 140 590 566 567 151 435 51 140 141 152 436 51 140 141 424 429 51 140 141 425 430 51 140 141 426 431 51 140 440 568 439 438 51 140 440 568 427 432 51 140 141 153 428 51 140 141 154 434 51 140 141 155 437 51 140 141 423 433 51 140 441 218 442 51 140 441 219 458 51 140 441 220 459 51 140 441 221 460 51 140 441 222 461 51 140 441 223 462 51 140 441 224 463 51 140 441 225 464 51 140 441 226 465 51 140 441 227 466 51 140 441 316 467 51 140 441 317 468 51 140 441 318 469 51 140 441 319 470 51 140 441 228 471 51 140 441 229 472 51 140 441 230 473 51 140 441 536 540 51 140 441 231 474 51 140 441 232 475 51 140 441 233 476 51 140 441 234 477 51 140 441 235 478 51 140 591 5 569 236 479 51 140 141 237 480 51 140 141 238 101 51 140 141 239 102 51 140 141 240 103 51 140 141 241 104 51 140 141 242 105 51 140 141 243 106 51 140 141 244 107 51 140 141 245 108 51 140 141 246 109 51 140 141 247 481 382 140 141 248 482 382 140 141 249 483 382 140 141 250 484 382 140 141 251 485 382 140 141 252 486 382 140 141 253 487 382 140 141 254 89 382 140 141 255 488 382 140 141 256 90 382 140 141 257 489 382 140 141 258 92 382 140 141 259 490 382 140 141 260 491 382 140 141 261 492 382 140 141 262 493 382 140 141 263 494 382 140 141 264 495 382 140 141 265 496 382 140 141 266 498 497 570 267 499 382 140 141 268 500 382 140 141 269 501 382 140 141 270 502 382 140 141 271 503 382 140 141 272 504 382 140 141 273 505 382 140 141 274 96 382 140 141 275 97 382 140 141 276 506 382 140 141 277 98 382 140 141 278 507 51 140 592 569 279 508 51 140 592 569 280 509 382 140 141 281 510 382 140 141 282 511 382 140 141 283 512 382 140 141 537 541 382 140 141 538 542 382 140 141 539 543 382 140 141 284 513 382 140 141 285 514 382 140 141 286 515 382 140 141 287 516 382 140 141 288 517 382 140 141 289 518 382 140 141 290 519 51 140 141 291 520 51 140 141 292 521 51 140 141 293 522 51 140 141 294 524 51 140 591 571 295 525 51 140 591 571 296 526 51 140 141 297 527 51 140 141 298 528 51 140 141 299 529 51 140 141 300 530 51 140 141 301 531 51 140 141 302 532 51 140 141 303 533 51 140 534 304 110 51 140 535 10 11 12 18 139 138 139 138 52 51 140 141 53 51 140 141 74 51 140 141 54 51 140 141 75 51 140 141 55 51 140 141 556 51 140 141 56 51 140 141 57 51 140 141 58 51 140 141 76 51 140 141 59 51 140 141 60 51 140 141 61 51 140 141 62 51 140 141 63 51 140 141 64 51 140 141 65 51 140 141 77 51 140 141 66 51 140 141 67 51 140 141 78 140 141 68 140 141 79 51 140 141 80 51 140 141 69 51 140 141 81 51 140 141 70 51 140 141 82 51 140 141 71 51 140 141 72 51 140 141 72 51 140 141 73 51 140 141 83 557 140 593 598 84 51 140 593 598 85 51 140 593 598 86 51 140 593 598 87 51 140 593 598 555 51 140 141 88 557 593 598 21 22 139 138 139 138 113 51 140 141 114 51 140 141 115 51 140 141 13 139 138 139 138 110 382 140 141 111 112 14 139 138 139 138 101 382 140 141 102 382 140 141 103 382 140 141 104 382 140 141 105 382 140 141 106 382 140 141 107 382 140 141 108 382 140 141 109 382 140 141 15 5 16 558 51 140 593 598 559 51 140 593 598 560 51 140 593 598 561 564 140 593 598 562 564 140 593 598 563 564 140 593 598 5 17 89 422 90 91 92 93 94 95 374 140 594 598 96 97 98 5 523 595 599 600

6 9 99 139 138 139 138 146 118 51 140 145 147 141 119 51 140 145 147 141 120 51 140 145 147 141 121 51 140 145 147 141 117 51 140 577 147 141 572 5 122 51 140 577 147 141 572 123 51 140 578 147 141 596 124 51 140 578 147 141 596 125 51 140 578 147 141 596 126 51 140 578 147 141 596 127 51 140 578 147 141 596 5 128 51 140 578 147 141 596 129 51 140 443 147 141 596 130 51 140 579 147 141 596 131 51 142 141 147 141 132 51 142 141 147 141 133 51 142 141 147 141 134 51 142 141 147 141 135 51 142 141 147 141 136 51 142 141 147 141 137 51 142 141 147 141 19 139 138 139 138 23 51 140 141 147 141 24 51 140 141 147 141 143 144 140 141 147 141 25 51 140 141 147 141 26 51 140 141 147 141 27 51 140 141 147 141 28 51 140 141 147 141 29 51 140 141 147 141 30 51 140 141 147 141 31 148 140 580 147 141 32 51 140 580 147 141 33 51 140 141 147 141 34 51 140 141 147 141 35 51 140 141 147 141 36 51 140 141 147 141 37 51 140 141 147 141 38 51 140 141 147 141 39 51 140 141 147 141 20 139 138 139 138 40 41 42 43 51 140 581 573 44 45 51 140 581 573 46 47 51 140 582 574 48 49 51 140 582 574 446 544 444 140 453 545 444 140 454 546 444 140 455 547 444 140 456 548 444 140 447 549 444 140 448 550 444 140 449 551 444 140 450 552 444 140 451 553 444 140 452 554 444 140 149 50 444 140 445 5 100 139 138 139 138 323 148 140 583 573 325 148 140 583 573 326 148 140 583 573 327 148 140 583 573 328 148 140 583 573 324 148 140 332 573 329 148 140 330 575 331 148 140 333 575 159 334 51 140 141 575 160 335 51 140 141 575 161 336 51 140 141 575 337 51 140 141 575 338 51 140 141 575 339 51 140 141 575 340 51 140 141 575 341 51 140 141 575 342 51 140 141 575 343 51 140 141 575 344 51 140 141 575 345 51 140 141 575 346 51 140 141 575 347 51 140 141 575 348 51 140 141 575 162 349 51 140 141 575 163 350 51 140 141 575 164 351 51 140 141 575 156 565 51 140 584 573 157 352 51 140 585 573 158 353 51 140 585 573 165 354 51 140 141 575 166 355 51 140 141 575 167 357 51 140 141 575 168 356 51 140 141 575 169 358 51 140 141 575 170 359 51 140 141 575 171 360 51 140 457 576 172 361 51 140 141 575 601 324 51 140 141 575 311 362 51 140 141 575 305 308 51 140 586 573 173 363 51 140 141 575 309 310 51 140 141 575 312 364 51 140 141 575 313 365 51 140 141 575 314 366 51 140 141 575 306 307 51 140 586 573 315 367 51 140 586 573 174 368 51 140 141 175 369 51 140 587 573 176 177 51 140 587 573 178 370 51 140 587 573 179 371 51 140 587 573 180 372 51 140 587 573 181 373 51 140 141 182 375 382 140 588 573 376 382 140 588 573 377 382 140 588 573 378 382 140 588 573 379 382 140 588 573 380 382 140 588 573 381 382 140 588 573 381 51 140 141 183 383 51 140 141 184 384 51 140 141 185 385 51 140 141 186 386 51 140 141 387 331 51 140 589 573 187 388 51 140 588 573 188 389 51 140 588 573 189 390 51 140 588 573 190 391 51 140 141 191 392 374 140 141 192 393 51 140 141 193 394 382 140 141 194 395 51 140 141 195 396 374 140 141 196 397 374 140 141 197 398 374 140 141 198 399 374 140 141 199 400 374 140 141 200 401 374 140 141 201 402 374 140 141 202 403 374 140 141 203 404 374 140 141 204 405 374 140 141 205 406 51 140 141 206 407 51 140 141 207 408 51 140 141 208 409 51 140 141 209 410 51 140 141 210 411 51 140 141 211 412 51 140 141 212 413 51 140 141 213 414 51 140 141 214 415 51 140 141 215 416 51 140 141 216 417 51 140 141 217 418 51 140 419 147 420 597 320 421 51 140 590 566 567 150 113 51 140 141 321 114 382 140 590 147 141 567 322 115 51 140 590 566 567 151 435 51 140 141 152 436 51 140 141 424 429 51 140 141 425 430 51 140 141 426 431 51 140 440 568 439 438 51 140 440 568 427 432 51 140 141 153 428 51 140 141 154 434 51 140 141 155 437 51 140 141 423 433 51 140 441 218 442 51 140 441 219 458 51 140 441 220 459 51 140 441 221 460 51 140 441 222 461 51 140 441 223 462 51 140 441 224 463 51 140 441 225 464 51 140 441 226 465 51 140 441 227 466 51 140 441 316 467 51 140 441 317 468 51 140 441 318 469 51 140 441 319 470 51 140 441 228 471 51 140 441 229 472 51 140 441 230 473 51 140 441 536 540 51 140 441 231 474 51 140 441 232 475 51 140 441 233 476 51 140 441 234 477 51 140 441 235 478 51 140 591 5 569 236 479 51 140 141 237 480 51 140 141 238 101 51 140 141 239 102 51 140 141 240 103 51 140 141 241 104 51 140 141 242 105 51 140 141 243 106 51 140 141 244 107 51 140 141 245 108 51 140 141 246 109 51 140 141 247 481 382 140 141 248 482 382 140 141 249 483 382 140 141 250 484 382 140 141 251 485 382 140 141 252 486 382 140 141 253 487 382 140 141 254 89 382 140 141 255 488 382 140 141 256 90 382 140 141 257 489 382 140 141 258 92 382 140 141 259 490 382 140 141 260 491 382 140 141 261 492 382 140 141 262 493 382 140 141 263 494 382 140 141 264 495 382 140 141 265 496 382 140 141 266 498 497 570 267 499 382 140 141 268 500 382 140 141 269 501 382 140 141 270 502 382 140 141 271 503 382 140 141 272 504 382 140 141 273 505 382 140 141 274 96 382 140 141 275 97 382 140 141 276 506 382 140 141 277 98 382 140 141 278 507 51 140 592 569 279 508 51 140 592 569 280 509 382 140 141 281 510 382 140 141 282 511 382 140 141 283 512 382 140 141 537 541 382 140 141 538 542 382 140 141 539 543 382 140 141 284 513 382 140 141 285 514 382 140 141 286 515 382 140 141 287 516 382 140 141 288 517 382 140 141 289 518 382 140 141 290 519 51 140 141 291 520 51 140 141 292 521 51 140 141 293 522 51 140 141 294 524 51 140 591 571 295 525 51 140 591 571 296 526 51 140 141 297 527 51 140 141 298 528 51 140 141 299 529 51 140 141 300 530 51 140 141 301 531 51 140 141 302 532 51 140 141 303 533 51 140 534 304 110 51 140 535 10 11 12 18 139 138 139 138 52 51 140 141 53 51 140 141 74 51 140 141 54 51 140 141 75 51 140 141 55 51 140 141 556 51 140 141 56 51 140 141 57 51 140 141 58 51 140 141 76 51 140 141 59 51 140 141 60 51 140 141 61 51 140 141 62 51 140 141 63 51 140 141 64 51 140 141 65 51 140 141 77 51 140 141 66 51 140 141 67 51 140 141 78 140 141 68 140 141 79 51 140 141 80 51 140 141 69 51 140 141 81 51 140 141 70 51 140 141 82 51 140 141 71 51 140 141 72 51 140 141 72 51 140 141 73 51 140 141 83 557 140 593 598 84 51 140 593 598 85 51 140 593 598 86 51 140 593 598 87 51 140 593 598 555 51 140 141 88 557 593 598 21 22 139 138 139 138 113 51 140 141 114 51 140 141 115 51 140 141 13 139 138 139 138 110 382 140 141 111 112 14 139 138 139 138 101 382 140 141 102 382 140 141 103 382 140 141 104 382 140 141 105 382 140 141 106 382 140 141 107 382 140 141 108 382 140 141 109 382 140 141 15 5 16 558 51 140 593 598 559 51 140 593 598 560 51 140 593 598 561 564 140 593 598 562 564 140 593 598 563 564 140 593 598 5 17 89 422 90 91 92 93 94 95 374 140 594 598 96 97 98 5 523 595 599 600

607 661 660 604 602 603 606 138 146 610 620 611 621 612 622 613 623 614 624 615 625 616 626 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 617 627 618 628 633 634 635 636 637 634 638 639 640 641 642 143 619 651 650 649 648 609 647 646 645 644 643 652 653 654 655 656 657 658 659 331 388 388 390

607 661 660 604 602 603 606 138 146 610 620 611 621 612 622 613 623 614 624 615 625 616 626 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 617 627 618 628 633 634 635 636 637 634 638 639 640 641 642 143 619 651 650 649 648 609 647 646 645 644 643 652 653 654 655 656 657 658 659 331 388 388 390

607 661 660 604 602 603 606 138 146 610 620 611 621 612 622 613 623 614 624 615 625 616 626 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 617 627 618 628 633 634 635 636 637 634 638 639 640 641 642 143 619 651 650 649 648 609 647 646 645 644 643 652 653 654 655 656 657 658 659 331 388 388 390

607 661 660 604 602 603 606 138 146 610 620 611 621 612 622 613 623 614 624 615 625 616 626 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 617 627 618 628 633 634 635 636 637 634 638 639 640 641 642 143 619 651 650 649 648 609 647 646 645 644 643 652 653 654 655 656 657 658 659 331 388 388 390

607 661 660 604 602 603 606 138 146 610 620 611 621 612 622 613 623 614 624 615 625 616 626 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 617 627 618 628 633 634 635 636 637 634 638 639 640 641 642 143 619 651 650 649 648 609 647 646 645 644 643 652 653 654 655 656 657 658 659 331 388 388 390

607 661 660 604 602 603 606 138 146 610 620 611 621 612 622 613 623 614 624 615 625 616 626 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 617 627 618 628 633 634 635 636 637 634 638 639 640 641 642 143 619 651 650 649 648 609 647 646 645 644 643 652 653 654 655 656 657 658 659 331 388 388 390

607 661 660 604 602 603 606 138 146 610 620 611 621 612 622 613 623 614 624 615 625 616 626 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 617 627 618 628 633 634 635 636 637 634 638 639 640 641 642 143 619 651 650 649 648 609 647 646 645 644 643 652 653 654 655 656 657 658 659 331 388 388 390

607 661 660 604 602 603 606 138 146 610 620 611 621 612 622 613 623 614 624 615 625 616 626 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 617 627 618 628 633 634 635 636 637 634 638 639 640 641 642 143 619 651 650 649 648 609 647 646 645 644 643 652 653 654 655 656 657 658 659 331 388 388 390

607 661 660 604 602 603 606 138 146 610 620 611 621 612 622 613 623 614 624 615 625 616 626 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 617 627 618 628 633 634 635 636 637 634 638 639 640 641 642 143 619 651 650 649 648 609 647 646 645 644 643 652 653 654 655 656 657 658 659 331 388 388 390

607 661 660 604 602 603 606 138 146 610 620 611 621 612 622 613 623 614 624 615 625 616 626 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 617 627 618 628 633 634 635 636 637 634 638 639 640 641 642 143 619 651 650 649 648 609 647 646 645 644 643 652 653 654 655 656 657 658 659 331 388 388 390

607 661 660 604 602 603 606 138 146 610 620 611 621 612 622 613 623 614 624 615 625 616 626 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 617 627 618 628 633 634 635 636 637 634 638 639 640 641 642 143 619 651 650 649 648 609 647 646 645 644 643 652 653 654 655 656 657 658 659 331 388 388 390

607 661 660 604 602 603 606 138 146 610 620 611 621 612 622 613 623 614 624 615 625 616 626 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 617 627 618 628 633 634 635 636 637 634 638 639 640 641 642 143 619 651 650 649 648 609 647 646 645 644 643 652 653 654 655 656 657 658 659 331 388 388 390

607 661 660 604 602 603 606 138 146 610 620 611 621 612 622 613 623 614 624 615 625 616 626 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 617 627 618 628 633 634 635 636 637 634 638 639 640 641 642 143 619 651 650 649 648 609 647 646 645 644 643 652 653 654 655 656 657 658 659 331 388 388 390

607 661 660 604 602 603 606 138 146 610 620 611 621 612 622 613 623 614 624 615 625 616 626 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 617 627 618 628 633 634 635 636 637 634 638 639 640 641 642 143 619 651 650 649 648 609 647 646 645 644 643 652 653 654 655 656 657 658 659 331 388 388 390

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

6 9 99 139 138 139 138 146 118 51 140 145 147 141 119 51 140 145 147 141 120 51 140 145 147 141 121 51 140 145 147 141 117 51 140 577 147 141 572 5 122 51 140 577 147 141 572 123 51 140 578 147 141 596 124 51 140 578 147 141 596 125 51 140 578 147 141 596 126 51 140 578 147 141 596 127 51 140 578 147 141 596 5 128 51 140 578 147 141 596 129 51 140 443 147 141 596 130 51 140 579 147 141 596 131 51 142 141 147 141 132 51 142 141 147 141 133 51 142 141 147 141 134 51 142 141 147 141 135 51 142 141 147 141 136 51 142 141 147 141 137 51 142 141 147 141 19 139 138 139 138 23 51 140 141 147 141 24 51 140 141 147 141 143 144 140 141 147 141 25 51 140 141 147 141 26 51 140 141 147 141 27 51 140 141 147 141 28 51 140 141 147 141 29 51 140 141 147 141 30 51 140 141 147 141 31 148 140 580 147 141 32 51 140 580 147 141 33 51 140 141 147 141 34 51 140 141 147 141 35 51 140 141 147 141 36 51 140 141 147 141 37 51 140 141 147 141 38 51 140 141 147 141 39 51 140 141 147 141 20 139 138 139 138 40 41 42 43 51 140 581 573 44 45 51 140 581 573 46 47 51 140 582 574 48 49 51 140 582 574 446 544 444 140 453 545 444 140 454 546 444 140 455 547 444 140 456 548 444 140 447 549 444 140 448 550 444 140 449 551 444 140 450 552 444 140 451 553 444 140 452 554 444 140 149 50 444 140 445 5 100 139 138 139 138 323 148 140 583 573 325 148 140 583 573 326 148 140 583 573 327 148 140 583 573 328 148 140 583 573 324 148 140 332 573 329 148 140 330 575 331 148 140 333 575 159 334 51 140 141 575 160 335 51 140 141 575 161 336 51 140 141 575 337 51 140 141 575 338 51 140 141 575 339 51 140 141 575 340 51 140 141 575 341 51 140 141 575 342 51 140 141 575 343 51 140 141 575 344 51 140 141 575 345 51 140 141 575 346 51 140 141 575 347 51 140 141 575 348 51 140 141 575 162 349 51 140 141 575 163 350 51 140 141 575 164 351 51 140 141 575 156 565 51 140 584 573 157 352 51 140 585 573 158 353 51 140 585 573 165 354 51 140 141 575 166 355 51 140 141 575 167 357 51 140 141 575 168 356 51 140 141 575 169 358 51 140 141 575 170 359 51 140 141 575 171 360 51 140 457 576 172 361 51 140 141 575 601 324 51 140 141 575 311 362 51 140 141 575 305 308 51 140 586 573 173 363 51 140 141 575 309 310 51 140 141 575 312 364 51 140 141 575 313 365 51 140 141 575 314 366 51 140 141 575 306 307 51 140 586 573 315 367 51 140 586 573 174 368 51 140 141 175 369 51 140 587 573 176 177 51 140 587 573 178 370 51 140 587 573 179 371 51 140 587 573 180 372 51 140 587 573 181 373 51 140 141 182 375 382 140 588 573 376 382 140 588 573 377 382 140 588 573 378 382 140 588 573 379 382 140 588 573 380 382 140 588 573 381 382 140 588 573 381 51 140 141 183 383 51 140 141 184 384 51 140 141 185 385 51 140 141 186 386 51 140 141 387 331 51 140 589 573 187 388 51 140 588 573 188 389 51 140 588 573 189 390 51 140 588 573 190 391 51 140 141 191 392 374 140 141 192 393 51 140 141 193 394 382 140 141 194 395 51 140 141 195 396 374 140 141 196 397 374 140 141 197 398 374 140 141 198 399 374 140 141 199 400 374 140 141 200 401 374 140 141 201 402 374 140 141 202 403 374 140 141 203 404 374 140 141 204 405 374 140 141 205 406 51 140 141 206 407 51 140 141 207 408 51 140 141 208 409 51 140 141 209 410 51 140 141 210 411 51 140 141 211 412 51 140 141 212 413 51 140 141 213 414 51 140 141 214 415 51 140 141 215 416 51 140 141 216 417 51 140 141 217 418 51 140 419 147 420 597 320 421 51 140 590 566 567 150 113 51 140 141 321 114 382 140 590 147 141 567 322 115 51 140 590 566 567 151 435 51 140 141 152 436 51 140 141 424 429 51 140 141 425 430 51 140 141 426 431 51 140 440 568 439 438 51 140 440 568 427 432 51 140 141 153 428 51 140 141 154 434 51 140 141 155 437 51 140 141 423 433 51 140 441 218 442 51 140 441 219 458 51 140 441 220 459 51 140 441 221 460 51 140 441 222 461 51 140 441 223 462 51 140 441 224 463 51 140 441 225 464 51 140 441 226 465 51 140 441 227 466 51 140 441 316 467 51 140 441 317 468 51 140 441 318 469 51 140 441 319 470 51 140 441 228 471 51 140 441 229 472 51 140 441 230 473 51 140 441 536 540 51 140 441 231 474 51 140 441 232 475 51 140 441 233 476 51 140 441 234 477 51 140 441 235 478 51 140 591 5 569 236 479 51 140 141 237 480 51 140 141 238 101 51 140 141 239 102 51 140 141 240 103 51 140 141 241 104 51 140 141 242 105 51 140 141 243 106 51 140 141 244 107 51 140 141 245 108 51 140 141 246 109 51 140 141 247 481 382 140 141 248 482 382 140 141 249 483 382 140 141 250 484 382 140 141 251 485 382 140 141 252 486 382 140 141 253 487 382 140 141 254 89 382 140 141 255 488 382 140 141 256 90 382 140 141 257 489 382 140 141 258 92 382 140 141 259 490 382 140 141 260 491 382 140 141 261 492 382 140 141 262 493 382 140 141 263 494 382 140 141 264 495 382 140 141 265 496 382 140 141 266 498 497 570 267 499 382 140 141 268 500 382 140 141 269 501 382 140 141 270 502 382 140 141 271 503 382 140 141 272 504 382 140 141 273 505 382 140 141 274 96 382 140 141 275 97 382 140 141 276 506 382 140 141 277 98 382 140 141 278 507 51 140 592 569 279 508 51 140 592 569 280 509 382 140 141 281 510 382 140 141 282 511 382 140 141 283 512 382 140 141 537 541 382 140 141 538 542 382 140 141 539 543 382 140 141 284 513 382 140 141 285 514 382 140 141 286 515 382 140 141 287 516 382 140 141 288 517 382 140 141 289 518 382 140 141 290 519 51 140 141 291 520 51 140 141 292 521 51 140 141 293 522 51 140 141 294 524 51 140 591 571 295 525 51 140 591 571 296 526 51 140 141 297 527 51 140 141 298 528 51 140 141 299 529 51 140 141 300 530 51 140 141 301 531 51 140 141 302 532 51 140 141 303 533 51 140 534 304 110 51 140 535 10 11 12 18 139 138 139 138 52 51 140 141 53 51 140 141 74 51 140 141 54 51 140 141 75 51 140 141 55 51 140 141 556 51 140 141 56 51 140 141 57 51 140 141 58 51 140 141 76 51 140 141 59 51 140 141 60 51 140 141 61 51 140 141 62 51 140 141 63 51 140 141 64 51 140 141 65 51 140 141 77 51 140 141 66 51 140 141 67 51 140 141 78 140 141 68 140 141 79 51 140 141 80 51 140 141 69 51 140 141 81 51 140 141 70 51 140 141 82 51 140 141 71 51 140 141 72 51 140 141 72 51 140 141 73 51 140 141 83 557 140 593 598 84 51 140 593 598 85 51 140 593 598 86 51 140 593 598 87 51 140 593 598 555 51 140 141 88 557 593 598 21 22 139 138 139 138 113 51 140 141 114 51 140 141 115 51 140 141 13 139 138 139 138 110 382 140 141 111 112 14 139 138 139 138 101 382 140 141 102 382 140 141 103 382 140 141 104 382 140 141 105 382 140 141 106 382 140 141 107 382 140 141 108 382 140 141 109 382 140 141 15 5 16 558 51 140 593 598 559 51 140 593 598 560 51 140 593 598 561 564 140 593 598 562 564 140 593 598 563 564 140 593 598 5 17 89 422 90 91 92 93 94 95 374 140 594 598 96 97 98 5 523 595 599 600

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP ie Checked STAR in GOLD- Code not in non covered SG 10.12.18 AR STAR - Codes moved to PA term. AR 10.12.18 Removed in GOLD. AR 10.12.18 Added term date in CPT / Svccode table of 12/31/2015 STAR - Not in STAR non covered SG. AR 10.12.18 This code is configured in STAR beneit term MED ALLERGY IMMUNOTHERAPY ADMIN and set to require PA in GOLD Validated not in Medicaid Non Covered list - GOLD AR 10.17.18 Yes, code in w/PA benefit terms - AR 10.17.18 Validated in w PA term. AR 10.17.18 Validated still listed in TMHP Medicaid Non Covered Per TMH Manual may be reimbursed, verify in QNXT, does not show up in Ben Term Sheet Star Per Amysis not a covered MA , Deny XZ, Verify in QNXT does not show in Noncovered for STAR - add to Medicaid Non Covered List Per Amysis not a covered MA , Deny XZ, Verify in QNXT does not show in Noncovered for STAR Per TMH is a covered service w/ Auth - need to remove from noncovered in QNXT for STAR - COMPLETE Per TMHP Manual is covered w/ auth- Remove from QNXT Noncovered list - COMPLETE QNXT set up under BEN AUTH SURGERY Cosmetic is that okay? Per TMHP Manual maybe covered for injury or trauma - Remove from QNXT Noncovered List - COMPLETE PER TMHP Manual is limited to 2 svc per lifetime (only for breast reconstruction)- Remove from QNXT is noncovered, PA flag set in QNXT for STAR - COMPLETE PER TMHP Manual is limited to 2 svc per lifetime (only for breast reconstruction)- Remove from QNXT noncovered, PA flag set in QNXT for STAR - COMPLETE Per TMHP Manual is covered - Remove from QNXT noncovered - COMPLETE Remove from QNXT noncovered - is set for PA on STAR Term - COMPLETE Noncovered for STAR - Should be added to QNXT noncovered - COMPLETE Remove from QNXT noncovered - is set for PA on STAR Term - COMPLETE. Remove from noncovered list QNXT Need to remove from QNXT non covered Need to removed from QNXT Noncovered - Needs PA Set Need to set PA Flag in QNXT Needs to be added to PA QNXT - is covered per TMHP - is on Noncovered list for QNXT Add to STAR TMHP Non Covered SG - Ann 10.12.18 Removed code form STAR TMHP Non Covered SG Added to CHIP Non Covered SG 10.17.18 AR Code added to PA terms in GOLD 10.17.18 AR Validated STAR TMHP Non Covered SG…. Code is Not listed in GOLD AR 10.17.18 I see it listed as Non Covered for Commercial fg CPT Codes Descriptions PA Set in QNXT Yes or No Oncology drugs when utilized for off label use UFCP UFCP ONLY Video EEG Monitoring Unlisted laparoscopy procedure, biliary tract Unlisted procedure, stomach Anesthesia for intraperitoneal procedures in upper abdomen including laparoscopy; gastric restrictive procedure for morbid obesity Vagus nerve blocking therapy (morbid obesity); laparoscopic implantation of neurostimulator electrode array, anterior and posterior vagal trunks adjacent to esophagogastric junction (EGJ), with implantation of pulse generator, includes programming Vagus nerve blocking therapy (morbid obesity); laparoscopic revision or replacement of vagal trunk neurostimulator electrode array, including connection to existing pulse generator Vagus nerve blocking therapy (morbid obesity); laparoscopic removal of vagal trunk neurostimulator electrode array and pulse generator Vagus nerve blocking therapy (morbid obesity); removal of pulse generator Vagus nerve blocking therapy (morbid obesity); replacement of pulse generator Vagus nerve blocking therapy (morbid obesity); neurostimulator pulse generator electronic analysis, includes reprogramming when performed Face-to-face behavioral counseling for obesity, 15 minutes Face-to-face behavioral counseling for obesity, group (2-10), 30 minutes Cancer Chemotherapy: requires preauthorization for allowable charges >$500 per dose Out-of -Network Bone Growth Stimulators Long Term Support Services (LTSS) – per State benefit Gastrectomy, total; with esophagoenterostomy with Roux-hyphenen-hyphenY reconstruction with formation of intestinal pouch, any type Gastrectomy, partial, distal; with gastroduodenostomy with gastrojejunostomy with formation of intestinal pouch Vagotomy when performed with partial distal gastrectomy (List separately in addition to code(s) for primary procedure) Biopsy of liver, needle; percutaneous [in the absence of signs or symptoms of liver disease (e.g., elevated liver enzymes, enlarged liver)] Biopsy of liver, needle; when done for indicated purpose at tine of other major procedure (list separately in addition to code for primary procedure) [in the absence of signs or symptoms of liver disease (e.g., elevated liver disease, enlarged liver)] Biopsy of liver, wedge [in the absence of signs or symptoms of liver disease (e.g., elevated liver disease, enlarged liver)] Cholecystectomy with exploration of common duct; with transduodenal sphincterotomy or sphincteroplasty, with or without cholangiography Cholecystectomy with exploration of common duct; with choledochoenterostomy Cholecystectomy with exploration of common duct; Cholecystectomy; with cholangiography Cholecystectomy; Laparoscopy, surgical; cholecystoenterostomy Laparoscopy, surgical; cholecystectomy with exploration of common duct Laparoscopy, surgical; cholecystectomy with cholangiography Laparoscopy, surgical; cholecystectomy Adjustment of gastric band diameter via subcutaneous port by injection or aspiration of saline Weight management classes, non-hyphenphysician provider, per session Exercise classes, non-hyphenphysician provider, per session Nutrition classes, non-hyphenphysician provider, per session Per 2019 Auth List Obesity Treatment and Surgery - ALL obesity treatment and surgery must be performed at University Hospital See important Endnotes. STAR

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

6 9 99 139 138 139 138 146 118 51 140 145 147 141 119 51 140 145 147 141 120 51 140 145 147 141 121 51 140 145 147 141 117 51 140 577 147 141 572 5 122 51 140 577 147 141 572 123 51 140 578 147 141 596 124 51 140 578 147 141 596 125 51 140 578 147 141 596 126 51 140 578 147 141 596 127 51 140 578 147 141 596 5 128 51 140 578 147 141 596 129 51 140 443 147 141 596 130 51 140 579 147 141 596 131 51 142 141 147 141 132 51 142 141 147 141 133 51 142 141 147 141 134 51 142 141 147 141 135 51 142 141 147 141 136 51 142 141 147 141 137 51 142 141 147 141 19 139 138 139 138 23 51 140 141 147 141 24 51 140 141 147 141 143 144 140 141 147 141 25 51 140 141 147 141 26 51 140 141 147 141 27 51 140 141 147 141 28 51 140 141 147 141 29 51 140 141 147 141 30 51 140 141 147 141 31 148 140 580 147 141 32 51 140 580 147 141 33 51 140 141 147 141 34 51 140 141 147 141 35 51 140 141 147 141 36 51 140 141 147 141 37 51 140 141 147 141 38 51 140 141 147 141 39 51 140 141 147 141 20 139 138 139 138 40 41 42 43 51 140 581 573 44 45 51 140 581 573 46 47 51 140 582 574 48 49 51 140 582 574 446 544 444 140 453 545 444 140 454 546 444 140 455 547 444 140 456 548 444 140 447 549 444 140 448 550 444 140 449 551 444 140 450 552 444 140 451 553 444 140 452 554 444 140 149 50 444 140 445 5 100 139 138 139 138 323 148 140 583 573 325 148 140 583 573 326 148 140 583 573 327 148 140 583 573 328 148 140 583 573 324 148 140 332 573 329 148 140 330 575 331 148 140 333 575 159 334 51 140 141 575 160 335 51 140 141 575 161 336 51 140 141 575 337 51 140 141 575 338 51 140 141 575 339 51 140 141 575 340 51 140 141 575 341 51 140 141 575 342 51 140 141 575 343 51 140 141 575 344 51 140 141 575 345 51 140 141 575 346 51 140 141 575 347 51 140 141 575 348 51 140 141 575 162 349 51 140 141 575 163 350 51 140 141 575 164 351 51 140 141 575 156 565 51 140 584 573 157 352 51 140 585 573 158 353 51 140 585 573 165 354 51 140 141 575 166 355 51 140 141 575 167 357 51 140 141 575 168 356 51 140 141 575 169 358 51 140 141 575 170 359 51 140 141 575 171 360 51 140 457 576 172 361 51 140 141 575 601 324 51 140 141 575 311 362 51 140 141 575 305 308 51 140 586 573 173 363 51 140 141 575 309 310 51 140 141 575 312 364 51 140 141 575 313 365 51 140 141 575 314 366 51 140 141 575 306 307 51 140 586 573 315 367 51 140 586 573 174 368 51 140 141 175 369 51 140 587 573 176 177 51 140 587 573 178 370 51 140 587 573 179 371 51 140 587 573 180 372 51 140 587 573 181 373 51 140 141 182 375 382 140 588 573 376 382 140 588 573 377 382 140 588 573 378 382 140 588 573 379 382 140 588 573 380 382 140 588 573 381 382 140 588 573 381 51 140 141 183 383 51 140 141 184 384 51 140 141 185 385 51 140 141 186 386 51 140 141 387 331 51 140 589 573 187 388 51 140 588 573 188 389 51 140 588 573 189 390 51 140 588 573 190 391 51 140 141 191 392 374 140 141 192 393 51 140 141 193 394 382 140 141 194 395 51 140 141 195 396 374 140 141 196 397 374 140 141 197 398 374 140 141 198 399 374 140 141 199 400 374 140 141 200 401 374 140 141 201 402 374 140 141 202 403 374 140 141 203 404 374 140 141 204 405 374 140 141 205 406 51 140 141 206 407 51 140 141 207 408 51 140 141 208 409 51 140 141 209 410 51 140 141 210 411 51 140 141 211 412 51 140 141 212 413 51 140 141 213 414 51 140 141 214 415 51 140 141 215 416 51 140 141 216 417 51 140 141 217 418 51 140 419 147 420 597 320 421 51 140 590 566 567 150 113 51 140 141 321 114 382 140 590 147 141 567 322 115 51 140 590 566 567 151 435 51 140 141 152 436 51 140 141 424 429 51 140 141 425 430 51 140 141 426 431 51 140 440 568 439 438 51 140 440 568 427 432 51 140 141 153 428 51 140 141 154 434 51 140 141 155 437 51 140 141 423 433 51 140 441 218 442 51 140 441 219 458 51 140 441 220 459 51 140 441 221 460 51 140 441 222 461 51 140 441 223 462 51 140 441 224 463 51 140 441 225 464 51 140 441 226 465 51 140 441 227 466 51 140 441 316 467 51 140 441 317 468 51 140 441 318 469 51 140 441 319 470 51 140 441 228 471 51 140 441 229 472 51 140 441 230 473 51 140 441 536 540 51 140 441 231 474 51 140 441 232 475 51 140 441 233 476 51 140 441 234 477 51 140 441 235 478 51 140 591 5 569 236 479 51 140 141 237 480 51 140 141 238 101 51 140 141 239 102 51 140 141 240 103 51 140 141 241 104 51 140 141 242 105 51 140 141 243 106 51 140 141 244 107 51 140 141 245 108 51 140 141 246 109 51 140 141 247 481 382 140 141 248 482 382 140 141 249 483 382 140 141 250 484 382 140 141 251 485 382 140 141 252 486 382 140 141 253 487 382 140 141 254 89 382 140 141 255 488 382 140 141 256 90 382 140 141 257 489 382 140 141 258 92 382 140 141 259 490 382 140 141 260 491 382 140 141 261 492 382 140 141 262 493 382 140 141 263 494 382 140 141 264 495 382 140 141 265 496 382 140 141 266 498 497 570 267 499 382 140 141 268 500 382 140 141 269 501 382 140 141 270 502 382 140 141 271 503 382 140 141 272 504 382 140 141 273 505 382 140 141 274 96 382 140 141 275 97 382 140 141 276 506 382 140 141 277 98 382 140 141 278 507 51 140 592 569 279 508 51 140 592 569 280 509 382 140 141 281 510 382 140 141 282 511 382 140 141 283 512 382 140 141 537 541 382 140 141 538 542 382 140 141 539 543 382 140 141 284 513 382 140 141 285 514 382 140 141 286 515 382 140 141 287 516 382 140 141 288 517 382 140 141 289 518 382 140 141 290 519 51 140 141 291 520 51 140 141 292 521 51 140 141 293 522 51 140 141 294 524 51 140 591 571 295 525 51 140 591 571 296 526 51 140 141 297 527 51 140 141 298 528 51 140 141 299 529 51 140 141 300 530 51 140 141 301 531 51 140 141 302 532 51 140 141 303 533 51 140 534 304 110 51 140 535 10 11 12 18 139 138 139 138 52 51 140 141 53 51 140 141 74 51 140 141 54 51 140 141 75 51 140 141 55 51 140 141 556 51 140 141 56 51 140 141 57 51 140 141 58 51 140 141 76 51 140 141 59 51 140 141 60 51 140 141 61 51 140 141 62 51 140 141 63 51 140 141 64 51 140 141 65 51 140 141 77 51 140 141 66 51 140 141 67 51 140 141 78 140 141 68 140 141 79 51 140 141 80 51 140 141 69 51 140 141 81 51 140 141 70 51 140 141 82 51 140 141 71 51 140 141 72 51 140 141 72 51 140 141 73 51 140 141 83 557 140 593 598 84 51 140 593 598 85 51 140 593 598 86 51 140 593 598 87 51 140 593 598 555 51 140 141 88 557 593 598 21 22 139 138 139 138 113 51 140 141 114 51 140 141 115 51 140 141 13 139 138 139 138 110 382 140 141 111 112 14 139 138 139 138 101 382 140 141 102 382 140 141 103 382 140 141 104 382 140 141 105 382 140 141 106 382 140 141 107 382 140 141 108 382 140 141 109 382 140 141 15 5 16 558 51 140 593 598 559 51 140 593 598 560 51 140 593 598 561 564 140 593 598 562 564 140 593 598 563 564 140 593 598 5 17 89 422 90 91 92 93 94 95 374 140 594 598 96 97 98 5 523 595 599 600

6 9 99 139 138 139 138 146 118 51 140 145 147 141 119 51 140 145 147 141 120 51 140 145 147 141 121 51 140 145 147 141 117 51 140 577 147 141 572 5 122 51 140 577 147 141 572 123 51 140 578 147 141 596 124 51 140 578 147 141 596 125 51 140 578 147 141 596 126 51 140 578 147 141 596 127 51 140 578 147 141 596 5 128 51 140 578 147 141 596 129 51 140 443 147 141 596 130 51 140 579 147 141 596 131 51 142 141 147 141 132 51 142 141 147 141 133 51 142 141 147 141 134 51 142 141 147 141 135 51 142 141 147 141 136 51 142 141 147 141 137 51 142 141 147 141 19 139 138 139 138 23 51 140 141 147 141 24 51 140 141 147 141 143 144 140 141 147 141 25 51 140 141 147 141 26 51 140 141 147 141 27 51 140 141 147 141 28 51 140 141 147 141 29 51 140 141 147 141 30 51 140 141 147 141 31 148 140 580 147 141 32 51 140 580 147 141 33 51 140 141 147 141 34 51 140 141 147 141 35 51 140 141 147 141 36 51 140 141 147 141 37 51 140 141 147 141 38 51 140 141 147 141 39 51 140 141 147 141 20 139 138 139 138 40 41 42 43 51 140 581 573 44 45 51 140 581 573 46 47 51 140 582 574 48 49 51 140 582 574 446 544 444 140 453 545 444 140 454 546 444 140 455 547 444 140 456 548 444 140 447 549 444 140 448 550 444 140 449 551 444 140 450 552 444 140 451 553 444 140 452 554 444 140 149 50 444 140 445 5 100 139 138 139 138 323 148 140 583 573 325 148 140 583 573 326 148 140 583 573 327 148 140 583 573 328 148 140 583 573 324 148 140 332 573 329 148 140 330 575 331 148 140 333 575 159 334 51 140 141 575 160 335 51 140 141 575 161 336 51 140 141 575 337 51 140 141 575 338 51 140 141 575 339 51 140 141 575 340 51 140 141 575 341 51 140 141 575 342 51 140 141 575 343 51 140 141 575 344 51 140 141 575 345 51 140 141 575 346 51 140 141 575 347 51 140 141 575 348 51 140 141 575 162 349 51 140 141 575 163 350 51 140 141 575 164 351 51 140 141 575 156 565 51 140 584 573 157 352 51 140 585 573 158 353 51 140 585 573 165 354 51 140 141 575 166 355 51 140 141 575 167 357 51 140 141 575 168 356 51 140 141 575 169 358 51 140 141 575 170 359 51 140 141 575 171 360 51 140 457 576 172 361 51 140 141 575 601 324 51 140 141 575 311 362 51 140 141 575 305 308 51 140 586 573 173 363 51 140 141 575 309 310 51 140 141 575 312 364 51 140 141 575 313 365 51 140 141 575 314 366 51 140 141 575 306 307 51 140 586 573 315 367 51 140 586 573 174 368 51 140 141 175 369 51 140 587 573 176 177 51 140 587 573 178 370 51 140 587 573 179 371 51 140 587 573 180 372 51 140 587 573 181 373 51 140 141 182 375 382 140 588 573 376 382 140 588 573 377 382 140 588 573 378 382 140 588 573 379 382 140 588 573 380 382 140 588 573 381 382 140 588 573 381 51 140 141 183 383 51 140 141 184 384 51 140 141 185 385 51 140 141 186 386 51 140 141 387 331 51 140 589 573 187 388 51 140 588 573 188 389 51 140 588 573 189 390 51 140 588 573 190 391 51 140 141 191 392 374 140 141 192 393 51 140 141 193 394 382 140 141 194 395 51 140 141 195 396 374 140 141 196 397 374 140 141 197 398 374 140 141 198 399 374 140 141 199 400 374 140 141 200 401 374 140 141 201 402 374 140 141 202 403 374 140 141 203 404 374 140 141 204 405 374 140 141 205 406 51 140 141 206 407 51 140 141 207 408 51 140 141 208 409 51 140 141 209 410 51 140 141 210 411 51 140 141 211 412 51 140 141 212 413 51 140 141 213 414 51 140 141 214 415 51 140 141 215 416 51 140 141 216 417 51 140 141 217 418 51 140 419 147 420 597 320 421 51 140 590 566 567 150 113 51 140 141 321 114 382 140 590 147 141 567 322 115 51 140 590 566 567 151 435 51 140 141 152 436 51 140 141 424 429 51 140 141 425 430 51 140 141 426 431 51 140 440 568 439 438 51 140 440 568 427 432 51 140 141 153 428 51 140 141 154 434 51 140 141 155 437 51 140 141 423 433 51 140 441 218 442 51 140 441 219 458 51 140 441 220 459 51 140 441 221 460 51 140 441 222 461 51 140 441 223 462 51 140 441 224 463 51 140 441 225 464 51 140 441 226 465 51 140 441 227 466 51 140 441 316 467 51 140 441 317 468 51 140 441 318 469 51 140 441 319 470 51 140 441 228 471 51 140 441 229 472 51 140 441 230 473 51 140 441 536 540 51 140 441 231 474 51 140 441 232 475 51 140 441 233 476 51 140 441 234 477 51 140 441 235 478 51 140 591 5 569 236 479 51 140 141 237 480 51 140 141 238 101 51 140 141 239 102 51 140 141 240 103 51 140 141 241 104 51 140 141 242 105 51 140 141 243 106 51 140 141 244 107 51 140 141 245 108 51 140 141 246 109 51 140 141 247 481 382 140 141 248 482 382 140 141 249 483 382 140 141 250 484 382 140 141 251 485 382 140 141 252 486 382 140 141 253 487 382 140 141 254 89 382 140 141 255 488 382 140 141 256 90 382 140 141 257 489 382 140 141 258 92 382 140 141 259 490 382 140 141 260 491 382 140 141 261 492 382 140 141 262 493 382 140 141 263 494 382 140 141 264 495 382 140 141 265 496 382 140 141 266 498 497 570 267 499 382 140 141 268 500 382 140 141 269 501 382 140 141 270 502 382 140 141 271 503 382 140 141 272 504 382 140 141 273 505 382 140 141 274 96 382 140 141 275 97 382 140 141 276 506 382 140 141 277 98 382 140 141 278 507 51 140 592 569 279 508 51 140 592 569 280 509 382 140 141 281 510 382 140 141 282 511 382 140 141 283 512 382 140 141 537 541 382 140 141 538 542 382 140 141 539 543 382 140 141 284 513 382 140 141 285 514 382 140 141 286 515 382 140 141 287 516 382 140 141 288 517 382 140 141 289 518 382 140 141 290 519 51 140 141 291 520 51 140 141 292 521 51 140 141 293 522 51 140 141 294 524 51 140 591 571 295 525 51 140 591 571 296 526 51 140 141 297 527 51 140 141 298 528 51 140 141 299 529 51 140 141 300 530 51 140 141 301 531 51 140 141 302 532 51 140 141 303 533 51 140 534 304 110 51 140 535 10 11 12 18 139 138 139 138 52 51 140 141 53 51 140 141 74 51 140 141 54 51 140 141 75 51 140 141 55 51 140 141 556 51 140 141 56 51 140 141 57 51 140 141 58 51 140 141 76 51 140 141 59 51 140 141 60 51 140 141 61 51 140 141 62 51 140 141 63 51 140 141 64 51 140 141 65 51 140 141 77 51 140 141 66 51 140 141 67 51 140 141 78 140 141 68 140 141 79 51 140 141 80 51 140 141 69 51 140 141 81 51 140 141 70 51 140 141 82 51 140 141 71 51 140 141 72 51 140 141 72 51 140 141 73 51 140 141 83 557 140 593 598 84 51 140 593 598 85 51 140 593 598 86 51 140 593 598 87 51 140 593 598 555 51 140 141 88 557 593 598 21 22 139 138 139 138 113 51 140 141 114 51 140 141 115 51 140 141 13 139 138 139 138 110 382 140 141 111 112 14 139 138 139 138 101 382 140 141 102 382 140 141 103 382 140 141 104 382 140 141 105 382 140 141 106 382 140 141 107 382 140 141 108 382 140 141 109 382 140 141 15 5 16 558 51 140 593 598 559 51 140 593 598 560 51 140 593 598 561 564 140 593 598 562 564 140 593 598 563 564 140 593 598 5 17 89 422 90 91 92 93 94 95 374 140 594 598 96 97 98 5 523 595 599 600

6 9 99 139 138 139 138 146 118 51 140 145 147 141 119 51 140 145 147 141 120 51 140 145 147 141 121 51 140 145 147 141 117 51 140 577 147 141 572 5 122 51 140 577 147 141 572 123 51 140 578 147 141 596 124 51 140 578 147 141 596 125 51 140 578 147 141 596 126 51 140 578 147 141 596 127 51 140 578 147 141 596 5 128 51 140 578 147 141 596 129 51 140 443 147 141 596 130 51 140 579 147 141 596 131 51 142 141 147 141 132 51 142 141 147 141 133 51 142 141 147 141 134 51 142 141 147 141 135 51 142 141 147 141 136 51 142 141 147 141 137 51 142 141 147 141 19 139 138 139 138 23 51 140 141 147 141 24 51 140 141 147 141 143 144 140 141 147 141 25 51 140 141 147 141 26 51 140 141 147 141 27 51 140 141 147 141 28 51 140 141 147 141 29 51 140 141 147 141 30 51 140 141 147 141 31 148 140 580 147 141 32 51 140 580 147 141 33 51 140 141 147 141 34 51 140 141 147 141 35 51 140 141 147 141 36 51 140 141 147 141 37 51 140 141 147 141 38 51 140 141 147 141 39 51 140 141 147 141 20 139 138 139 138 40 41 42 43 51 140 581 573 44 45 51 140 581 573 46 47 51 140 582 574 48 49 51 140 582 574 446 544 444 140 453 545 444 140 454 546 444 140 455 547 444 140 456 548 444 140 447 549 444 140 448 550 444 140 449 551 444 140 450 552 444 140 451 553 444 140 452 554 444 140 149 50 444 140 445 5 100 139 138 139 138 323 148 140 583 573 325 148 140 583 573 326 148 140 583 573 327 148 140 583 573 328 148 140 583 573 324 148 140 332 573 329 148 140 330 575 331 148 140 333 575 159 334 51 140 141 575 160 335 51 140 141 575 161 336 51 140 141 575 337 51 140 141 575 338 51 140 141 575 339 51 140 141 575 340 51 140 141 575 341 51 140 141 575 342 51 140 141 575 343 51 140 141 575 344 51 140 141 575 345 51 140 141 575 346 51 140 141 575 347 51 140 141 575 348 51 140 141 575 162 349 51 140 141 575 163 350 51 140 141 575 164 351 51 140 141 575 156 565 51 140 584 573 157 352 51 140 585 573 158 353 51 140 585 573 165 354 51 140 141 575 166 355 51 140 141 575 167 357 51 140 141 575 168 356 51 140 141 575 169 358 51 140 141 575 170 359 51 140 141 575 171 360 51 140 457 576 172 361 51 140 141 575 601 324 51 140 141 575 311 362 51 140 141 575 305 308 51 140 586 573 173 363 51 140 141 575 309 310 51 140 141 575 312 364 51 140 141 575 313 365 51 140 141 575 314 366 51 140 141 575 306 307 51 140 586 573 315 367 51 140 586 573 174 368 51 140 141 175 369 51 140 587 573 176 177 51 140 587 573 178 370 51 140 587 573 179 371 51 140 587 573 180 372 51 140 587 573 181 373 51 140 141 182 375 382 140 588 573 376 382 140 588 573 377 382 140 588 573 378 382 140 588 573 379 382 140 588 573 380 382 140 588 573 381 382 140 588 573 381 51 140 141 183 383 51 140 141 184 384 51 140 141 185 385 51 140 141 186 386 51 140 141 387 331 51 140 589 573 187 388 51 140 588 573 188 389 51 140 588 573 189 390 51 140 588 573 190 391 51 140 141 191 392 374 140 141 192 393 51 140 141 193 394 382 140 141 194 395 51 140 141 195 396 374 140 141 196 397 374 140 141 197 398 374 140 141 198 399 374 140 141 199 400 374 140 141 200 401 374 140 141 201 402 374 140 141 202 403 374 140 141 203 404 374 140 141 204 405 374 140 141 205 406 51 140 141 206 407 51 140 141 207 408 51 140 141 208 409 51 140 141 209 410 51 140 141 210 411 51 140 141 211 412 51 140 141 212 413 51 140 141 213 414 51 140 141 214 415 51 140 141 215 416 51 140 141 216 417 51 140 141 217 418 51 140 419 147 420 597 320 421 51 140 590 566 567 150 113 51 140 141 321 114 382 140 590 147 141 567 322 115 51 140 590 566 567 151 435 51 140 141 152 436 51 140 141 424 429 51 140 141 425 430 51 140 141 426 431 51 140 440 568 439 438 51 140 440 568 427 432 51 140 141 153 428 51 140 141 154 434 51 140 141 155 437 51 140 141 423 433 51 140 441 218 442 51 140 441 219 458 51 140 441 220 459 51 140 441 221 460 51 140 441 222 461 51 140 441 223 462 51 140 441 224 463 51 140 441 225 464 51 140 441 226 465 51 140 441 227 466 51 140 441 316 467 51 140 441 317 468 51 140 441 318 469 51 140 441 319 470 51 140 441 228 471 51 140 441 229 472 51 140 441 230 473 51 140 441 536 540 51 140 441 231 474 51 140 441 232 475 51 140 441 233 476 51 140 441 234 477 51 140 441 235 478 51 140 591 5 569 236 479 51 140 141 237 480 51 140 141 238 101 51 140 141 239 102 51 140 141 240 103 51 140 141 241 104 51 140 141 242 105 51 140 141 243 106 51 140 141 244 107 51 140 141 245 108 51 140 141 246 109 51 140 141 247 481 382 140 141 248 482 382 140 141 249 483 382 140 141 250 484 382 140 141 251 485 382 140 141 252 486 382 140 141 253 487 382 140 141 254 89 382 140 141 255 488 382 140 141 256 90 382 140 141 257 489 382 140 141 258 92 382 140 141 259 490 382 140 141 260 491 382 140 141 261 492 382 140 141 262 493 382 140 141 263 494 382 140 141 264 495 382 140 141 265 496 382 140 141 266 498 497 570 267 499 382 140 141 268 500 382 140 141 269 501 382 140 141 270 502 382 140 141 271 503 382 140 141 272 504 382 140 141 273 505 382 140 141 274 96 382 140 141 275 97 382 140 141 276 506 382 140 141 277 98 382 140 141 278 507 51 140 592 569 279 508 51 140 592 569 280 509 382 140 141 281 510 382 140 141 282 511 382 140 141 283 512 382 140 141 537 541 382 140 141 538 542 382 140 141 539 543 382 140 141 284 513 382 140 141 285 514 382 140 141 286 515 382 140 141 287 516 382 140 141 288 517 382 140 141 289 518 382 140 141 290 519 51 140 141 291 520 51 140 141 292 521 51 140 141 293 522 51 140 141 294 524 51 140 591 571 295 525 51 140 591 571 296 526 51 140 141 297 527 51 140 141 298 528 51 140 141 299 529 51 140 141 300 530 51 140 141 301 531 51 140 141 302 532 51 140 141 303 533 51 140 534 304 110 51 140 535 10 11 12 18 139 138 139 138 52 51 140 141 53 51 140 141 74 51 140 141 54 51 140 141 75 51 140 141 55 51 140 141 556 51 140 141 56 51 140 141 57 51 140 141 58 51 140 141 76 51 140 141 59 51 140 141 60 51 140 141 61 51 140 141 62 51 140 141 63 51 140 141 64 51 140 141 65 51 140 141 77 51 140 141 66 51 140 141 67 51 140 141 78 140 141 68 140 141 79 51 140 141 80 51 140 141 69 51 140 141 81 51 140 141 70 51 140 141 82 51 140 141 71 51 140 141 72 51 140 141 72 51 140 141 73 51 140 141 83 557 140 593 598 84 51 140 593 598 85 51 140 593 598 86 51 140 593 598 87 51 140 593 598 555 51 140 141 88 557 593 598 21 22 139 138 139 138 113 51 140 141 114 51 140 141 115 51 140 141 13 139 138 139 138 110 382 140 141 111 112 14 139 138 139 138 101 382 140 141 102 382 140 141 103 382 140 141 104 382 140 141 105 382 140 141 106 382 140 141 107 382 140 141 108 382 140 141 109 382 140 141 15 5 16 558 51 140 593 598 559 51 140 593 598 560 51 140 593 598 561 564 140 593 598 562 564 140 593 598 563 564 140 593 598 5 17 89 422 90 91 92 93 94 95 374 140 594 598 96 97 98 5 523 595 599 600

6 9 99 139 138 139 138 146 118 51 140 145 147 141 119 51 140 145 147 141 120 51 140 145 147 141 121 51 140 145 147 141 117 51 140 577 147 141 572 5 122 51 140 577 147 141 572 123 51 140 578 147 141 596 124 51 140 578 147 141 596 125 51 140 578 147 141 596 126 51 140 578 147 141 596 127 51 140 578 147 141 596 5 128 51 140 578 147 141 596 129 51 140 443 147 141 596 130 51 140 579 147 141 596 131 51 142 141 147 141 132 51 142 141 147 141 133 51 142 141 147 141 134 51 142 141 147 141 135 51 142 141 147 141 136 51 142 141 147 141 137 51 142 141 147 141 19 139 138 139 138 23 51 140 141 147 141 24 51 140 141 147 141 143 144 140 141 147 141 25 51 140 141 147 141 26 51 140 141 147 141 27 51 140 141 147 141 28 51 140 141 147 141 29 51 140 141 147 141 30 51 140 141 147 141 31 148 140 580 147 141 32 51 140 580 147 141 33 51 140 141 147 141 34 51 140 141 147 141 35 51 140 141 147 141 36 51 140 141 147 141 37 51 140 141 147 141 38 51 140 141 147 141 39 51 140 141 147 141 20 139 138 139 138 40 41 42 43 51 140 581 573 44 45 51 140 581 573 46 47 51 140 582 574 48 49 51 140 582 574 446 544 444 140 453 545 444 140 454 546 444 140 455 547 444 140 456 548 444 140 447 549 444 140 448 550 444 140 449 551 444 140 450 552 444 140 451 553 444 140 452 554 444 140 149 50 444 140 445 5 100 139 138 139 138 323 148 140 583 573 325 148 140 583 573 326 148 140 583 573 327 148 140 583 573 328 148 140 583 573 324 148 140 332 573 329 148 140 330 575 331 148 140 333 575 159 334 51 140 141 575 160 335 51 140 141 575 161 336 51 140 141 575 337 51 140 141 575 338 51 140 141 575 339 51 140 141 575 340 51 140 141 575 341 51 140 141 575 342 51 140 141 575 343 51 140 141 575 344 51 140 141 575 345 51 140 141 575 346 51 140 141 575 347 51 140 141 575 348 51 140 141 575 162 349 51 140 141 575 163 350 51 140 141 575 164 351 51 140 141 575 156 565 51 140 584 573 157 352 51 140 585 573 158 353 51 140 585 573 165 354 51 140 141 575 166 355 51 140 141 575 167 357 51 140 141 575 168 356 51 140 141 575 169 358 51 140 141 575 170 359 51 140 141 575 171 360 51 140 457 576 172 361 51 140 141 575 601 324 51 140 141 575 311 362 51 140 141 575 305 308 51 140 586 573 173 363 51 140 141 575 309 310 51 140 141 575 312 364 51 140 141 575 313 365 51 140 141 575 314 366 51 140 141 575 306 307 51 140 586 573 315 367 51 140 586 573 174 368 51 140 141 175 369 51 140 587 573 176 177 51 140 587 573 178 370 51 140 587 573 179 371 51 140 587 573 180 372 51 140 587 573 181 373 51 140 141 182 375 382 140 588 573 376 382 140 588 573 377 382 140 588 573 378 382 140 588 573 379 382 140 588 573 380 382 140 588 573 381 382 140 588 573 381 51 140 141 183 383 51 140 141 184 384 51 140 141 185 385 51 140 141 186 386 51 140 141 387 331 51 140 589 573 187 388 51 140 588 573 188 389 51 140 588 573 189 390 51 140 588 573 190 391 51 140 141 191 392 374 140 141 192 393 51 140 141 193 394 382 140 141 194 395 51 140 141 195 396 374 140 141 196 397 374 140 141 197 398 374 140 141 198 399 374 140 141 199 400 374 140 141 200 401 374 140 141 201 402 374 140 141 202 403 374 140 141 203 404 374 140 141 204 405 374 140 141 205 406 51 140 141 206 407 51 140 141 207 408 51 140 141 208 409 51 140 141 209 410 51 140 141 210 411 51 140 141 211 412 51 140 141 212 413 51 140 141 213 414 51 140 141 214 415 51 140 141 215 416 51 140 141 216 417 51 140 141 217 418 51 140 419 147 420 597 320 421 51 140 590 566 567 150 113 51 140 141 321 114 382 140 590 147 141 567 322 115 51 140 590 566 567 151 435 51 140 141 152 436 51 140 141 424 429 51 140 141 425 430 51 140 141 426 431 51 140 440 568 439 438 51 140 440 568 427 432 51 140 141 153 428 51 140 141 154 434 51 140 141 155 437 51 140 141 423 433 51 140 441 218 442 51 140 441 219 458 51 140 441 220 459 51 140 441 221 460 51 140 441 222 461 51 140 441 223 462 51 140 441 224 463 51 140 441 225 464 51 140 441 226 465 51 140 441 227 466 51 140 441 316 467 51 140 441 317 468 51 140 441 318 469 51 140 441 319 470 51 140 441 228 471 51 140 441 229 472 51 140 441 230 473 51 140 441 536 540 51 140 441 231 474 51 140 441 232 475 51 140 441 233 476 51 140 441 234 477 51 140 441 235 478 51 140 591 5 569 236 479 51 140 141 237 480 51 140 141 238 101 51 140 141 239 102 51 140 141 240 103 51 140 141 241 104 51 140 141 242 105 51 140 141 243 106 51 140 141 244 107 51 140 141 245 108 51 140 141 246 109 51 140 141 247 481 382 140 141 248 482 382 140 141 249 483 382 140 141 250 484 382 140 141 251 485 382 140 141 252 486 382 140 141 253 487 382 140 141 254 89 382 140 141 255 488 382 140 141 256 90 382 140 141 257 489 382 140 141 258 92 382 140 141 259 490 382 140 141 260 491 382 140 141 261 492 382 140 141 262 493 382 140 141 263 494 382 140 141 264 495 382 140 141 265 496 382 140 141 266 498 497 570 267 499 382 140 141 268 500 382 140 141 269 501 382 140 141 270 502 382 140 141 271 503 382 140 141 272 504 382 140 141 273 505 382 140 141 274 96 382 140 141 275 97 382 140 141 276 506 382 140 141 277 98 382 140 141 278 507 51 140 592 569 279 508 51 140 592 569 280 509 382 140 141 281 510 382 140 141 282 511 382 140 141 283 512 382 140 141 537 541 382 140 141 538 542 382 140 141 539 543 382 140 141 284 513 382 140 141 285 514 382 140 141 286 515 382 140 141 287 516 382 140 141 288 517 382 140 141 289 518 382 140 141 290 519 51 140 141 291 520 51 140 141 292 521 51 140 141 293 522 51 140 141 294 524 51 140 591 571 295 525 51 140 591 571 296 526 51 140 141 297 527 51 140 141 298 528 51 140 141 299 529 51 140 141 300 530 51 140 141 301 531 51 140 141 302 532 51 140 141 303 533 51 140 534 304 110 51 140 535 10 11 12 18 139 138 139 138 52 51 140 141 53 51 140 141 74 51 140 141 54 51 140 141 75 51 140 141 55 51 140 141 556 51 140 141 56 51 140 141 57 51 140 141 58 51 140 141 76 51 140 141 59 51 140 141 60 51 140 141 61 51 140 141 62 51 140 141 63 51 140 141 64 51 140 141 65 51 140 141 77 51 140 141 66 51 140 141 67 51 140 141 78 140 141 68 140 141 79 51 140 141 80 51 140 141 69 51 140 141 81 51 140 141 70 51 140 141 82 51 140 141 71 51 140 141 72 51 140 141 72 51 140 141 73 51 140 141 83 557 140 593 598 84 51 140 593 598 85 51 140 593 598 86 51 140 593 598 87 51 140 593 598 555 51 140 141 88 557 593 598 21 22 139 138 139 138 113 51 140 141 114 51 140 141 115 51 140 141 13 139 138 139 138 110 382 140 141 111 112 14 139 138 139 138 101 382 140 141 102 382 140 141 103 382 140 141 104 382 140 141 105 382 140 141 106 382 140 141 107 382 140 141 108 382 140 141 109 382 140 141 15 5 16 558 51 140 593 598 559 51 140 593 598 560 51 140 593 598 561 564 140 593 598 562 564 140 593 598 563 564 140 593 598 5 17 89 422 90 91 92 93 94 95 374 140 594 598 96 97 98 5 523 595 599 600

6 9 99 139 138 139 138 146 118 51 140 145 147 141 119 51 140 145 147 141 120 51 140 145 147 141 121 51 140 145 147 141 117 51 140 577 147 141 572 5 122 51 140 577 147 141 572 123 51 140 578 147 141 596 124 51 140 578 147 141 596 125 51 140 578 147 141 596 126 51 140 578 147 141 596 127 51 140 578 147 141 596 5 128 51 140 578 147 141 596 129 51 140 443 147 141 596 130 51 140 579 147 141 596 131 51 142 141 147 141 132 51 142 141 147 141 133 51 142 141 147 141 134 51 142 141 147 141 135 51 142 141 147 141 136 51 142 141 147 141 137 51 142 141 147 141 19 139 138 139 138 23 51 140 141 147 141 24 51 140 141 147 141 143 144 140 141 147 141 25 51 140 141 147 141 26 51 140 141 147 141 27 51 140 141 147 141 28 51 140 141 147 141 29 51 140 141 147 141 30 51 140 141 147 141 31 148 140 580 147 141 32 51 140 580 147 141 33 51 140 141 147 141 34 51 140 141 147 141 35 51 140 141 147 141 36 51 140 141 147 141 37 51 140 141 147 141 38 51 140 141 147 141 39 51 140 141 147 141 20 139 138 139 138 40 41 42 43 51 140 581 573 44 45 51 140 581 573 46 47 51 140 582 574 48 49 51 140 582 574 446 544 444 140 453 545 444 140 454 546 444 140 455 547 444 140 456 548 444 140 447 549 444 140 448 550 444 140 449 551 444 140 450 552 444 140 451 553 444 140 452 554 444 140 149 50 444 140 445 5 100 139 138 139 138 323 148 140 583 573 325 148 140 583 573 326 148 140 583 573 327 148 140 583 573 328 148 140 583 573 324 148 140 332 573 329 148 140 330 575 331 148 140 333 575 159 334 51 140 141 575 160 335 51 140 141 575 161 336 51 140 141 575 337 51 140 141 575 338 51 140 141 575 339 51 140 141 575 340 51 140 141 575 341 51 140 141 575 342 51 140 141 575 343 51 140 141 575 344 51 140 141 575 345 51 140 141 575 346 51 140 141 575 347 51 140 141 575 348 51 140 141 575 162 349 51 140 141 575 163 350 51 140 141 575 164 351 51 140 141 575 156 565 51 140 584 573 157 352 51 140 585 573 158 353 51 140 585 573 165 354 51 140 141 575 166 355 51 140 141 575 167 357 51 140 141 575 168 356 51 140 141 575 169 358 51 140 141 575 170 359 51 140 141 575 171 360 51 140 457 576 172 361 51 140 141 575 601 324 51 140 141 575 311 362 51 140 141 575 305 308 51 140 586 573 173 363 51 140 141 575 309 310 51 140 141 575 312 364 51 140 141 575 313 365 51 140 141 575 314 366 51 140 141 575 306 307 51 140 586 573 315 367 51 140 586 573 174 368 51 140 141 175 369 51 140 587 573 176 177 51 140 587 573 178 370 51 140 587 573 179 371 51 140 587 573 180 372 51 140 587 573 181 373 51 140 141 182 375 382 140 588 573 376 382 140 588 573 377 382 140 588 573 378 382 140 588 573 379 382 140 588 573 380 382 140 588 573 381 382 140 588 573 381 51 140 141 183 383 51 140 141 184 384 51 140 141 185 385 51 140 141 186 386 51 140 141 387 331 51 140 589 573 187 388 51 140 588 573 188 389 51 140 588 573 189 390 51 140 588 573 190 391 51 140 141 191 392 374 140 141 192 393 51 140 141 193 394 382 140 141 194 395 51 140 141 195 396 374 140 141 196 397 374 140 141 197 398 374 140 141 198 399 374 140 141 199 400 374 140 141 200 401 374 140 141 201 402 374 140 141 202 403 374 140 141 203 404 374 140 141 204 405 374 140 141 205 406 51 140 141 206 407 51 140 141 207 408 51 140 141 208 409 51 140 141 209 410 51 140 141 210 411 51 140 141 211 412 51 140 141 212 413 51 140 141 213 414 51 140 141 214 415 51 140 141 215 416 51 140 141 216 417 51 140 141 217 418 51 140 419 147 420 597 320 421 51 140 590 566 567 150 113 51 140 141 321 114 382 140 590 147 141 567 322 115 51 140 590 566 567 151 435 51 140 141 152 436 51 140 141 424 429 51 140 141 425 430 51 140 141 426 431 51 140 440 568 439 438 51 140 440 568 427 432 51 140 141 153 428 51 140 141 154 434 51 140 141 155 437 51 140 141 423 433 51 140 441 218 442 51 140 441 219 458 51 140 441 220 459 51 140 441 221 460 51 140 441 222 461 51 140 441 223 462 51 140 441 224 463 51 140 441 225 464 51 140 441 226 465 51 140 441 227 466 51 140 441 316 467 51 140 441 317 468 51 140 441 318 469 51 140 441 319 470 51 140 441 228 471 51 140 441 229 472 51 140 441 230 473 51 140 441 536 540 51 140 441 231 474 51 140 441 232 475 51 140 441 233 476 51 140 441 234 477 51 140 441 235 478 51 140 591 5 569 236 479 51 140 141 237 480 51 140 141 238 101 51 140 141 239 102 51 140 141 240 103 51 140 141 241 104 51 140 141 242 105 51 140 141 243 106 51 140 141 244 107 51 140 141 245 108 51 140 141 246 109 51 140 141 247 481 382 140 141 248 482 382 140 141 249 483 382 140 141 250 484 382 140 141 251 485 382 140 141 252 486 382 140 141 253 487 382 140 141 254 89 382 140 141 255 488 382 140 141 256 90 382 140 141 257 489 382 140 141 258 92 382 140 141 259 490 382 140 141 260 491 382 140 141 261 492 382 140 141 262 493 382 140 141 263 494 382 140 141 264 495 382 140 141 265 496 382 140 141 266 498 497 570 267 499 382 140 141 268 500 382 140 141 269 501 382 140 141 270 502 382 140 141 271 503 382 140 141 272 504 382 140 141 273 505 382 140 141 274 96 382 140 141 275 97 382 140 141 276 506 382 140 141 277 98 382 140 141 278 507 51 140 592 569 279 508 51 140 592 569 280 509 382 140 141 281 510 382 140 141 282 511 382 140 141 283 512 382 140 141 537 541 382 140 141 538 542 382 140 141 539 543 382 140 141 284 513 382 140 141 285 514 382 140 141 286 515 382 140 141 287 516 382 140 141 288 517 382 140 141 289 518 382 140 141 290 519 51 140 141 291 520 51 140 141 292 521 51 140 141 293 522 51 140 141 294 524 51 140 591 571 295 525 51 140 591 571 296 526 51 140 141 297 527 51 140 141 298 528 51 140 141 299 529 51 140 141 300 530 51 140 141 301 531 51 140 141 302 532 51 140 141 303 533 51 140 534 304 110 51 140 535 10 11 12 18 139 138 139 138 52 51 140 141 53 51 140 141 74 51 140 141 54 51 140 141 75 51 140 141 55 51 140 141 556 51 140 141 56 51 140 141 57 51 140 141 58 51 140 141 76 51 140 141 59 51 140 141 60 51 140 141 61 51 140 141 62 51 140 141 63 51 140 141 64 51 140 141 65 51 140 141 77 51 140 141 66 51 140 141 67 51 140 141 78 140 141 68 140 141 79 51 140 141 80 51 140 141 69 51 140 141 81 51 140 141 70 51 140 141 82 51 140 141 71 51 140 141 72 51 140 141 72 51 140 141 73 51 140 141 83 557 140 593 598 84 51 140 593 598 85 51 140 593 598 86 51 140 593 598 87 51 140 593 598 555 51 140 141 88 557 593 598 21 22 139 138 139 138 113 51 140 141 114 51 140 141 115 51 140 141 13 139 138 139 138 110 382 140 141 111 112 14 139 138 139 138 101 382 140 141 102 382 140 141 103 382 140 141 104 382 140 141 105 382 140 141 106 382 140 141 107 382 140 141 108 382 140 141 109 382 140 141 15 5 16 558 51 140 593 598 559 51 140 593 598 560 51 140 593 598 561 564 140 593 598 562 564 140 593 598 563 564 140 593 598 5 17 89 422 90 91 92 93 94 95 374 140 594 598 96 97 98 5 523 595 599 600

6 9 99 139 138 139 138 146 118 51 140 145 147 141 119 51 140 145 147 141 120 51 140 145 147 141 121 51 140 145 147 141 117 51 140 577 147 141 572 5 122 51 140 577 147 141 572 123 51 140 578 147 141 596 124 51 140 578 147 141 596 125 51 140 578 147 141 596 126 51 140 578 147 141 596 127 51 140 578 147 141 596 5 128 51 140 578 147 141 596 129 51 140 443 147 141 596 130 51 140 579 147 141 596 131 51 142 141 147 141 132 51 142 141 147 141 133 51 142 141 147 141 134 51 142 141 147 141 135 51 142 141 147 141 136 51 142 141 147 141 137 51 142 141 147 141 19 139 138 139 138 23 51 140 141 147 141 24 51 140 141 147 141 143 144 140 141 147 141 25 51 140 141 147 141 26 51 140 141 147 141 27 51 140 141 147 141 28 51 140 141 147 141 29 51 140 141 147 141 30 51 140 141 147 141 31 148 140 580 147 141 32 51 140 580 147 141 33 51 140 141 147 141 34 51 140 141 147 141 35 51 140 141 147 141 36 51 140 141 147 141 37 51 140 141 147 141 38 51 140 141 147 141 39 51 140 141 147 141 20 139 138 139 138 40 41 42 43 51 140 581 573 44 45 51 140 581 573 46 47 51 140 582 574 48 49 51 140 582 574 446 544 444 140 453 545 444 140 454 546 444 140 455 547 444 140 456 548 444 140 447 549 444 140 448 550 444 140 449 551 444 140 450 552 444 140 451 553 444 140 452 554 444 140 149 50 444 140 445 5 100 139 138 139 138 323 148 140 583 573 325 148 140 583 573 326 148 140 583 573 327 148 140 583 573 328 148 140 583 573 324 148 140 332 573 329 148 140 330 575 331 148 140 333 575 159 334 51 140 141 575 160 335 51 140 141 575 161 336 51 140 141 575 337 51 140 141 575 338 51 140 141 575 339 51 140 141 575 340 51 140 141 575 341 51 140 141 575 342 51 140 141 575 343 51 140 141 575 344 51 140 141 575 345 51 140 141 575 346 51 140 141 575 347 51 140 141 575 348 51 140 141 575 162 349 51 140 141 575 163 350 51 140 141 575 164 351 51 140 141 575 156 565 51 140 584 573 157 352 51 140 585 573 158 353 51 140 585 573 165 354 51 140 141 575 166 355 51 140 141 575 167 357 51 140 141 575 168 356 51 140 141 575 169 358 51 140 141 575 170 359 51 140 141 575 171 360 51 140 457 576 172 361 51 140 141 575 601 324 51 140 141 575 311 362 51 140 141 575 305 308 51 140 586 573 173 363 51 140 141 575 309 310 51 140 141 575 312 364 51 140 141 575 313 365 51 140 141 575 314 366 51 140 141 575 306 307 51 140 586 573 315 367 51 140 586 573 174 368 51 140 141 175 369 51 140 587 573 176 177 51 140 587 573 178 370 51 140 587 573 179 371 51 140 587 573 180 372 51 140 587 573 181 373 51 140 141 182 375 382 140 588 573 376 382 140 588 573 377 382 140 588 573 378 382 140 588 573 379 382 140 588 573 380 382 140 588 573 381 382 140 588 573 381 51 140 141 183 383 51 140 141 184 384 51 140 141 185 385 51 140 141 186 386 51 140 141 387 331 51 140 589 573 187 388 51 140 588 573 188 389 51 140 588 573 189 390 51 140 588 573 190 391 51 140 141 191 392 374 140 141 192 393 51 140 141 193 394 382 140 141 194 395 51 140 141 195 396 374 140 141 196 397 374 140 141 197 398 374 140 141 198 399 374 140 141 199 400 374 140 141 200 401 374 140 141 201 402 374 140 141 202 403 374 140 141 203 404 374 140 141 204 405 374 140 141 205 406 51 140 141 206 407 51 140 141 207 408 51 140 141 208 409 51 140 141 209 410 51 140 141 210 411 51 140 141 211 412 51 140 141 212 413 51 140 141 213 414 51 140 141 214 415 51 140 141 215 416 51 140 141 216 417 51 140 141 217 418 51 140 419 147 420 597 320 421 51 140 590 566 567 150 113 51 140 141 321 114 382 140 590 147 141 567 322 115 51 140 590 566 567 151 435 51 140 141 152 436 51 140 141 424 429 51 140 141 425 430 51 140 141 426 431 51 140 440 568 439 438 51 140 440 568 427 432 51 140 141 153 428 51 140 141 154 434 51 140 141 155 437 51 140 141 423 433 51 140 441 218 442 51 140 441 219 458 51 140 441 220 459 51 140 441 221 460 51 140 441 222 461 51 140 441 223 462 51 140 441 224 463 51 140 441 225 464 51 140 441 226 465 51 140 441 227 466 51 140 441 316 467 51 140 441 317 468 51 140 441 318 469 51 140 441 319 470 51 140 441 228 471 51 140 441 229 472 51 140 441 230 473 51 140 441 536 540 51 140 441 231 474 51 140 441 232 475 51 140 441 233 476 51 140 441 234 477 51 140 441 235 478 51 140 591 5 569 236 479 51 140 141 237 480 51 140 141 238 101 51 140 141 239 102 51 140 141 240 103 51 140 141 241 104 51 140 141 242 105 51 140 141 243 106 51 140 141 244 107 51 140 141 245 108 51 140 141 246 109 51 140 141 247 481 382 140 141 248 482 382 140 141 249 483 382 140 141 250 484 382 140 141 251 485 382 140 141 252 486 382 140 141 253 487 382 140 141 254 89 382 140 141 255 488 382 140 141 256 90 382 140 141 257 489 382 140 141 258 92 382 140 141 259 490 382 140 141 260 491 382 140 141 261 492 382 140 141 262 493 382 140 141 263 494 382 140 141 264 495 382 140 141 265 496 382 140 141 266 498 497 570 267 499 382 140 141 268 500 382 140 141 269 501 382 140 141 270 502 382 140 141 271 503 382 140 141 272 504 382 140 141 273 505 382 140 141 274 96 382 140 141 275 97 382 140 141 276 506 382 140 141 277 98 382 140 141 278 507 51 140 592 569 279 508 51 140 592 569 280 509 382 140 141 281 510 382 140 141 282 511 382 140 141 283 512 382 140 141 537 541 382 140 141 538 542 382 140 141 539 543 382 140 141 284 513 382 140 141 285 514 382 140 141 286 515 382 140 141 287 516 382 140 141 288 517 382 140 141 289 518 382 140 141 290 519 51 140 141 291 520 51 140 141 292 521 51 140 141 293 522 51 140 141 294 524 51 140 591 571 295 525 51 140 591 571 296 526 51 140 141 297 527 51 140 141 298 528 51 140 141 299 529 51 140 141 300 530 51 140 141 301 531 51 140 141 302 532 51 140 141 303 533 51 140 534 304 110 51 140 535 10 11 12 18 139 138 139 138 52 51 140 141 53 51 140 141 74 51 140 141 54 51 140 141 75 51 140 141 55 51 140 141 556 51 140 141 56 51 140 141 57 51 140 141 58 51 140 141 76 51 140 141 59 51 140 141 60 51 140 141 61 51 140 141 62 51 140 141 63 51 140 141 64 51 140 141 65 51 140 141 77 51 140 141 66 51 140 141 67 51 140 141 78 140 141 68 140 141 79 51 140 141 80 51 140 141 69 51 140 141 81 51 140 141 70 51 140 141 82 51 140 141 71 51 140 141 72 51 140 141 72 51 140 141 73 51 140 141 83 557 140 593 598 84 51 140 593 598 85 51 140 593 598 86 51 140 593 598 87 51 140 593 598 555 51 140 141 88 557 593 598 21 22 139 138 139 138 113 51 140 141 114 51 140 141 115 51 140 141 13 139 138 139 138 110 382 140 141 111 112 14 139 138 139 138 101 382 140 141 102 382 140 141 103 382 140 141 104 382 140 141 105 382 140 141 106 382 140 141 107 382 140 141 108 382 140 141 109 382 140 141 15 5 16 558 51 140 593 598 559 51 140 593 598 560 51 140 593 598 561 564 140 593 598 562 564 140 593 598 563 564 140 593 598 5 17 89 422 90 91 92 93 94 95 374 140 594 598 96 97 98 5 523 595 599 600

6 9 99 139 138 139 138 146 118 51 140 145 147 141 119 51 140 145 147 141 120 51 140 145 147 141 121 51 140 145 147 141 117 51 140 577 147 141 572 5 122 51 140 577 147 141 572 123 51 140 578 147 141 596 124 51 140 578 147 141 596 125 51 140 578 147 141 596 126 51 140 578 147 141 596 127 51 140 578 147 141 596 5 128 51 140 578 147 141 596 129 51 140 443 147 141 596 130 51 140 579 147 141 596 131 51 142 141 147 141 132 51 142 141 147 141 133 51 142 141 147 141 134 51 142 141 147 141 135 51 142 141 147 141 136 51 142 141 147 141 137 51 142 141 147 141 19 139 138 139 138 23 51 140 141 147 141 24 51 140 141 147 141 143 144 140 141 147 141 25 51 140 141 147 141 26 51 140 141 147 141 27 51 140 141 147 141 28 51 140 141 147 141 29 51 140 141 147 141 30 51 140 141 147 141 31 148 140 580 147 141 32 51 140 580 147 141 33 51 140 141 147 141 34 51 140 141 147 141 35 51 140 141 147 141 36 51 140 141 147 141 37 51 140 141 147 141 38 51 140 141 147 141 39 51 140 141 147 141 20 139 138 139 138 40 41 42 43 51 140 581 573 44 45 51 140 581 573 46 47 51 140 582 574 48 49 51 140 582 574 446 544 444 140 453 545 444 140 454 546 444 140 455 547 444 140 456 548 444 140 447 549 444 140 448 550 444 140 449 551 444 140 450 552 444 140 451 553 444 140 452 554 444 140 149 50 444 140 445 5 100 139 138 139 138 323 148 140 583 573 325 148 140 583 573 326 148 140 583 573 327 148 140 583 573 328 148 140 583 573 324 148 140 332 573 329 148 140 330 575 331 148 140 333 575 159 334 51 140 141 575 160 335 51 140 141 575 161 336 51 140 141 575 337 51 140 141 575 338 51 140 141 575 339 51 140 141 575 340 51 140 141 575 341 51 140 141 575 342 51 140 141 575 343 51 140 141 575 344 51 140 141 575 345 51 140 141 575 346 51 140 141 575 347 51 140 141 575 348 51 140 141 575 162 349 51 140 141 575 163 350 51 140 141 575 164 351 51 140 141 575 156 565 51 140 584 573 157 352 51 140 585 573 158 353 51 140 585 573 165 354 51 140 141 575 166 355 51 140 141 575 167 357 51 140 141 575 168 356 51 140 141 575 169 358 51 140 141 575 170 359 51 140 141 575 171 360 51 140 457 576 172 361 51 140 141 575 601 324 51 140 141 575 311 362 51 140 141 575 305 308 51 140 586 573 173 363 51 140 141 575 309 310 51 140 141 575 312 364 51 140 141 575 313 365 51 140 141 575 314 366 51 140 141 575 306 307 51 140 586 573 315 367 51 140 586 573 174 368 51 140 141 175 369 51 140 587 573 176 177 51 140 587 573 178 370 51 140 587 573 179 371 51 140 587 573 180 372 51 140 587 573 181 373 51 140 141 182 375 382 140 588 573 376 382 140 588 573 377 382 140 588 573 378 382 140 588 573 379 382 140 588 573 380 382 140 588 573 381 382 140 588 573 381 51 140 141 183 383 51 140 141 184 384 51 140 141 185 385 51 140 141 186 386 51 140 141 387 331 51 140 589 573 187 388 51 140 588 573 188 389 51 140 588 573 189 390 51 140 588 573 190 391 51 140 141 191 392 374 140 141 192 393 51 140 141 193 394 382 140 141 194 395 51 140 141 195 396 374 140 141 196 397 374 140 141 197 398 374 140 141 198 399 374 140 141 199 400 374 140 141 200 401 374 140 141 201 402 374 140 141 202 403 374 140 141 203 404 374 140 141 204 405 374 140 141 205 406 51 140 141 206 407 51 140 141 207 408 51 140 141 208 409 51 140 141 209 410 51 140 141 210 411 51 140 141 211 412 51 140 141 212 413 51 140 141 213 414 51 140 141 214 415 51 140 141 215 416 51 140 141 216 417 51 140 141 217 418 51 140 419 147 420 597 320 421 51 140 590 566 567 150 113 51 140 141 321 114 382 140 590 147 141 567 322 115 51 140 590 566 567 151 435 51 140 141 152 436 51 140 141 424 429 51 140 141 425 430 51 140 141 426 431 51 140 440 568 439 438 51 140 440 568 427 432 51 140 141 153 428 51 140 141 154 434 51 140 141 155 437 51 140 141 423 433 51 140 441 218 442 51 140 441 219 458 51 140 441 220 459 51 140 441 221 460 51 140 441 222 461 51 140 441 223 462 51 140 441 224 463 51 140 441 225 464 51 140 441 226 465 51 140 441 227 466 51 140 441 316 467 51 140 441 317 468 51 140 441 318 469 51 140 441 319 470 51 140 441 228 471 51 140 441 229 472 51 140 441 230 473 51 140 441 536 540 51 140 441 231 474 51 140 441 232 475 51 140 441 233 476 51 140 441 234 477 51 140 441 235 478 51 140 591 5 569 236 479 51 140 141 237 480 51 140 141 238 101 51 140 141 239 102 51 140 141 240 103 51 140 141 241 104 51 140 141 242 105 51 140 141 243 106 51 140 141 244 107 51 140 141 245 108 51 140 141 246 109 51 140 141 247 481 382 140 141 248 482 382 140 141 249 483 382 140 141 250 484 382 140 141 251 485 382 140 141 252 486 382 140 141 253 487 382 140 141 254 89 382 140 141 255 488 382 140 141 256 90 382 140 141 257 489 382 140 141 258 92 382 140 141 259 490 382 140 141 260 491 382 140 141 261 492 382 140 141 262 493 382 140 141 263 494 382 140 141 264 495 382 140 141 265 496 382 140 141 266 498 497 570 267 499 382 140 141 268 500 382 140 141 269 501 382 140 141 270 502 382 140 141 271 503 382 140 141 272 504 382 140 141 273 505 382 140 141 274 96 382 140 141 275 97 382 140 141 276 506 382 140 141 277 98 382 140 141 278 507 51 140 592 569 279 508 51 140 592 569 280 509 382 140 141 281 510 382 140 141 282 511 382 140 141 283 512 382 140 141 537 541 382 140 141 538 542 382 140 141 539 543 382 140 141 284 513 382 140 141 285 514 382 140 141 286 515 382 140 141 287 516 382 140 141 288 517 382 140 141 289 518 382 140 141 290 519 51 140 141 291 520 51 140 141 292 521 51 140 141 293 522 51 140 141 294 524 51 140 591 571 295 525 51 140 591 571 296 526 51 140 141 297 527 51 140 141 298 528 51 140 141 299 529 51 140 141 300 530 51 140 141 301 531 51 140 141 302 532 51 140 141 303 533 51 140 534 304 110 51 140 535 10 11 12 18 139 138 139 138 52 51 140 141 53 51 140 141 74 51 140 141 54 51 140 141 75 51 140 141 55 51 140 141 556 51 140 141 56 51 140 141 57 51 140 141 58 51 140 141 76 51 140 141 59 51 140 141 60 51 140 141 61 51 140 141 62 51 140 141 63 51 140 141 64 51 140 141 65 51 140 141 77 51 140 141 66 51 140 141 67 51 140 141 78 140 141 68 140 141 79 51 140 141 80 51 140 141 69 51 140 141 81 51 140 141 70 51 140 141 82 51 140 141 71 51 140 141 72 51 140 141 72 51 140 141 73 51 140 141 83 557 140 593 598 84 51 140 593 598 85 51 140 593 598 86 51 140 593 598 87 51 140 593 598 555 51 140 141 88 557 593 598 21 22 139 138 139 138 113 51 140 141 114 51 140 141 115 51 140 141 13 139 138 139 138 110 382 140 141 111 112 14 139 138 139 138 101 382 140 141 102 382 140 141 103 382 140 141 104 382 140 141 105 382 140 141 106 382 140 141 107 382 140 141 108 382 140 141 109 382 140 141 15 5 16 558 51 140 593 598 559 51 140 593 598 560 51 140 593 598 561 564 140 593 598 562 564 140 593 598 563 564 140 593 598 5 17 89 422 90 91 92 93 94 95 374 140 594 598 96 97 98 5 523 595 599 600

6 9 99 139 138 139 138 146 118 51 140 145 147 141 119 51 140 145 147 141 120 51 140 145 147 141 121 51 140 145 147 141 117 51 140 577 147 141 572 5 122 51 140 577 147 141 572 123 51 140 578 147 141 596 124 51 140 578 147 141 596 125 51 140 578 147 141 596 126 51 140 578 147 141 596 127 51 140 578 147 141 596 5 128 51 140 578 147 141 596 129 51 140 443 147 141 596 130 51 140 579 147 141 596 131 51 142 141 147 141 132 51 142 141 147 141 133 51 142 141 147 141 134 51 142 141 147 141 135 51 142 141 147 141 136 51 142 141 147 141 137 51 142 141 147 141 19 139 138 139 138 23 51 140 141 147 141 24 51 140 141 147 141 143 144 140 141 147 141 25 51 140 141 147 141 26 51 140 141 147 141 27 51 140 141 147 141 28 51 140 141 147 141 29 51 140 141 147 141 30 51 140 141 147 141 31 148 140 580 147 141 32 51 140 580 147 141 33 51 140 141 147 141 34 51 140 141 147 141 35 51 140 141 147 141 36 51 140 141 147 141 37 51 140 141 147 141 38 51 140 141 147 141 39 51 140 141 147 141 20 139 138 139 138 40 41 42 43 51 140 581 573 44 45 51 140 581 573 46 47 51 140 582 574 48 49 51 140 582 574 446 544 444 140 453 545 444 140 454 546 444 140 455 547 444 140 456 548 444 140 447 549 444 140 448 550 444 140 449 551 444 140 450 552 444 140 451 553 444 140 452 554 444 140 149 50 444 140 445 5 100 139 138 139 138 323 148 140 583 573 325 148 140 583 573 326 148 140 583 573 327 148 140 583 573 328 148 140 583 573 324 148 140 332 573 329 148 140 330 575 331 148 140 333 575 159 334 51 140 141 575 160 335 51 140 141 575 161 336 51 140 141 575 337 51 140 141 575 338 51 140 141 575 339 51 140 141 575 340 51 140 141 575 341 51 140 141 575 342 51 140 141 575 343 51 140 141 575 344 51 140 141 575 345 51 140 141 575 346 51 140 141 575 347 51 140 141 575 348 51 140 141 575 162 349 51 140 141 575 163 350 51 140 141 575 164 351 51 140 141 575 156 565 51 140 584 573 157 352 51 140 585 573 158 353 51 140 585 573 165 354 51 140 141 575 166 355 51 140 141 575 167 357 51 140 141 575 168 356 51 140 141 575 169 358 51 140 141 575 170 359 51 140 141 575 171 360 51 140 457 576 172 361 51 140 141 575 601 324 51 140 141 575 311 362 51 140 141 575 305 308 51 140 586 573 173 363 51 140 141 575 309 310 51 140 141 575 312 364 51 140 141 575 313 365 51 140 141 575 314 366 51 140 141 575 306 307 51 140 586 573 315 367 51 140 586 573 174 368 51 140 141 175 369 51 140 587 573 176 177 51 140 587 573 178 370 51 140 587 573 179 371 51 140 587 573 180 372 51 140 587 573 181 373 51 140 141 182 375 382 140 588 573 376 382 140 588 573 377 382 140 588 573 378 382 140 588 573 379 382 140 588 573 380 382 140 588 573 381 382 140 588 573 381 51 140 141 183 383 51 140 141 184 384 51 140 141 185 385 51 140 141 186 386 51 140 141 387 331 51 140 589 573 187 388 51 140 588 573 188 389 51 140 588 573 189 390 51 140 588 573 190 391 51 140 141 191 392 374 140 141 192 393 51 140 141 193 394 382 140 141 194 395 51 140 141 195 396 374 140 141 196 397 374 140 141 197 398 374 140 141 198 399 374 140 141 199 400 374 140 141 200 401 374 140 141 201 402 374 140 141 202 403 374 140 141 203 404 374 140 141 204 405 374 140 141 205 406 51 140 141 206 407 51 140 141 207 408 51 140 141 208 409 51 140 141 209 410 51 140 141 210 411 51 140 141 211 412 51 140 141 212 413 51 140 141 213 414 51 140 141 214 415 51 140 141 215 416 51 140 141 216 417 51 140 141 217 418 51 140 419 147 420 597 320 421 51 140 590 566 567 150 113 51 140 141 321 114 382 140 590 147 141 567 322 115 51 140 590 566 567 151 435 51 140 141 152 436 51 140 141 424 429 51 140 141 425 430 51 140 141 426 431 51 140 440 568 439 438 51 140 440 568 427 432 51 140 141 153 428 51 140 141 154 434 51 140 141 155 437 51 140 141 423 433 51 140 441 218 442 51 140 441 219 458 51 140 441 220 459 51 140 441 221 460 51 140 441 222 461 51 140 441 223 462 51 140 441 224 463 51 140 441 225 464 51 140 441 226 465 51 140 441 227 466 51 140 441 316 467 51 140 441 317 468 51 140 441 318 469 51 140 441 319 470 51 140 441 228 471 51 140 441 229 472 51 140 441 230 473 51 140 441 536 540 51 140 441 231 474 51 140 441 232 475 51 140 441 233 476 51 140 441 234 477 51 140 441 235 478 51 140 591 5 569 236 479 51 140 141 237 480 51 140 141 238 101 51 140 141 239 102 51 140 141 240 103 51 140 141 241 104 51 140 141 242 105 51 140 141 243 106 51 140 141 244 107 51 140 141 245 108 51 140 141 246 109 51 140 141 247 481 382 140 141 248 482 382 140 141 249 483 382 140 141 250 484 382 140 141 251 485 382 140 141 252 486 382 140 141 253 487 382 140 141 254 89 382 140 141 255 488 382 140 141 256 90 382 140 141 257 489 382 140 141 258 92 382 140 141 259 490 382 140 141 260 491 382 140 141 261 492 382 140 141 262 493 382 140 141 263 494 382 140 141 264 495 382 140 141 265 496 382 140 141 266 498 497 570 267 499 382 140 141 268 500 382 140 141 269 501 382 140 141 270 502 382 140 141 271 503 382 140 141 272 504 382 140 141 273 505 382 140 141 274 96 382 140 141 275 97 382 140 141 276 506 382 140 141 277 98 382 140 141 278 507 51 140 592 569 279 508 51 140 592 569 280 509 382 140 141 281 510 382 140 141 282 511 382 140 141 283 512 382 140 141 537 541 382 140 141 538 542 382 140 141 539 543 382 140 141 284 513 382 140 141 285 514 382 140 141 286 515 382 140 141 287 516 382 140 141 288 517 382 140 141 289 518 382 140 141 290 519 51 140 141 291 520 51 140 141 292 521 51 140 141 293 522 51 140 141 294 524 51 140 591 571 295 525 51 140 591 571 296 526 51 140 141 297 527 51 140 141 298 528 51 140 141 299 529 51 140 141 300 530 51 140 141 301 531 51 140 141 302 532 51 140 141 303 533 51 140 534 304 110 51 140 535 10 11 12 18 139 138 139 138 52 51 140 141 53 51 140 141 74 51 140 141 54 51 140 141 75 51 140 141 55 51 140 141 556 51 140 141 56 51 140 141 57 51 140 141 58 51 140 141 76 51 140 141 59 51 140 141 60 51 140 141 61 51 140 141 62 51 140 141 63 51 140 141 64 51 140 141 65 51 140 141 77 51 140 141 66 51 140 141 67 51 140 141 78 140 141 68 140 141 79 51 140 141 80 51 140 141 69 51 140 141 81 51 140 141 70 51 140 141 82 51 140 141 71 51 140 141 72 51 140 141 72 51 140 141 73 51 140 141 83 557 140 593 598 84 51 140 593 598 85 51 140 593 598 86 51 140 593 598 87 51 140 593 598 555 51 140 141 88 557 593 598 21 22 139 138 139 138 113 51 140 141 114 51 140 141 115 51 140 141 13 139 138 139 138 110 382 140 141 111 112 14 139 138 139 138 101 382 140 141 102 382 140 141 103 382 140 141 104 382 140 141 105 382 140 141 106 382 140 141 107 382 140 141 108 382 140 141 109 382 140 141 15 5 16 558 51 140 593 598 559 51 140 593 598 560 51 140 593 598 561 564 140 593 598 562 564 140 593 598 563 564 140 593 598 5 17 89 422 90 91 92 93 94 95 374 140 594 598 96 97 98 5 523 595 599 600

6 9 99 139 138 139 138 146 118 51 140 145 147 141 119 51 140 145 147 141 120 51 140 145 147 141 121 51 140 145 147 141 117 51 140 577 147 141 572 5 122 51 140 577 147 141 572 123 51 140 578 147 141 596 124 51 140 578 147 141 596 125 51 140 578 147 141 596 126 51 140 578 147 141 596 127 51 140 578 147 141 596 5 128 51 140 578 147 141 596 129 51 140 443 147 141 596 130 51 140 579 147 141 596 131 51 142 141 147 141 132 51 142 141 147 141 133 51 142 141 147 141 134 51 142 141 147 141 135 51 142 141 147 141 136 51 142 141 147 141 137 51 142 141 147 141 19 139 138 139 138 23 51 140 141 147 141 24 51 140 141 147 141 143 144 140 141 147 141 25 51 140 141 147 141 26 51 140 141 147 141 27 51 140 141 147 141 28 51 140 141 147 141 29 51 140 141 147 141 30 51 140 141 147 141 31 148 140 580 147 141 32 51 140 580 147 141 33 51 140 141 147 141 34 51 140 141 147 141 35 51 140 141 147 141 36 51 140 141 147 141 37 51 140 141 147 141 38 51 140 141 147 141 39 51 140 141 147 141 20 139 138 139 138 40 41 42 43 51 140 581 573 44 45 51 140 581 573 46 47 51 140 582 574 48 49 51 140 582 574 446 544 444 140 453 545 444 140 454 546 444 140 455 547 444 140 456 548 444 140 447 549 444 140 448 550 444 140 449 551 444 140 450 552 444 140 451 553 444 140 452 554 444 140 149 50 444 140 445 5 100 139 138 139 138 323 148 140 583 573 325 148 140 583 573 326 148 140 583 573 327 148 140 583 573 328 148 140 583 573 324 148 140 332 573 329 148 140 330 575 331 148 140 333 575 159 334 51 140 141 575 160 335 51 140 141 575 161 336 51 140 141 575 337 51 140 141 575 338 51 140 141 575 339 51 140 141 575 340 51 140 141 575 341 51 140 141 575 342 51 140 141 575 343 51 140 141 575 344 51 140 141 575 345 51 140 141 575 346 51 140 141 575 347 51 140 141 575 348 51 140 141 575 162 349 51 140 141 575 163 350 51 140 141 575 164 351 51 140 141 575 156 565 51 140 584 573 157 352 51 140 585 573 158 353 51 140 585 573 165 354 51 140 141 575 166 355 51 140 141 575 167 357 51 140 141 575 168 356 51 140 141 575 169 358 51 140 141 575 170 359 51 140 141 575 171 360 51 140 457 576 172 361 51 140 141 575 601 324 51 140 141 575 311 362 51 140 141 575 305 308 51 140 586 573 173 363 51 140 141 575 309 310 51 140 141 575 312 364 51 140 141 575 313 365 51 140 141 575 314 366 51 140 141 575 306 307 51 140 586 573 315 367 51 140 586 573 174 368 51 140 141 175 369 51 140 587 573 176 177 51 140 587 573 178 370 51 140 587 573 179 371 51 140 587 573 180 372 51 140 587 573 181 373 51 140 141 182 375 382 140 588 573 376 382 140 588 573 377 382 140 588 573 378 382 140 588 573 379 382 140 588 573 380 382 140 588 573 381 382 140 588 573 381 51 140 141 183 383 51 140 141 184 384 51 140 141 185 385 51 140 141 186 386 51 140 141 387 331 51 140 589 573 187 388 51 140 588 573 188 389 51 140 588 573 189 390 51 140 588 573 190 391 51 140 141 191 392 374 140 141 192 393 51 140 141 193 394 382 140 141 194 395 51 140 141 195 396 374 140 141 196 397 374 140 141 197 398 374 140 141 198 399 374 140 141 199 400 374 140 141 200 401 374 140 141 201 402 374 140 141 202 403 374 140 141 203 404 374 140 141 204 405 374 140 141 205 406 51 140 141 206 407 51 140 141 207 408 51 140 141 208 409 51 140 141 209 410 51 140 141 210 411 51 140 141 211 412 51 140 141 212 413 51 140 141 213 414 51 140 141 214 415 51 140 141 215 416 51 140 141 216 417 51 140 141 217 418 51 140 419 147 420 597 320 421 51 140 590 566 567 150 113 51 140 141 321 114 382 140 590 147 141 567 322 115 51 140 590 566 567 151 435 51 140 141 152 436 51 140 141 424 429 51 140 141 425 430 51 140 141 426 431 51 140 440 568 439 438 51 140 440 568 427 432 51 140 141 153 428 51 140 141 154 434 51 140 141 155 437 51 140 141 423 433 51 140 441 218 442 51 140 441 219 458 51 140 441 220 459 51 140 441 221 460 51 140 441 222 461 51 140 441 223 462 51 140 441 224 463 51 140 441 225 464 51 140 441 226 465 51 140 441 227 466 51 140 441 316 467 51 140 441 317 468 51 140 441 318 469 51 140 441 319 470 51 140 441 228 471 51 140 441 229 472 51 140 441 230 473 51 140 441 536 540 51 140 441 231 474 51 140 441 232 475 51 140 441 233 476 51 140 441 234 477 51 140 441 235 478 51 140 591 5 569 236 479 51 140 141 237 480 51 140 141 238 101 51 140 141 239 102 51 140 141 240 103 51 140 141 241 104 51 140 141 242 105 51 140 141 243 106 51 140 141 244 107 51 140 141 245 108 51 140 141 246 109 51 140 141 247 481 382 140 141 248 482 382 140 141 249 483 382 140 141 250 484 382 140 141 251 485 382 140 141 252 486 382 140 141 253 487 382 140 141 254 89 382 140 141 255 488 382 140 141 256 90 382 140 141 257 489 382 140 141 258 92 382 140 141 259 490 382 140 141 260 491 382 140 141 261 492 382 140 141 262 493 382 140 141 263 494 382 140 141 264 495 382 140 141 265 496 382 140 141 266 498 497 570 267 499 382 140 141 268 500 382 140 141 269 501 382 140 141 270 502 382 140 141 271 503 382 140 141 272 504 382 140 141 273 505 382 140 141 274 96 382 140 141 275 97 382 140 141 276 506 382 140 141 277 98 382 140 141 278 507 51 140 592 569 279 508 51 140 592 569 280 509 382 140 141 281 510 382 140 141 282 511 382 140 141 283 512 382 140 141 537 541 382 140 141 538 542 382 140 141 539 543 382 140 141 284 513 382 140 141 285 514 382 140 141 286 515 382 140 141 287 516 382 140 141 288 517 382 140 141 289 518 382 140 141 290 519 51 140 141 291 520 51 140 141 292 521 51 140 141 293 522 51 140 141 294 524 51 140 591 571 295 525 51 140 591 571 296 526 51 140 141 297 527 51 140 141 298 528 51 140 141 299 529 51 140 141 300 530 51 140 141 301 531 51 140 141 302 532 51 140 141 303 533 51 140 534 304 110 51 140 535 10 11 12 18 139 138 139 138 52 51 140 141 53 51 140 141 74 51 140 141 54 51 140 141 75 51 140 141 55 51 140 141 556 51 140 141 56 51 140 141 57 51 140 141 58 51 140 141 76 51 140 141 59 51 140 141 60 51 140 141 61 51 140 141 62 51 140 141 63 51 140 141 64 51 140 141 65 51 140 141 77 51 140 141 66 51 140 141 67 51 140 141 78 140 141 68 140 141 79 51 140 141 80 51 140 141 69 51 140 141 81 51 140 141 70 51 140 141 82 51 140 141 71 51 140 141 72 51 140 141 72 51 140 141 73 51 140 141 83 557 140 593 598 84 51 140 593 598 85 51 140 593 598 86 51 140 593 598 87 51 140 593 598 555 51 140 141 88 557 593 598 21 22 139 138 139 138 113 51 140 141 114 51 140 141 115 51 140 141 13 139 138 139 138 110 382 140 141 111 112 14 139 138 139 138 101 382 140 141 102 382 140 141 103 382 140 141 104 382 140 141 105 382 140 141 106 382 140 141 107 382 140 141 108 382 140 141 109 382 140 141 15 5 16 558 51 140 593 598 559 51 140 593 598 560 51 140 593 598 561 564 140 593 598 562 564 140 593 598 563 564 140 593 598 5 17 89 422 90 91 92 93 94 95 374 140 594 598 96 97 98 5 523 595 599 600

6 9 99 139 138 139 138 146 118 51 140 145 147 141 119 51 140 145 147 141 120 51 140 145 147 141 121 51 140 145 147 141 117 51 140 577 147 141 572 5 122 51 140 577 147 141 572 123 51 140 578 147 141 596 124 51 140 578 147 141 596 125 51 140 578 147 141 596 126 51 140 578 147 141 596 127 51 140 578 147 141 596 5 128 51 140 578 147 141 596 129 51 140 443 147 141 596 130 51 140 579 147 141 596 131 51 142 141 147 141 132 51 142 141 147 141 133 51 142 141 147 141 134 51 142 141 147 141 135 51 142 141 147 141 136 51 142 141 147 141 137 51 142 141 147 141 19 139 138 139 138 23 51 140 141 147 141 24 51 140 141 147 141 143 144 140 141 147 141 25 51 140 141 147 141 26 51 140 141 147 141 27 51 140 141 147 141 28 51 140 141 147 141 29 51 140 141 147 141 30 51 140 141 147 141 31 148 140 580 147 141 32 51 140 580 147 141 33 51 140 141 147 141 34 51 140 141 147 141 35 51 140 141 147 141 36 51 140 141 147 141 37 51 140 141 147 141 38 51 140 141 147 141 39 51 140 141 147 141 20 139 138 139 138 40 41 42 43 51 140 581 573 44 45 51 140 581 573 46 47 51 140 582 574 48 49 51 140 582 574 446 544 444 140 453 545 444 140 454 546 444 140 455 547 444 140 456 548 444 140 447 549 444 140 448 550 444 140 449 551 444 140 450 552 444 140 451 553 444 140 452 554 444 140 149 50 444 140 445 5 100 139 138 139 138 323 148 140 583 573 325 148 140 583 573 326 148 140 583 573 327 148 140 583 573 328 148 140 583 573 324 148 140 332 573 329 148 140 330 575 331 148 140 333 575 159 334 51 140 141 575 160 335 51 140 141 575 161 336 51 140 141 575 337 51 140 141 575 338 51 140 141 575 339 51 140 141 575 340 51 140 141 575 341 51 140 141 575 342 51 140 141 575 343 51 140 141 575 344 51 140 141 575 345 51 140 141 575 346 51 140 141 575 347 51 140 141 575 348 51 140 141 575 162 349 51 140 141 575 163 350 51 140 141 575 164 351 51 140 141 575 156 565 51 140 584 573 157 352 51 140 585 573 158 353 51 140 585 573 165 354 51 140 141 575 166 355 51 140 141 575 167 357 51 140 141 575 168 356 51 140 141 575 169 358 51 140 141 575 170 359 51 140 141 575 171 360 51 140 457 576 172 361 51 140 141 575 601 324 51 140 141 575 311 362 51 140 141 575 305 308 51 140 586 573 173 363 51 140 141 575 309 310 51 140 141 575 312 364 51 140 141 575 313 365 51 140 141 575 314 366 51 140 141 575 306 307 51 140 586 573 315 367 51 140 586 573 174 368 51 140 141 175 369 51 140 587 573 176 177 51 140 587 573 178 370 51 140 587 573 179 371 51 140 587 573 180 372 51 140 587 573 181 373 51 140 141 182 375 382 140 588 573 376 382 140 588 573 377 382 140 588 573 378 382 140 588 573 379 382 140 588 573 380 382 140 588 573 381 382 140 588 573 381 51 140 141 183 383 51 140 141 184 384 51 140 141 185 385 51 140 141 186 386 51 140 141 387 331 51 140 589 573 187 388 51 140 588 573 188 389 51 140 588 573 189 390 51 140 588 573 190 391 51 140 141 191 392 374 140 141 192 393 51 140 141 193 394 382 140 141 194 395 51 140 141 195 396 374 140 141 196 397 374 140 141 197 398 374 140 141 198 399 374 140 141 199 400 374 140 141 200 401 374 140 141 201 402 374 140 141 202 403 374 140 141 203 404 374 140 141 204 405 374 140 141 205 406 51 140 141 206 407 51 140 141 207 408 51 140 141 208 409 51 140 141 209 410 51 140 141 210 411 51 140 141 211 412 51 140 141 212 413 51 140 141 213 414 51 140 141 214 415 51 140 141 215 416 51 140 141 216 417 51 140 141 217 418 51 140 419 147 420 597 320 421 51 140 590 566 567 150 113 51 140 141 321 114 382 140 590 147 141 567 322 115 51 140 590 566 567 151 435 51 140 141 152 436 51 140 141 424 429 51 140 141 425 430 51 140 141 426 431 51 140 440 568 439 438 51 140 440 568 427 432 51 140 141 153 428 51 140 141 154 434 51 140 141 155 437 51 140 141 423 433 51 140 441 218 442 51 140 441 219 458 51 140 441 220 459 51 140 441 221 460 51 140 441 222 461 51 140 441 223 462 51 140 441 224 463 51 140 441 225 464 51 140 441 226 465 51 140 441 227 466 51 140 441 316 467 51 140 441 317 468 51 140 441 318 469 51 140 441 319 470 51 140 441 228 471 51 140 441 229 472 51 140 441 230 473 51 140 441 536 540 51 140 441 231 474 51 140 441 232 475 51 140 441 233 476 51 140 441 234 477 51 140 441 235 478 51 140 591 5 569 236 479 51 140 141 237 480 51 140 141 238 101 51 140 141 239 102 51 140 141 240 103 51 140 141 241 104 51 140 141 242 105 51 140 141 243 106 51 140 141 244 107 51 140 141 245 108 51 140 141 246 109 51 140 141 247 481 382 140 141 248 482 382 140 141 249 483 382 140 141 250 484 382 140 141 251 485 382 140 141 252 486 382 140 141 253 487 382 140 141 254 89 382 140 141 255 488 382 140 141 256 90 382 140 141 257 489 382 140 141 258 92 382 140 141 259 490 382 140 141 260 491 382 140 141 261 492 382 140 141 262 493 382 140 141 263 494 382 140 141 264 495 382 140 141 265 496 382 140 141 266 498 497 570 267 499 382 140 141 268 500 382 140 141 269 501 382 140 141 270 502 382 140 141 271 503 382 140 141 272 504 382 140 141 273 505 382 140 141 274 96 382 140 141 275 97 382 140 141 276 506 382 140 141 277 98 382 140 141 278 507 51 140 592 569 279 508 51 140 592 569 280 509 382 140 141 281 510 382 140 141 282 511 382 140 141 283 512 382 140 141 537 541 382 140 141 538 542 382 140 141 539 543 382 140 141 284 513 382 140 141 285 514 382 140 141 286 515 382 140 141 287 516 382 140 141 288 517 382 140 141 289 518 382 140 141 290 519 51 140 141 291 520 51 140 141 292 521 51 140 141 293 522 51 140 141 294 524 51 140 591 571 295 525 51 140 591 571 296 526 51 140 141 297 527 51 140 141 298 528 51 140 141 299 529 51 140 141 300 530 51 140 141 301 531 51 140 141 302 532 51 140 141 303 533 51 140 534 304 110 51 140 535 10 11 12 18 139 138 139 138 52 51 140 141 53 51 140 141 74 51 140 141 54 51 140 141 75 51 140 141 55 51 140 141 556 51 140 141 56 51 140 141 57 51 140 141 58 51 140 141 76 51 140 141 59 51 140 141 60 51 140 141 61 51 140 141 62 51 140 141 63 51 140 141 64 51 140 141 65 51 140 141 77 51 140 141 66 51 140 141 67 51 140 141 78 140 141 68 140 141 79 51 140 141 80 51 140 141 69 51 140 141 81 51 140 141 70 51 140 141 82 51 140 141 71 51 140 141 72 51 140 141 72 51 140 141 73 51 140 141 83 557 140 593 598 84 51 140 593 598 85 51 140 593 598 86 51 140 593 598 87 51 140 593 598 555 51 140 141 88 557 593 598 21 22 139 138 139 138 113 51 140 141 114 51 140 141 115 51 140 141 13 139 138 139 138 110 382 140 141 111 112 14 139 138 139 138 101 382 140 141 102 382 140 141 103 382 140 141 104 382 140 141 105 382 140 141 106 382 140 141 107 382 140 141 108 382 140 141 109 382 140 141 15 5 16 558 51 140 593 598 559 51 140 593 598 560 51 140 593 598 561 564 140 593 598 562 564 140 593 598 563 564 140 593 598 5 17 89 422 90 91 92 93 94 95 374 140 594 598 96 97 98 5 523 595 599 600

6 9 99 139 138 139 138 146 118 51 140 145 147 141 119 51 140 145 147 141 120 51 140 145 147 141 121 51 140 145 147 141 117 51 140 577 147 141 572 5 122 51 140 577 147 141 572 123 51 140 578 147 141 596 124 51 140 578 147 141 596 125 51 140 578 147 141 596 126 51 140 578 147 141 596 127 51 140 578 147 141 596 5 128 51 140 578 147 141 596 129 51 140 443 147 141 596 130 51 140 579 147 141 596 131 51 142 141 147 141 132 51 142 141 147 141 133 51 142 141 147 141 134 51 142 141 147 141 135 51 142 141 147 141 136 51 142 141 147 141 137 51 142 141 147 141 19 139 138 139 138 23 51 140 141 147 141 24 51 140 141 147 141 143 144 140 141 147 141 25 51 140 141 147 141 26 51 140 141 147 141 27 51 140 141 147 141 28 51 140 141 147 141 29 51 140 141 147 141 30 51 140 141 147 141 31 148 140 580 147 141 32 51 140 580 147 141 33 51 140 141 147 141 34 51 140 141 147 141 35 51 140 141 147 141 36 51 140 141 147 141 37 51 140 141 147 141 38 51 140 141 147 141 39 51 140 141 147 141 20 139 138 139 138 40 41 42 43 51 140 581 573 44 45 51 140 581 573 46 47 51 140 582 574 48 49 51 140 582 574 446 544 444 140 453 545 444 140 454 546 444 140 455 547 444 140 456 548 444 140 447 549 444 140 448 550 444 140 449 551 444 140 450 552 444 140 451 553 444 140 452 554 444 140 149 50 444 140 445 5 100 139 138 139 138 323 148 140 583 573 325 148 140 583 573 326 148 140 583 573 327 148 140 583 573 328 148 140 583 573 324 148 140 332 573 329 148 140 330 575 331 148 140 333 575 159 334 51 140 141 575 160 335 51 140 141 575 161 336 51 140 141 575 337 51 140 141 575 338 51 140 141 575 339 51 140 141 575 340 51 140 141 575 341 51 140 141 575 342 51 140 141 575 343 51 140 141 575 344 51 140 141 575 345 51 140 141 575 346 51 140 141 575 347 51 140 141 575 348 51 140 141 575 162 349 51 140 141 575 163 350 51 140 141 575 164 351 51 140 141 575 156 565 51 140 584 573 157 352 51 140 585 573 158 353 51 140 585 573 165 354 51 140 141 575 166 355 51 140 141 575 167 357 51 140 141 575 168 356 51 140 141 575 169 358 51 140 141 575 170 359 51 140 141 575 171 360 51 140 457 576 172 361 51 140 141 575 601 324 51 140 141 575 311 362 51 140 141 575 305 308 51 140 586 573 173 363 51 140 141 575 309 310 51 140 141 575 312 364 51 140 141 575 313 365 51 140 141 575 314 366 51 140 141 575 306 307 51 140 586 573 315 367 51 140 586 573 174 368 51 140 141 175 369 51 140 587 573 176 177 51 140 587 573 178 370 51 140 587 573 179 371 51 140 587 573 180 372 51 140 587 573 181 373 51 140 141 182 375 382 140 588 573 376 382 140 588 573 377 382 140 588 573 378 382 140 588 573 379 382 140 588 573 380 382 140 588 573 381 382 140 588 573 381 51 140 141 183 383 51 140 141 184 384 51 140 141 185 385 51 140 141 186 386 51 140 141 387 331 51 140 589 573 187 388 51 140 588 573 188 389 51 140 588 573 189 390 51 140 588 573 190 391 51 140 141 191 392 374 140 141 192 393 51 140 141 193 394 382 140 141 194 395 51 140 141 195 396 374 140 141 196 397 374 140 141 197 398 374 140 141 198 399 374 140 141 199 400 374 140 141 200 401 374 140 141 201 402 374 140 141 202 403 374 140 141 203 404 374 140 141 204 405 374 140 141 205 406 51 140 141 206 407 51 140 141 207 408 51 140 141 208 409 51 140 141 209 410 51 140 141 210 411 51 140 141 211 412 51 140 141 212 413 51 140 141 213 414 51 140 141 214 415 51 140 141 215 416 51 140 141 216 417 51 140 141 217 418 51 140 419 147 420 597 320 421 51 140 590 566 567 150 113 51 140 141 321 114 382 140 590 147 141 567 322 115 51 140 590 566 567 151 435 51 140 141 152 436 51 140 141 424 429 51 140 141 425 430 51 140 141 426 431 51 140 440 568 439 438 51 140 440 568 427 432 51 140 141 153 428 51 140 141 154 434 51 140 141 155 437 51 140 141 423 433 51 140 441 218 442 51 140 441 219 458 51 140 441 220 459 51 140 441 221 460 51 140 441 222 461 51 140 441 223 462 51 140 441 224 463 51 140 441 225 464 51 140 441 226 465 51 140 441 227 466 51 140 441 316 467 51 140 441 317 468 51 140 441 318 469 51 140 441 319 470 51 140 441 228 471 51 140 441 229 472 51 140 441 230 473 51 140 441 536 540 51 140 441 231 474 51 140 441 232 475 51 140 441 233 476 51 140 441 234 477 51 140 441 235 478 51 140 591 5 569 236 479 51 140 141 237 480 51 140 141 238 101 51 140 141 239 102 51 140 141 240 103 51 140 141 241 104 51 140 141 242 105 51 140 141 243 106 51 140 141 244 107 51 140 141 245 108 51 140 141 246 109 51 140 141 247 481 382 140 141 248 482 382 140 141 249 483 382 140 141 250 484 382 140 141 251 485 382 140 141 252 486 382 140 141 253 487 382 140 141 254 89 382 140 141 255 488 382 140 141 256 90 382 140 141 257 489 382 140 141 258 92 382 140 141 259 490 382 140 141 260 491 382 140 141 261 492 382 140 141 262 493 382 140 141 263 494 382 140 141 264 495 382 140 141 265 496 382 140 141 266 498 497 570 267 499 382 140 141 268 500 382 140 141 269 501 382 140 141 270 502 382 140 141 271 503 382 140 141 272 504 382 140 141 273 505 382 140 141 274 96 382 140 141 275 97 382 140 141 276 506 382 140 141 277 98 382 140 141 278 507 51 140 592 569 279 508 51 140 592 569 280 509 382 140 141 281 510 382 140 141 282 511 382 140 141 283 512 382 140 141 537 541 382 140 141 538 542 382 140 141 539 543 382 140 141 284 513 382 140 141 285 514 382 140 141 286 515 382 140 141 287 516 382 140 141 288 517 382 140 141 289 518 382 140 141 290 519 51 140 141 291 520 51 140 141 292 521 51 140 141 293 522 51 140 141 294 524 51 140 591 571 295 525 51 140 591 571 296 526 51 140 141 297 527 51 140 141 298 528 51 140 141 299 529 51 140 141 300 530 51 140 141 301 531 51 140 141 302 532 51 140 141 303 533 51 140 534 304 110 51 140 535 10 11 12 18 139 138 139 138 52 51 140 141 53 51 140 141 74 51 140 141 54 51 140 141 75 51 140 141 55 51 140 141 556 51 140 141 56 51 140 141 57 51 140 141 58 51 140 141 76 51 140 141 59 51 140 141 60 51 140 141 61 51 140 141 62 51 140 141 63 51 140 141 64 51 140 141 65 51 140 141 77 51 140 141 66 51 140 141 67 51 140 141 78 140 141 68 140 141 79 51 140 141 80 51 140 141 69 51 140 141 81 51 140 141 70 51 140 141 82 51 140 141 71 51 140 141 72 51 140 141 72 51 140 141 73 51 140 141 83 557 140 593 598 84 51 140 593 598 85 51 140 593 598 86 51 140 593 598 87 51 140 593 598 555 51 140 141 88 557 593 598 21 22 139 138 139 138 113 51 140 141 114 51 140 141 115 51 140 141 13 139 138 139 138 110 382 140 141 111 112 14 139 138 139 138 101 382 140 141 102 382 140 141 103 382 140 141 104 382 140 141 105 382 140 141 106 382 140 141 107 382 140 141 108 382 140 141 109 382 140 141 15 5 16 558 51 140 593 598 559 51 140 593 598 560 51 140 593 598 561 564 140 593 598 562 564 140 593 598 563 564 140 593 598 5 17 89 422 90 91 92 93 94 95 374 140 594 598 96 97 98 5 523 595 599 600

6 9 99 139 138 139 138 146 118 51 140 145 147 141 119 51 140 145 147 141 120 51 140 145 147 141 121 51 140 145 147 141 117 51 140 577 147 141 572 5 122 51 140 577 147 141 572 123 51 140 578 147 141 596 124 51 140 578 147 141 596 125 51 140 578 147 141 596 126 51 140 578 147 141 596 127 51 140 578 147 141 596 5 128 51 140 578 147 141 596 129 51 140 443 147 141 596 130 51 140 579 147 141 596 131 51 142 141 147 141 132 51 142 141 147 141 133 51 142 141 147 141 134 51 142 141 147 141 135 51 142 141 147 141 136 51 142 141 147 141 137 51 142 141 147 141 19 139 138 139 138 23 51 140 141 147 141 24 51 140 141 147 141 143 144 140 141 147 141 25 51 140 141 147 141 26 51 140 141 147 141 27 51 140 141 147 141 28 51 140 141 147 141 29 51 140 141 147 141 30 51 140 141 147 141 31 148 140 580 147 141 32 51 140 580 147 141 33 51 140 141 147 141 34 51 140 141 147 141 35 51 140 141 147 141 36 51 140 141 147 141 37 51 140 141 147 141 38 51 140 141 147 141 39 51 140 141 147 141 20 139 138 139 138 40 41 42 43 51 140 581 573 44 45 51 140 581 573 46 47 51 140 582 574 48 49 51 140 582 574 446 544 444 140 453 545 444 140 454 546 444 140 455 547 444 140 456 548 444 140 447 549 444 140 448 550 444 140 449 551 444 140 450 552 444 140 451 553 444 140 452 554 444 140 149 50 444 140 445 5 100 139 138 139 138 323 148 140 583 573 325 148 140 583 573 326 148 140 583 573 327 148 140 583 573 328 148 140 583 573 324 148 140 332 573 329 148 140 330 575 331 148 140 333 575 159 334 51 140 141 575 160 335 51 140 141 575 161 336 51 140 141 575 337 51 140 141 575 338 51 140 141 575 339 51 140 141 575 340 51 140 141 575 341 51 140 141 575 342 51 140 141 575 343 51 140 141 575 344 51 140 141 575 345 51 140 141 575 346 51 140 141 575 347 51 140 141 575 348 51 140 141 575 162 349 51 140 141 575 163 350 51 140 141 575 164 351 51 140 141 575 156 565 51 140 584 573 157 352 51 140 585 573 158 353 51 140 585 573 165 354 51 140 141 575 166 355 51 140 141 575 167 357 51 140 141 575 168 356 51 140 141 575 169 358 51 140 141 575 170 359 51 140 141 575 171 360 51 140 457 576 172 361 51 140 141 575 601 324 51 140 141 575 311 362 51 140 141 575 305 308 51 140 586 573 173 363 51 140 141 575 309 310 51 140 141 575 312 364 51 140 141 575 313 365 51 140 141 575 314 366 51 140 141 575 306 307 51 140 586 573 315 367 51 140 586 573 174 368 51 140 141 175 369 51 140 587 573 176 177 51 140 587 573 178 370 51 140 587 573 179 371 51 140 587 573 180 372 51 140 587 573 181 373 51 140 141 182 375 382 140 588 573 376 382 140 588 573 377 382 140 588 573 378 382 140 588 573 379 382 140 588 573 380 382 140 588 573 381 382 140 588 573 381 51 140 141 183 383 51 140 141 184 384 51 140 141 185 385 51 140 141 186 386 51 140 141 387 331 51 140 589 573 187 388 51 140 588 573 188 389 51 140 588 573 189 390 51 140 588 573 190 391 51 140 141 191 392 374 140 141 192 393 51 140 141 193 394 382 140 141 194 395 51 140 141 195 396 374 140 141 196 397 374 140 141 197 398 374 140 141 198 399 374 140 141 199 400 374 140 141 200 401 374 140 141 201 402 374 140 141 202 403 374 140 141 203 404 374 140 141 204 405 374 140 141 205 406 51 140 141 206 407 51 140 141 207 408 51 140 141 208 409 51 140 141 209 410 51 140 141 210 411 51 140 141 211 412 51 140 141 212 413 51 140 141 213 414 51 140 141 214 415 51 140 141 215 416 51 140 141 216 417 51 140 141 217 418 51 140 419 147 420 597 320 421 51 140 590 566 567 150 113 51 140 141 321 114 382 140 590 147 141 567 322 115 51 140 590 566 567 151 435 51 140 141 152 436 51 140 141 424 429 51 140 141 425 430 51 140 141 426 431 51 140 440 568 439 438 51 140 440 568 427 432 51 140 141 153 428 51 140 141 154 434 51 140 141 155 437 51 140 141 423 433 51 140 441 218 442 51 140 441 219 458 51 140 441 220 459 51 140 441 221 460 51 140 441 222 461 51 140 441 223 462 51 140 441 224 463 51 140 441 225 464 51 140 441 226 465 51 140 441 227 466 51 140 441 316 467 51 140 441 317 468 51 140 441 318 469 51 140 441 319 470 51 140 441 228 471 51 140 441 229 472 51 140 441 230 473 51 140 441 536 540 51 140 441 231 474 51 140 441 232 475 51 140 441 233 476 51 140 441 234 477 51 140 441 235 478 51 140 591 5 569 236 479 51 140 141 237 480 51 140 141 238 101 51 140 141 239 102 51 140 141 240 103 51 140 141 241 104 51 140 141 242 105 51 140 141 243 106 51 140 141 244 107 51 140 141 245 108 51 140 141 246 109 51 140 141 247 481 382 140 141 248 482 382 140 141 249 483 382 140 141 250 484 382 140 141 251 485 382 140 141 252 486 382 140 141 253 487 382 140 141 254 89 382 140 141 255 488 382 140 141 256 90 382 140 141 257 489 382 140 141 258 92 382 140 141 259 490 382 140 141 260 491 382 140 141 261 492 382 140 141 262 493 382 140 141 263 494 382 140 141 264 495 382 140 141 265 496 382 140 141 266 498 497 570 267 499 382 140 141 268 500 382 140 141 269 501 382 140 141 270 502 382 140 141 271 503 382 140 141 272 504 382 140 141 273 505 382 140 141 274 96 382 140 141 275 97 382 140 141 276 506 382 140 141 277 98 382 140 141 278 507 51 140 592 569 279 508 51 140 592 569 280 509 382 140 141 281 510 382 140 141 282 511 382 140 141 283 512 382 140 141 537 541 382 140 141 538 542 382 140 141 539 543 382 140 141 284 513 382 140 141 285 514 382 140 141 286 515 382 140 141 287 516 382 140 141 288 517 382 140 141 289 518 382 140 141 290 519 51 140 141 291 520 51 140 141 292 521 51 140 141 293 522 51 140 141 294 524 51 140 591 571 295 525 51 140 591 571 296 526 51 140 141 297 527 51 140 141 298 528 51 140 141 299 529 51 140 141 300 530 51 140 141 301 531 51 140 141 302 532 51 140 141 303 533 51 140 534 304 110 51 140 535 10 11 12 18 139 138 139 138 52 51 140 141 53 51 140 141 74 51 140 141 54 51 140 141 75 51 140 141 55 51 140 141 556 51 140 141 56 51 140 141 57 51 140 141 58 51 140 141 76 51 140 141 59 51 140 141 60 51 140 141 61 51 140 141 62 51 140 141 63 51 140 141 64 51 140 141 65 51 140 141 77 51 140 141 66 51 140 141 67 51 140 141 78 140 141 68 140 141 79 51 140 141 80 51 140 141 69 51 140 141 81 51 140 141 70 51 140 141 82 51 140 141 71 51 140 141 72 51 140 141 72 51 140 141 73 51 140 141 83 557 140 593 598 84 51 140 593 598 85 51 140 593 598 86 51 140 593 598 87 51 140 593 598 555 51 140 141 88 557 593 598 21 22 139 138 139 138 113 51 140 141 114 51 140 141 115 51 140 141 13 139 138 139 138 110 382 140 141 111 112 14 139 138 139 138 101 382 140 141 102 382 140 141 103 382 140 141 104 382 140 141 105 382 140 141 106 382 140 141 107 382 140 141 108 382 140 141 109 382 140 141 15 5 16 558 51 140 593 598 559 51 140 593 598 560 51 140 593 598 561 564 140 593 598 562 564 140 593 598 563 564 140 593 598 5 17 89 422 90 91 92 93 94 95 374 140 594 598 96 97 98 5 523 595 599 600

6 9 99 139 138 139 138 146 118 51 140 145 147 141 119 51 140 145 147 141 120 51 140 145 147 141 121 51 140 145 147 141 117 51 140 577 147 141 572 5 122 51 140 577 147 141 572 123 51 140 578 147 141 596 124 51 140 578 147 141 596 125 51 140 578 147 141 596 126 51 140 578 147 141 596 127 51 140 578 147 141 596 5 128 51 140 578 147 141 596 129 51 140 443 147 141 596 130 51 140 579 147 141 596 131 51 142 141 147 141 132 51 142 141 147 141 133 51 142 141 147 141 134 51 142 141 147 141 135 51 142 141 147 141 136 51 142 141 147 141 137 51 142 141 147 141 19 139 138 139 138 23 51 140 141 147 141 24 51 140 141 147 141 143 144 140 141 147 141 25 51 140 141 147 141 26 51 140 141 147 141 27 51 140 141 147 141 28 51 140 141 147 141 29 51 140 141 147 141 30 51 140 141 147 141 31 148 140 580 147 141 32 51 140 580 147 141 33 51 140 141 147 141 34 51 140 141 147 141 35 51 140 141 147 141 36 51 140 141 147 141 37 51 140 141 147 141 38 51 140 141 147 141 39 51 140 141 147 141 20 139 138 139 138 40 41 42 43 51 140 581 573 44 45 51 140 581 573 46 47 51 140 582 574 48 49 51 140 582 574 446 544 444 140 453 545 444 140 454 546 444 140 455 547 444 140 456 548 444 140 447 549 444 140 448 550 444 140 449 551 444 140 450 552 444 140 451 553 444 140 452 554 444 140 149 50 444 140 445 5 100 139 138 139 138 323 148 140 583 573 325 148 140 583 573 326 148 140 583 573 327 148 140 583 573 328 148 140 583 573 324 148 140 332 573 329 148 140 330 575 331 148 140 333 575 159 334 51 140 141 575 160 335 51 140 141 575 161 336 51 140 141 575 337 51 140 141 575 338 51 140 141 575 339 51 140 141 575 340 51 140 141 575 341 51 140 141 575 342 51 140 141 575 343 51 140 141 575 344 51 140 141 575 345 51 140 141 575 346 51 140 141 575 347 51 140 141 575 348 51 140 141 575 162 349 51 140 141 575 163 350 51 140 141 575 164 351 51 140 141 575 156 565 51 140 584 573 157 352 51 140 585 573 158 353 51 140 585 573 165 354 51 140 141 575 166 355 51 140 141 575 167 357 51 140 141 575 168 356 51 140 141 575 169 358 51 140 141 575 170 359 51 140 141 575 171 360 51 140 457 576 172 361 51 140 141 575 601 324 51 140 141 575 311 362 51 140 141 575 305 308 51 140 586 573 173 363 51 140 141 575 309 310 51 140 141 575 312 364 51 140 141 575 313 365 51 140 141 575 314 366 51 140 141 575 306 307 51 140 586 573 315 367 51 140 586 573 174 368 51 140 141 175 369 51 140 587 573 176 177 51 140 587 573 178 370 51 140 587 573 179 371 51 140 587 573 180 372 51 140 587 573 181 373 51 140 141 182 375 382 140 588 573 376 382 140 588 573 377 382 140 588 573 378 382 140 588 573 379 382 140 588 573 380 382 140 588 573 381 382 140 588 573 381 51 140 141 183 383 51 140 141 184 384 51 140 141 185 385 51 140 141 186 386 51 140 141 387 331 51 140 589 573 187 388 51 140 588 573 188 389 51 140 588 573 189 390 51 140 588 573 190 391 51 140 141 191 392 374 140 141 192 393 51 140 141 193 394 382 140 141 194 395 51 140 141 195 396 374 140 141 196 397 374 140 141 197 398 374 140 141 198 399 374 140 141 199 400 374 140 141 200 401 374 140 141 201 402 374 140 141 202 403 374 140 141 203 404 374 140 141 204 405 374 140 141 205 406 51 140 141 206 407 51 140 141 207 408 51 140 141 208 409 51 140 141 209 410 51 140 141 210 411 51 140 141 211 412 51 140 141 212 413 51 140 141 213 414 51 140 141 214 415 51 140 141 215 416 51 140 141 216 417 51 140 141 217 418 51 140 419 147 420 597 320 421 51 140 590 566 567 150 113 51 140 141 321 114 382 140 590 147 141 567 322 115 51 140 590 566 567 151 435 51 140 141 152 436 51 140 141 424 429 51 140 141 425 430 51 140 141 426 431 51 140 440 568 439 438 51 140 440 568 427 432 51 140 141 153 428 51 140 141 154 434 51 140 141 155 437 51 140 141 423 433 51 140 441 218 442 51 140 441 219 458 51 140 441 220 459 51 140 441 221 460 51 140 441 222 461 51 140 441 223 462 51 140 441 224 463 51 140 441 225 464 51 140 441 226 465 51 140 441 227 466 51 140 441 316 467 51 140 441 317 468 51 140 441 318 469 51 140 441 319 470 51 140 441 228 471 51 140 441 229 472 51 140 441 230 473 51 140 441 536 540 51 140 441 231 474 51 140 441 232 475 51 140 441 233 476 51 140 441 234 477 51 140 441 235 478 51 140 591 5 569 236 479 51 140 141 237 480 51 140 141 238 101 51 140 141 239 102 51 140 141 240 103 51 140 141 241 104 51 140 141 242 105 51 140 141 243 106 51 140 141 244 107 51 140 141 245 108 51 140 141 246 109 51 140 141 247 481 382 140 141 248 482 382 140 141 249 483 382 140 141 250 484 382 140 141 251 485 382 140 141 252 486 382 140 141 253 487 382 140 141 254 89 382 140 141 255 488 382 140 141 256 90 382 140 141 257 489 382 140 141 258 92 382 140 141 259 490 382 140 141 260 491 382 140 141 261 492 382 140 141 262 493 382 140 141 263 494 382 140 141 264 495 382 140 141 265 496 382 140 141 266 498 497 570 267 499 382 140 141 268 500 382 140 141 269 501 382 140 141 270 502 382 140 141 271 503 382 140 141 272 504 382 140 141 273 505 382 140 141 274 96 382 140 141 275 97 382 140 141 276 506 382 140 141 277 98 382 140 141 278 507 51 140 592 569 279 508 51 140 592 569 280 509 382 140 141 281 510 382 140 141 282 511 382 140 141 283 512 382 140 141 537 541 382 140 141 538 542 382 140 141 539 543 382 140 141 284 513 382 140 141 285 514 382 140 141 286 515 382 140 141 287 516 382 140 141 288 517 382 140 141 289 518 382 140 141 290 519 51 140 141 291 520 51 140 141 292 521 51 140 141 293 522 51 140 141 294 524 51 140 591 571 295 525 51 140 591 571 296 526 51 140 141 297 527 51 140 141 298 528 51 140 141 299 529 51 140 141 300 530 51 140 141 301 531 51 140 141 302 532 51 140 141 303 533 51 140 534 304 110 51 140 535 10 11 12 18 139 138 139 138 52 51 140 141 53 51 140 141 74 51 140 141 54 51 140 141 75 51 140 141 55 51 140 141 556 51 140 141 56 51 140 141 57 51 140 141 58 51 140 141 76 51 140 141 59 51 140 141 60 51 140 141 61 51 140 141 62 51 140 141 63 51 140 141 64 51 140 141 65 51 140 141 77 51 140 141 66 51 140 141 67 51 140 141 78 140 141 68 140 141 79 51 140 141 80 51 140 141 69 51 140 141 81 51 140 141 70 51 140 141 82 51 140 141 71 51 140 141 72 51 140 141 72 51 140 141 73 51 140 141 83 557 140 593 598 84 51 140 593 598 85 51 140 593 598 86 51 140 593 598 87 51 140 593 598 555 51 140 141 88 557 593 598 21 22 139 138 139 138 113 51 140 141 114 51 140 141 115 51 140 141 13 139 138 139 138 110 382 140 141 111 112 14 139 138 139 138 101 382 140 141 102 382 140 141 103 382 140 141 104 382 140 141 105 382 140 141 106 382 140 141 107 382 140 141 108 382 140 141 109 382 140 141 15 5 16 558 51 140 593 598 559 51 140 593 598 560 51 140 593 598 561 564 140 593 598 562 564 140 593 598 563 564 140 593 598 5 17 89 422 90 91 92 93 94 95 374 140 594 598 96 97 98 5 523 595 599 600

6 9 99 139 138 139 138 146 118 51 140 145 147 141 119 51 140 145 147 141 120 51 140 145 147 141 121 51 140 145 147 141 117 51 140 577 147 141 572 5 122 51 140 577 147 141 572 123 51 140 578 147 141 596 124 51 140 578 147 141 596 125 51 140 578 147 141 596 126 51 140 578 147 141 596 127 51 140 578 147 141 596 5 128 51 140 578 147 141 596 129 51 140 443 147 141 596 130 51 140 579 147 141 596 131 51 142 141 147 141 132 51 142 141 147 141 133 51 142 141 147 141 134 51 142 141 147 141 135 51 142 141 147 141 136 51 142 141 147 141 137 51 142 141 147 141 19 139 138 139 138 23 51 140 141 147 141 24 51 140 141 147 141 143 144 140 141 147 141 25 51 140 141 147 141 26 51 140 141 147 141 27 51 140 141 147 141 28 51 140 141 147 141 29 51 140 141 147 141 30 51 140 141 147 141 31 148 140 580 147 141 32 51 140 580 147 141 33 51 140 141 147 141 34 51 140 141 147 141 35 51 140 141 147 141 36 51 140 141 147 141 37 51 140 141 147 141 38 51 140 141 147 141 39 51 140 141 147 141 20 139 138 139 138 40 41 42 43 51 140 581 573 44 45 51 140 581 573 46 47 51 140 582 574 48 49 51 140 582 574 446 544 444 140 453 545 444 140 454 546 444 140 455 547 444 140 456 548 444 140 447 549 444 140 448 550 444 140 449 551 444 140 450 552 444 140 451 553 444 140 452 554 444 140 149 50 444 140 445 5 100 139 138 139 138 323 148 140 583 573 325 148 140 583 573 326 148 140 583 573 327 148 140 583 573 328 148 140 583 573 324 148 140 332 573 329 148 140 330 575 331 148 140 333 575 159 334 51 140 141 575 160 335 51 140 141 575 161 336 51 140 141 575 337 51 140 141 575 338 51 140 141 575 339 51 140 141 575 340 51 140 141 575 341 51 140 141 575 342 51 140 141 575 343 51 140 141 575 344 51 140 141 575 345 51 140 141 575 346 51 140 141 575 347 51 140 141 575 348 51 140 141 575 162 349 51 140 141 575 163 350 51 140 141 575 164 351 51 140 141 575 156 565 51 140 584 573 157 352 51 140 585 573 158 353 51 140 585 573 165 354 51 140 141 575 166 355 51 140 141 575 167 357 51 140 141 575 168 356 51 140 141 575 169 358 51 140 141 575 170 359 51 140 141 575 171 360 51 140 457 576 172 361 51 140 141 575 601 324 51 140 141 575 311 362 51 140 141 575 305 308 51 140 586 573 173 363 51 140 141 575 309 310 51 140 141 575 312 364 51 140 141 575 313 365 51 140 141 575 314 366 51 140 141 575 306 307 51 140 586 573 315 367 51 140 586 573 174 368 51 140 141 175 369 51 140 587 573 176 177 51 140 587 573 178 370 51 140 587 573 179 371 51 140 587 573 180 372 51 140 587 573 181 373 51 140 141 182 375 382 140 588 573 376 382 140 588 573 377 382 140 588 573 378 382 140 588 573 379 382 140 588 573 380 382 140 588 573 381 382 140 588 573 381 51 140 141 183 383 51 140 141 184 384 51 140 141 185 385 51 140 141 186 386 51 140 141 387 331 51 140 589 573 187 388 51 140 588 573 188 389 51 140 588 573 189 390 51 140 588 573 190 391 51 140 141 191 392 374 140 141 192 393 51 140 141 193 394 382 140 141 194 395 51 140 141 195 396 374 140 141 196 397 374 140 141 197 398 374 140 141 198 399 374 140 141 199 400 374 140 141 200 401 374 140 141 201 402 374 140 141 202 403 374 140 141 203 404 374 140 141 204 405 374 140 141 205 406 51 140 141 206 407 51 140 141 207 408 51 140 141 208 409 51 140 141 209 410 51 140 141 210 411 51 140 141 211 412 51 140 141 212 413 51 140 141 213 414 51 140 141 214 415 51 140 141 215 416 51 140 141 216 417 51 140 141 217 418 51 140 419 147 420 597 320 421 51 140 590 566 567 150 113 51 140 141 321 114 382 140 590 147 141 567 322 115 51 140 590 566 567 151 435 51 140 141 152 436 51 140 141 424 429 51 140 141 425 430 51 140 141 426 431 51 140 440 568 439 438 51 140 440 568 427 432 51 140 141 153 428 51 140 141 154 434 51 140 141 155 437 51 140 141 423 433 51 140 441 218 442 51 140 441 219 458 51 140 441 220 459 51 140 441 221 460 51 140 441 222 461 51 140 441 223 462 51 140 441 224 463 51 140 441 225 464 51 140 441 226 465 51 140 441 227 466 51 140 441 316 467 51 140 441 317 468 51 140 441 318 469 51 140 441 319 470 51 140 441 228 471 51 140 441 229 472 51 140 441 230 473 51 140 441 536 540 51 140 441 231 474 51 140 441 232 475 51 140 441 233 476 51 140 441 234 477 51 140 441 235 478 51 140 591 5 569 236 479 51 140 141 237 480 51 140 141 238 101 51 140 141 239 102 51 140 141 240 103 51 140 141 241 104 51 140 141 242 105 51 140 141 243 106 51 140 141 244 107 51 140 141 245 108 51 140 141 246 109 51 140 141 247 481 382 140 141 248 482 382 140 141 249 483 382 140 141 250 484 382 140 141 251 485 382 140 141 252 486 382 140 141 253 487 382 140 141 254 89 382 140 141 255 488 382 140 141 256 90 382 140 141 257 489 382 140 141 258 92 382 140 141 259 490 382 140 141 260 491 382 140 141 261 492 382 140 141 262 493 382 140 141 263 494 382 140 141 264 495 382 140 141 265 496 382 140 141 266 498 497 570 267 499 382 140 141 268 500 382 140 141 269 501 382 140 141 270 502 382 140 141 271 503 382 140 141 272 504 382 140 141 273 505 382 140 141 274 96 382 140 141 275 97 382 140 141 276 506 382 140 141 277 98 382 140 141 278 507 51 140 592 569 279 508 51 140 592 569 280 509 382 140 141 281 510 382 140 141 282 511 382 140 141 283 512 382 140 141 537 541 382 140 141 538 542 382 140 141 539 543 382 140 141 284 513 382 140 141 285 514 382 140 141 286 515 382 140 141 287 516 382 140 141 288 517 382 140 141 289 518 382 140 141 290 519 51 140 141 291 520 51 140 141 292 521 51 140 141 293 522 51 140 141 294 524 51 140 591 571 295 525 51 140 591 571 296 526 51 140 141 297 527 51 140 141 298 528 51 140 141 299 529 51 140 141 300 530 51 140 141 301 531 51 140 141 302 532 51 140 141 303 533 51 140 534 304 110 51 140 535 10 11 12 18 139 138 139 138 52 51 140 141 53 51 140 141 74 51 140 141 54 51 140 141 75 51 140 141 55 51 140 141 556 51 140 141 56 51 140 141 57 51 140 141 58 51 140 141 76 51 140 141 59 51 140 141 60 51 140 141 61 51 140 141 62 51 140 141 63 51 140 141 64 51 140 141 65 51 140 141 77 51 140 141 66 51 140 141 67 51 140 141 78 140 141 68 140 141 79 51 140 141 80 51 140 141 69 51 140 141 81 51 140 141 70 51 140 141 82 51 140 141 71 51 140 141 72 51 140 141 72 51 140 141 73 51 140 141 83 557 140 593 598 84 51 140 593 598 85 51 140 593 598 86 51 140 593 598 87 51 140 593 598 555 51 140 141 88 557 593 598 21 22 139 138 139 138 113 51 140 141 114 51 140 141 115 51 140 141 13 139 138 139 138 110 382 140 141 111 112 14 139 138 139 138 101 382 140 141 102 382 140 141 103 382 140 141 104 382 140 141 105 382 140 141 106 382 140 141 107 382 140 141 108 382 140 141 109 382 140 141 15 5 16 558 51 140 593 598 559 51 140 593 598 560 51 140 593 598 561 564 140 593 598 562 564 140 593 598 563 564 140 593 598 5 17 89 422 90 91 92 93 94 95 374 140 594 598 96 97 98 5 523 595 599 600

6 9 99 139 138 139 138 146 118 51 140 145 147 141 119 51 140 145 147 141 120 51 140 145 147 141 121 51 140 145 147 141 117 51 140 577 147 141 572 5 122 51 140 577 147 141 572 123 51 140 578 147 141 596 124 51 140 578 147 141 596 125 51 140 578 147 141 596 126 51 140 578 147 141 596 127 51 140 578 147 141 596 5 128 51 140 578 147 141 596 129 51 140 443 147 141 596 130 51 140 579 147 141 596 131 51 142 141 147 141 132 51 142 141 147 141 133 51 142 141 147 141 134 51 142 141 147 141 135 51 142 141 147 141 136 51 142 141 147 141 137 51 142 141 147 141 19 139 138 139 138 23 51 140 141 147 141 24 51 140 141 147 141 143 144 140 141 147 141 25 51 140 141 147 141 26 51 140 141 147 141 27 51 140 141 147 141 28 51 140 141 147 141 29 51 140 141 147 141 30 51 140 141 147 141 31 148 140 580 147 141 32 51 140 580 147 141 33 51 140 141 147 141 34 51 140 141 147 141 35 51 140 141 147 141 36 51 140 141 147 141 37 51 140 141 147 141 38 51 140 141 147 141 39 51 140 141 147 141 20 139 138 139 138 40 41 42 43 51 140 581 573 44 45 51 140 581 573 46 47 51 140 582 574 48 49 51 140 582 574 446 544 444 140 453 545 444 140 454 546 444 140 455 547 444 140 456 548 444 140 447 549 444 140 448 550 444 140 449 551 444 140 450 552 444 140 451 553 444 140 452 554 444 140 149 50 444 140 445 5 100 139 138 139 138 323 148 140 583 573 325 148 140 583 573 326 148 140 583 573 327 148 140 583 573 328 148 140 583 573 324 148 140 332 573 329 148 140 330 575 331 148 140 333 575 159 334 51 140 141 575 160 335 51 140 141 575 161 336 51 140 141 575 337 51 140 141 575 338 51 140 141 575 339 51 140 141 575 340 51 140 141 575 341 51 140 141 575 342 51 140 141 575 343 51 140 141 575 344 51 140 141 575 345 51 140 141 575 346 51 140 141 575 347 51 140 141 575 348 51 140 141 575 162 349 51 140 141 575 163 350 51 140 141 575 164 351 51 140 141 575 156 565 51 140 584 573 157 352 51 140 585 573 158 353 51 140 585 573 165 354 51 140 141 575 166 355 51 140 141 575 167 357 51 140 141 575 168 356 51 140 141 575 169 358 51 140 141 575 170 359 51 140 141 575 171 360 51 140 457 576 172 361 51 140 141 575 601 324 51 140 141 575 311 362 51 140 141 575 305 308 51 140 586 573 173 363 51 140 141 575 309 310 51 140 141 575 312 364 51 140 141 575 313 365 51 140 141 575 314 366 51 140 141 575 306 307 51 140 586 573 315 367 51 140 586 573 174 368 51 140 141 175 369 51 140 587 573 176 177 51 140 587 573 178 370 51 140 587 573 179 371 51 140 587 573 180 372 51 140 587 573 181 373 51 140 141 182 375 382 140 588 573 376 382 140 588 573 377 382 140 588 573 378 382 140 588 573 379 382 140 588 573 380 382 140 588 573 381 382 140 588 573 381 51 140 141 183 383 51 140 141 184 384 51 140 141 185 385 51 140 141 186 386 51 140 141 387 331 51 140 589 573 187 388 51 140 588 573 188 389 51 140 588 573 189 390 51 140 588 573 190 391 51 140 141 191 392 374 140 141 192 393 51 140 141 193 394 382 140 141 194 395 51 140 141 195 396 374 140 141 196 397 374 140 141 197 398 374 140 141 198 399 374 140 141 199 400 374 140 141 200 401 374 140 141 201 402 374 140 141 202 403 374 140 141 203 404 374 140 141 204 405 374 140 141 205 406 51 140 141 206 407 51 140 141 207 408 51 140 141 208 409 51 140 141 209 410 51 140 141 210 411 51 140 141 211 412 51 140 141 212 413 51 140 141 213 414 51 140 141 214 415 51 140 141 215 416 51 140 141 216 417 51 140 141 217 418 51 140 419 147 420 597 320 421 51 140 590 566 567 150 113 51 140 141 321 114 382 140 590 147 141 567 322 115 51 140 590 566 567 151 435 51 140 141 152 436 51 140 141 424 429 51 140 141 425 430 51 140 141 426 431 51 140 440 568 439 438 51 140 440 568 427 432 51 140 141 153 428 51 140 141 154 434 51 140 141 155 437 51 140 141 423 433 51 140 441 218 442 51 140 441 219 458 51 140 441 220 459 51 140 441 221 460 51 140 441 222 461 51 140 441 223 462 51 140 441 224 463 51 140 441 225 464 51 140 441 226 465 51 140 441 227 466 51 140 441 316 467 51 140 441 317 468 51 140 441 318 469 51 140 441 319 470 51 140 441 228 471 51 140 441 229 472 51 140 441 230 473 51 140 441 536 540 51 140 441 231 474 51 140 441 232 475 51 140 441 233 476 51 140 441 234 477 51 140 441 235 478 51 140 591 5 569 236 479 51 140 141 237 480 51 140 141 238 101 51 140 141 239 102 51 140 141 240 103 51 140 141 241 104 51 140 141 242 105 51 140 141 243 106 51 140 141 244 107 51 140 141 245 108 51 140 141 246 109 51 140 141 247 481 382 140 141 248 482 382 140 141 249 483 382 140 141 250 484 382 140 141 251 485 382 140 141 252 486 382 140 141 253 487 382 140 141 254 89 382 140 141 255 488 382 140 141 256 90 382 140 141 257 489 382 140 141 258 92 382 140 141 259 490 382 140 141 260 491 382 140 141 261 492 382 140 141 262 493 382 140 141 263 494 382 140 141 264 495 382 140 141 265 496 382 140 141 266 498 497 570 267 499 382 140 141 268 500 382 140 141 269 501 382 140 141 270 502 382 140 141 271 503 382 140 141 272 504 382 140 141 273 505 382 140 141 274 96 382 140 141 275 97 382 140 141 276 506 382 140 141 277 98 382 140 141 278 507 51 140 592 569 279 508 51 140 592 569 280 509 382 140 141 281 510 382 140 141 282 511 382 140 141 283 512 382 140 141 537 541 382 140 141 538 542 382 140 141 539 543 382 140 141 284 513 382 140 141 285 514 382 140 141 286 515 382 140 141 287 516 382 140 141 288 517 382 140 141 289 518 382 140 141 290 519 51 140 141 291 520 51 140 141 292 521 51 140 141 293 522 51 140 141 294 524 51 140 591 571 295 525 51 140 591 571 296 526 51 140 141 297 527 51 140 141 298 528 51 140 141 299 529 51 140 141 300 530 51 140 141 301 531 51 140 141 302 532 51 140 141 303 533 51 140 534 304 110 51 140 535 10 11 12 18 139 138 139 138 52 51 140 141 53 51 140 141 74 51 140 141 54 51 140 141 75 51 140 141 55 51 140 141 556 51 140 141 56 51 140 141 57 51 140 141 58 51 140 141 76 51 140 141 59 51 140 141 60 51 140 141 61 51 140 141 62 51 140 141 63 51 140 141 64 51 140 141 65 51 140 141 77 51 140 141 66 51 140 141 67 51 140 141 78 140 141 68 140 141 79 51 140 141 80 51 140 141 69 51 140 141 81 51 140 141 70 51 140 141 82 51 140 141 71 51 140 141 72 51 140 141 72 51 140 141 73 51 140 141 83 557 140 593 598 84 51 140 593 598 85 51 140 593 598 86 51 140 593 598 87 51 140 593 598 555 51 140 141 88 557 593 598 21 22 139 138 139 138 113 51 140 141 114 51 140 141 115 51 140 141 13 139 138 139 138 110 382 140 141 111 112 14 139 138 139 138 101 382 140 141 102 382 140 141 103 382 140 141 104 382 140 141 105 382 140 141 106 382 140 141 107 382 140 141 108 382 140 141 109 382 140 141 15 5 16 558 51 140 593 598 559 51 140 593 598 560 51 140 593 598 561 564 140 593 598 562 564 140 593 598 563 564 140 593 598 5 17 89 422 90 91 92 93 94 95 374 140 594 598 96 97 98 5 523 595 599 600

6 9 99 139 138 139 138 146 118 51 140 145 147 141 119 51 140 145 147 141 120 51 140 145 147 141 121 51 140 145 147 141 117 51 140 577 147 141 572 5 122 51 140 577 147 141 572 123 51 140 578 147 141 596 124 51 140 578 147 141 596 125 51 140 578 147 141 596 126 51 140 578 147 141 596 127 51 140 578 147 141 596 5 128 51 140 578 147 141 596 129 51 140 443 147 141 596 130 51 140 579 147 141 596 131 51 142 141 147 141 132 51 142 141 147 141 133 51 142 141 147 141 134 51 142 141 147 141 135 51 142 141 147 141 136 51 142 141 147 141 137 51 142 141 147 141 19 139 138 139 138 23 51 140 141 147 141 24 51 140 141 147 141 143 144 140 141 147 141 25 51 140 141 147 141 26 51 140 141 147 141 27 51 140 141 147 141 28 51 140 141 147 141 29 51 140 141 147 141 30 51 140 141 147 141 31 148 140 580 147 141 32 51 140 580 147 141 33 51 140 141 147 141 34 51 140 141 147 141 35 51 140 141 147 141 36 51 140 141 147 141 37 51 140 141 147 141 38 51 140 141 147 141 39 51 140 141 147 141 20 139 138 139 138 40 41 42 43 51 140 581 573 44 45 51 140 581 573 46 47 51 140 582 574 48 49 51 140 582 574 446 544 444 140 453 545 444 140 454 546 444 140 455 547 444 140 456 548 444 140 447 549 444 140 448 550 444 140 449 551 444 140 450 552 444 140 451 553 444 140 452 554 444 140 149 50 444 140 445 5 100 139 138 139 138 323 148 140 583 573 325 148 140 583 573 326 148 140 583 573 327 148 140 583 573 328 148 140 583 573 324 148 140 332 573 329 148 140 330 575 331 148 140 333 575 159 334 51 140 141 575 160 335 51 140 141 575 161 336 51 140 141 575 337 51 140 141 575 338 51 140 141 575 339 51 140 141 575 340 51 140 141 575 341 51 140 141 575 342 51 140 141 575 343 51 140 141 575 344 51 140 141 575 345 51 140 141 575 346 51 140 141 575 347 51 140 141 575 348 51 140 141 575 162 349 51 140 141 575 163 350 51 140 141 575 164 351 51 140 141 575 156 565 51 140 584 573 157 352 51 140 585 573 158 353 51 140 585 573 165 354 51 140 141 575 166 355 51 140 141 575 167 357 51 140 141 575 168 356 51 140 141 575 169 358 51 140 141 575 170 359 51 140 141 575 171 360 51 140 457 576 172 361 51 140 141 575 601 324 51 140 141 575 311 362 51 140 141 575 305 308 51 140 586 573 173 363 51 140 141 575 309 310 51 140 141 575 312 364 51 140 141 575 313 365 51 140 141 575 314 366 51 140 141 575 306 307 51 140 586 573 315 367 51 140 586 573 174 368 51 140 141 175 369 51 140 587 573 176 177 51 140 587 573 178 370 51 140 587 573 179 371 51 140 587 573 180 372 51 140 587 573 181 373 51 140 141 182 375 382 140 588 573 376 382 140 588 573 377 382 140 588 573 378 382 140 588 573 379 382 140 588 573 380 382 140 588 573 381 382 140 588 573 381 51 140 141 183 383 51 140 141 184 384 51 140 141 185 385 51 140 141 186 386 51 140 141 387 331 51 140 589 573 187 388 51 140 588 573 188 389 51 140 588 573 189 390 51 140 588 573 190 391 51 140 141 191 392 374 140 141 192 393 51 140 141 193 394 382 140 141 194 395 51 140 141 195 396 374 140 141 196 397 374 140 141 197 398 374 140 141 198 399 374 140 141 199 400 374 140 141 200 401 374 140 141 201 402 374 140 141 202 403 374 140 141 203 404 374 140 141 204 405 374 140 141 205 406 51 140 141 206 407 51 140 141 207 408 51 140 141 208 409 51 140 141 209 410 51 140 141 210 411 51 140 141 211 412 51 140 141 212 413 51 140 141 213 414 51 140 141 214 415 51 140 141 215 416 51 140 141 216 417 51 140 141 217 418 51 140 419 147 420 597 320 421 51 140 590 566 567 150 113 51 140 141 321 114 382 140 590 147 141 567 322 115 51 140 590 566 567 151 435 51 140 141 152 436 51 140 141 424 429 51 140 141 425 430 51 140 141 426 431 51 140 440 568 439 438 51 140 440 568 427 432 51 140 141 153 428 51 140 141 154 434 51 140 141 155 437 51 140 141 423 433 51 140 441 218 442 51 140 441 219 458 51 140 441 220 459 51 140 441 221 460 51 140 441 222 461 51 140 441 223 462 51 140 441 224 463 51 140 441 225 464 51 140 441 226 465 51 140 441 227 466 51 140 441 316 467 51 140 441 317 468 51 140 441 318 469 51 140 441 319 470 51 140 441 228 471 51 140 441 229 472 51 140 441 230 473 51 140 441 536 540 51 140 441 231 474 51 140 441 232 475 51 140 441 233 476 51 140 441 234 477 51 140 441 235 478 51 140 591 5 569 236 479 51 140 141 237 480 51 140 141 238 101 51 140 141 239 102 51 140 141 240 103 51 140 141 241 104 51 140 141 242 105 51 140 141 243 106 51 140 141 244 107 51 140 141 245 108 51 140 141 246 109 51 140 141 247 481 382 140 141 248 482 382 140 141 249 483 382 140 141 250 484 382 140 141 251 485 382 140 141 252 486 382 140 141 253 487 382 140 141 254 89 382 140 141 255 488 382 140 141 256 90 382 140 141 257 489 382 140 141 258 92 382 140 141 259 490 382 140 141 260 491 382 140 141 261 492 382 140 141 262 493 382 140 141 263 494 382 140 141 264 495 382 140 141 265 496 382 140 141 266 498 497 570 267 499 382 140 141 268 500 382 140 141 269 501 382 140 141 270 502 382 140 141 271 503 382 140 141 272 504 382 140 141 273 505 382 140 141 274 96 382 140 141 275 97 382 140 141 276 506 382 140 141 277 98 382 140 141 278 507 51 140 592 569 279 508 51 140 592 569 280 509 382 140 141 281 510 382 140 141 282 511 382 140 141 283 512 382 140 141 537 541 382 140 141 538 542 382 140 141 539 543 382 140 141 284 513 382 140 141 285 514 382 140 141 286 515 382 140 141 287 516 382 140 141 288 517 382 140 141 289 518 382 140 141 290 519 51 140 141 291 520 51 140 141 292 521 51 140 141 293 522 51 140 141 294 524 51 140 591 571 295 525 51 140 591 571 296 526 51 140 141 297 527 51 140 141 298 528 51 140 141 299 529 51 140 141 300 530 51 140 141 301 531 51 140 141 302 532 51 140 141 303 533 51 140 534 304 110 51 140 535 10 11 12 18 139 138 139 138 52 51 140 141 53 51 140 141 74 51 140 141 54 51 140 141 75 51 140 141 55 51 140 141 556 51 140 141 56 51 140 141 57 51 140 141 58 51 140 141 76 51 140 141 59 51 140 141 60 51 140 141 61 51 140 141 62 51 140 141 63 51 140 141 64 51 140 141 65 51 140 141 77 51 140 141 66 51 140 141 67 51 140 141 78 140 141 68 140 141 79 51 140 141 80 51 140 141 69 51 140 141 81 51 140 141 70 51 140 141 82 51 140 141 71 51 140 141 72 51 140 141 72 51 140 141 73 51 140 141 83 557 140 593 598 84 51 140 593 598 85 51 140 593 598 86 51 140 593 598 87 51 140 593 598 555 51 140 141 88 557 593 598 21 22 139 138 139 138 113 51 140 141 114 51 140 141 115 51 140 141 13 139 138 139 138 110 382 140 141 111 112 14 139 138 139 138 101 382 140 141 102 382 140 141 103 382 140 141 104 382 140 141 105 382 140 141 106 382 140 141 107 382 140 141 108 382 140 141 109 382 140 141 15 5 16 558 51 140 593 598 559 51 140 593 598 560 51 140 593 598 561 564 140 593 598 562 564 140 593 598 563 564 140 593 598 5 17 89 422 90 91 92 93 94 95 374 140 594 598 96 97 98 5 523 595 599 600

6 9 99 139 138 139 138 146 118 51 140 145 147 141 119 51 140 145 147 141 120 51 140 145 147 141 121 51 140 145 147 141 117 51 140 577 147 141 572 5 122 51 140 577 147 141 572 123 51 140 578 147 141 596 124 51 140 578 147 141 596 125 51 140 578 147 141 596 126 51 140 578 147 141 596 127 51 140 578 147 141 596 5 128 51 140 578 147 141 596 129 51 140 443 147 141 596 130 51 140 579 147 141 596 131 51 142 141 147 141 132 51 142 141 147 141 133 51 142 141 147 141 134 51 142 141 147 141 135 51 142 141 147 141 136 51 142 141 147 141 137 51 142 141 147 141 19 139 138 139 138 23 51 140 141 147 141 24 51 140 141 147 141 143 144 140 141 147 141 25 51 140 141 147 141 26 51 140 141 147 141 27 51 140 141 147 141 28 51 140 141 147 141 29 51 140 141 147 141 30 51 140 141 147 141 31 148 140 580 147 141 32 51 140 580 147 141 33 51 140 141 147 141 34 51 140 141 147 141 35 51 140 141 147 141 36 51 140 141 147 141 37 51 140 141 147 141 38 51 140 141 147 141 39 51 140 141 147 141 20 139 138 139 138 40 41 42 43 51 140 581 573 44 45 51 140 581 573 46 47 51 140 582 574 48 49 51 140 582 574 446 544 444 140 453 545 444 140 454 546 444 140 455 547 444 140 456 548 444 140 447 549 444 140 448 550 444 140 449 551 444 140 450 552 444 140 451 553 444 140 452 554 444 140 149 50 444 140 445 5 100 139 138 139 138 323 148 140 583 573 325 148 140 583 573 326 148 140 583 573 327 148 140 583 573 328 148 140 583 573 324 148 140 332 573 329 148 140 330 575 331 148 140 333 575 159 334 51 140 141 575 160 335 51 140 141 575 161 336 51 140 141 575 337 51 140 141 575 338 51 140 141 575 339 51 140 141 575 340 51 140 141 575 341 51 140 141 575 342 51 140 141 575 343 51 140 141 575 344 51 140 141 575 345 51 140 141 575 346 51 140 141 575 347 51 140 141 575 348 51 140 141 575 162 349 51 140 141 575 163 350 51 140 141 575 164 351 51 140 141 575 156 565 51 140 584 573 157 352 51 140 585 573 158 353 51 140 585 573 165 354 51 140 141 575 166 355 51 140 141 575 167 357 51 140 141 575 168 356 51 140 141 575 169 358 51 140 141 575 170 359 51 140 141 575 171 360 51 140 457 576 172 361 51 140 141 575 601 324 51 140 141 575 311 362 51 140 141 575 305 308 51 140 586 573 173 363 51 140 141 575 309 310 51 140 141 575 312 364 51 140 141 575 313 365 51 140 141 575 314 366 51 140 141 575 306 307 51 140 586 573 315 367 51 140 586 573 174 368 51 140 141 175 369 51 140 587 573 176 177 51 140 587 573 178 370 51 140 587 573 179 371 51 140 587 573 180 372 51 140 587 573 181 373 51 140 141 182 375 382 140 588 573 376 382 140 588 573 377 382 140 588 573 378 382 140 588 573 379 382 140 588 573 380 382 140 588 573 381 382 140 588 573 381 51 140 141 183 383 51 140 141 184 384 51 140 141 185 385 51 140 141 186 386 51 140 141 387 331 51 140 589 573 187 388 51 140 588 573 188 389 51 140 588 573 189 390 51 140 588 573 190 391 51 140 141 191 392 374 140 141 192 393 51 140 141 193 394 382 140 141 194 395 51 140 141 195 396 374 140 141 196 397 374 140 141 197 398 374 140 141 198 399 374 140 141 199 400 374 140 141 200 401 374 140 141 201 402 374 140 141 202 403 374 140 141 203 404 374 140 141 204 405 374 140 141 205 406 51 140 141 206 407 51 140 141 207 408 51 140 141 208 409 51 140 141 209 410 51 140 141 210 411 51 140 141 211 412 51 140 141 212 413 51 140 141 213 414 51 140 141 214 415 51 140 141 215 416 51 140 141 216 417 51 140 141 217 418 51 140 419 147 420 597 320 421 51 140 590 566 567 150 113 51 140 141 321 114 382 140 590 147 141 567 322 115 51 140 590 566 567 151 435 51 140 141 152 436 51 140 141 424 429 51 140 141 425 430 51 140 141 426 431 51 140 440 568 439 438 51 140 440 568 427 432 51 140 141 153 428 51 140 141 154 434 51 140 141 155 437 51 140 141 423 433 51 140 441 218 442 51 140 441 219 458 51 140 441 220 459 51 140 441 221 460 51 140 441 222 461 51 140 441 223 462 51 140 441 224 463 51 140 441 225 464 51 140 441 226 465 51 140 441 227 466 51 140 441 316 467 51 140 441 317 468 51 140 441 318 469 51 140 441 319 470 51 140 441 228 471 51 140 441 229 472 51 140 441 230 473 51 140 441 536 540 51 140 441 231 474 51 140 441 232 475 51 140 441 233 476 51 140 441 234 477 51 140 441 235 478 51 140 591 5 569 236 479 51 140 141 237 480 51 140 141 238 101 51 140 141 239 102 51 140 141 240 103 51 140 141 241 104 51 140 141 242 105 51 140 141 243 106 51 140 141 244 107 51 140 141 245 108 51 140 141 246 109 51 140 141 247 481 382 140 141 248 482 382 140 141 249 483 382 140 141 250 484 382 140 141 251 485 382 140 141 252 486 382 140 141 253 487 382 140 141 254 89 382 140 141 255 488 382 140 141 256 90 382 140 141 257 489 382 140 141 258 92 382 140 141 259 490 382 140 141 260 491 382 140 141 261 492 382 140 141 262 493 382 140 141 263 494 382 140 141 264 495 382 140 141 265 496 382 140 141 266 498 497 570 267 499 382 140 141 268 500 382 140 141 269 501 382 140 141 270 502 382 140 141 271 503 382 140 141 272 504 382 140 141 273 505 382 140 141 274 96 382 140 141 275 97 382 140 141 276 506 382 140 141 277 98 382 140 141 278 507 51 140 592 569 279 508 51 140 592 569 280 509 382 140 141 281 510 382 140 141 282 511 382 140 141 283 512 382 140 141 537 541 382 140 141 538 542 382 140 141 539 543 382 140 141 284 513 382 140 141 285 514 382 140 141 286 515 382 140 141 287 516 382 140 141 288 517 382 140 141 289 518 382 140 141 290 519 51 140 141 291 520 51 140 141 292 521 51 140 141 293 522 51 140 141 294 524 51 140 591 571 295 525 51 140 591 571 296 526 51 140 141 297 527 51 140 141 298 528 51 140 141 299 529 51 140 141 300 530 51 140 141 301 531 51 140 141 302 532 51 140 141 303 533 51 140 534 304 110 51 140 535 10 11 12 18 139 138 139 138 52 51 140 141 53 51 140 141 74 51 140 141 54 51 140 141 75 51 140 141 55 51 140 141 556 51 140 141 56 51 140 141 57 51 140 141 58 51 140 141 76 51 140 141 59 51 140 141 60 51 140 141 61 51 140 141 62 51 140 141 63 51 140 141 64 51 140 141 65 51 140 141 77 51 140 141 66 51 140 141 67 51 140 141 78 140 141 68 140 141 79 51 140 141 80 51 140 141 69 51 140 141 81 51 140 141 70 51 140 141 82 51 140 141 71 51 140 141 72 51 140 141 72 51 140 141 73 51 140 141 83 557 140 593 598 84 51 140 593 598 85 51 140 593 598 86 51 140 593 598 87 51 140 593 598 555 51 140 141 88 557 593 598 21 22 139 138 139 138 113 51 140 141 114 51 140 141 115 51 140 141 13 139 138 139 138 110 382 140 141 111 112 14 139 138 139 138 101 382 140 141 102 382 140 141 103 382 140 141 104 382 140 141 105 382 140 141 106 382 140 141 107 382 140 141 108 382 140 141 109 382 140 141 15 5 16 558 51 140 593 598 559 51 140 593 598 560 51 140 593 598 561 564 140 593 598 562 564 140 593 598 563 564 140 593 598 5 17 89 422 90 91 92 93 94 95 374 140 594 598 96 97 98 5 523 595 599 600

6 9 99 139 138 139 138 146 118 51 140 145 147 141 119 51 140 145 147 141 120 51 140 145 147 141 121 51 140 145 147 141 117 51 140 577 147 141 572 5 122 51 140 577 147 141 572 123 51 140 578 147 141 596 124 51 140 578 147 141 596 125 51 140 578 147 141 596 126 51 140 578 147 141 596 127 51 140 578 147 141 596 5 128 51 140 578 147 141 596 129 51 140 443 147 141 596 130 51 140 579 147 141 596 131 51 142 141 147 141 132 51 142 141 147 141 133 51 142 141 147 141 134 51 142 141 147 141 135 51 142 141 147 141 136 51 142 141 147 141 137 51 142 141 147 141 19 139 138 139 138 23 51 140 141 147 141 24 51 140 141 147 141 143 144 140 141 147 141 25 51 140 141 147 141 26 51 140 141 147 141 27 51 140 141 147 141 28 51 140 141 147 141 29 51 140 141 147 141 30 51 140 141 147 141 31 148 140 580 147 141 32 51 140 580 147 141 33 51 140 141 147 141 34 51 140 141 147 141 35 51 140 141 147 141 36 51 140 141 147 141 37 51 140 141 147 141 38 51 140 141 147 141 39 51 140 141 147 141 20 139 138 139 138 40 41 42 43 51 140 581 573 44 45 51 140 581 573 46 47 51 140 582 574 48 49 51 140 582 574 446 544 444 140 453 545 444 140 454 546 444 140 455 547 444 140 456 548 444 140 447 549 444 140 448 550 444 140 449 551 444 140 450 552 444 140 451 553 444 140 452 554 444 140 149 50 444 140 445 5 100 139 138 139 138 323 148 140 583 573 325 148 140 583 573 326 148 140 583 573 327 148 140 583 573 328 148 140 583 573 324 148 140 332 573 329 148 140 330 575 331 148 140 333 575 159 334 51 140 141 575 160 335 51 140 141 575 161 336 51 140 141 575 337 51 140 141 575 338 51 140 141 575 339 51 140 141 575 340 51 140 141 575 341 51 140 141 575 342 51 140 141 575 343 51 140 141 575 344 51 140 141 575 345 51 140 141 575 346 51 140 141 575 347 51 140 141 575 348 51 140 141 575 162 349 51 140 141 575 163 350 51 140 141 575 164 351 51 140 141 575 156 565 51 140 584 573 157 352 51 140 585 573 158 353 51 140 585 573 165 354 51 140 141 575 166 355 51 140 141 575 167 357 51 140 141 575 168 356 51 140 141 575 169 358 51 140 141 575 170 359 51 140 141 575 171 360 51 140 457 576 172 361 51 140 141 575 601 324 51 140 141 575 311 362 51 140 141 575 305 308 51 140 586 573 173 363 51 140 141 575 309 310 51 140 141 575 312 364 51 140 141 575 313 365 51 140 141 575 314 366 51 140 141 575 306 307 51 140 586 573 315 367 51 140 586 573 174 368 51 140 141 175 369 51 140 587 573 176 177 51 140 587 573 178 370 51 140 587 573 179 371 51 140 587 573 180 372 51 140 587 573 181 373 51 140 141 182 375 382 140 588 573 376 382 140 588 573 377 382 140 588 573 378 382 140 588 573 379 382 140 588 573 380 382 140 588 573 381 382 140 588 573 381 51 140 141 183 383 51 140 141 184 384 51 140 141 185 385 51 140 141 186 386 51 140 141 387 331 51 140 589 573 187 388 51 140 588 573 188 389 51 140 588 573 189 390 51 140 588 573 190 391 51 140 141 191 392 374 140 141 192 393 51 140 141 193 394 382 140 141 194 395 51 140 141 195 396 374 140 141 196 397 374 140 141 197 398 374 140 141 198 399 374 140 141 199 400 374 140 141 200 401 374 140 141 201 402 374 140 141 202 403 374 140 141 203 404 374 140 141 204 405 374 140 141 205 406 51 140 141 206 407 51 140 141 207 408 51 140 141 208 409 51 140 141 209 410 51 140 141 210 411 51 140 141 211 412 51 140 141 212 413 51 140 141 213 414 51 140 141 214 415 51 140 141 215 416 51 140 141 216 417 51 140 141 217 418 51 140 419 147 420 597 320 421 51 140 590 566 567 150 113 51 140 141 321 114 382 140 590 147 141 567 322 115 51 140 590 566 567 151 435 51 140 141 152 436 51 140 141 424 429 51 140 141 425 430 51 140 141 426 431 51 140 440 568 439 438 51 140 440 568 427 432 51 140 141 153 428 51 140 141 154 434 51 140 141 155 437 51 140 141 423 433 51 140 441 218 442 51 140 441 219 458 51 140 441 220 459 51 140 441 221 460 51 140 441 222 461 51 140 441 223 462 51 140 441 224 463 51 140 441 225 464 51 140 441 226 465 51 140 441 227 466 51 140 441 316 467 51 140 441 317 468 51 140 441 318 469 51 140 441 319 470 51 140 441 228 471 51 140 441 229 472 51 140 441 230 473 51 140 441 536 540 51 140 441 231 474 51 140 441 232 475 51 140 441 233 476 51 140 441 234 477 51 140 441 235 478 51 140 591 5 569 236 479 51 140 141 237 480 51 140 141 238 101 51 140 141 239 102 51 140 141 240 103 51 140 141 241 104 51 140 141 242 105 51 140 141 243 106 51 140 141 244 107 51 140 141 245 108 51 140 141 246 109 51 140 141 247 481 382 140 141 248 482 382 140 141 249 483 382 140 141 250 484 382 140 141 251 485 382 140 141 252 486 382 140 141 253 487 382 140 141 254 89 382 140 141 255 488 382 140 141 256 90 382 140 141 257 489 382 140 141 258 92 382 140 141 259 490 382 140 141 260 491 382 140 141 261 492 382 140 141 262 493 382 140 141 263 494 382 140 141 264 495 382 140 141 265 496 382 140 141 266 498 497 570 267 499 382 140 141 268 500 382 140 141 269 501 382 140 141 270 502 382 140 141 271 503 382 140 141 272 504 382 140 141 273 505 382 140 141 274 96 382 140 141 275 97 382 140 141 276 506 382 140 141 277 98 382 140 141 278 507 51 140 592 569 279 508 51 140 592 569 280 509 382 140 141 281 510 382 140 141 282 511 382 140 141 283 512 382 140 141 537 541 382 140 141 538 542 382 140 141 539 543 382 140 141 284 513 382 140 141 285 514 382 140 141 286 515 382 140 141 287 516 382 140 141 288 517 382 140 141 289 518 382 140 141 290 519 51 140 141 291 520 51 140 141 292 521 51 140 141 293 522 51 140 141 294 524 51 140 591 571 295 525 51 140 591 571 296 526 51 140 141 297 527 51 140 141 298 528 51 140 141 299 529 51 140 141 300 530 51 140 141 301 531 51 140 141 302 532 51 140 141 303 533 51 140 534 304 110 51 140 535 10 11 12 18 139 138 139 138 52 51 140 141 53 51 140 141 74 51 140 141 54 51 140 141 75 51 140 141 55 51 140 141 556 51 140 141 56 51 140 141 57 51 140 141 58 51 140 141 76 51 140 141 59 51 140 141 60 51 140 141 61 51 140 141 62 51 140 141 63 51 140 141 64 51 140 141 65 51 140 141 77 51 140 141 66 51 140 141 67 51 140 141 78 140 141 68 140 141 79 51 140 141 80 51 140 141 69 51 140 141 81 51 140 141 70 51 140 141 82 51 140 141 71 51 140 141 72 51 140 141 72 51 140 141 73 51 140 141 83 557 140 593 598 84 51 140 593 598 85 51 140 593 598 86 51 140 593 598 87 51 140 593 598 555 51 140 141 88 557 593 598 21 22 139 138 139 138 113 51 140 141 114 51 140 141 115 51 140 141 13 139 138 139 138 110 382 140 141 111 112 14 139 138 139 138 101 382 140 141 102 382 140 141 103 382 140 141 104 382 140 141 105 382 140 141 106 382 140 141 107 382 140 141 108 382 140 141 109 382 140 141 15 5 16 558 51 140 593 598 559 51 140 593 598 560 51 140 593 598 561 564 140 593 598 562 564 140 593 598 563 564 140 593 598 5 17 89 422 90 91 92 93 94 95 374 140 594 598 96 97 98 5 523 595 599 600

6 9 99 139 138 139 138 146 118 51 140 145 147 141 119 51 140 145 147 141 120 51 140 145 147 141 121 51 140 145 147 141 117 51 140 577 147 141 572 5 122 51 140 577 147 141 572 123 51 140 578 147 141 596 124 51 140 578 147 141 596 125 51 140 578 147 141 596 126 51 140 578 147 141 596 127 51 140 578 147 141 596 5 128 51 140 578 147 141 596 129 51 140 443 147 141 596 130 51 140 579 147 141 596 131 51 142 141 147 141 132 51 142 141 147 141 133 51 142 141 147 141 134 51 142 141 147 141 135 51 142 141 147 141 136 51 142 141 147 141 137 51 142 141 147 141 19 139 138 139 138 23 51 140 141 147 141 24 51 140 141 147 141 143 144 140 141 147 141 25 51 140 141 147 141 26 51 140 141 147 141 27 51 140 141 147 141 28 51 140 141 147 141 29 51 140 141 147 141 30 51 140 141 147 141 31 148 140 580 147 141 32 51 140 580 147 141 33 51 140 141 147 141 34 51 140 141 147 141 35 51 140 141 147 141 36 51 140 141 147 141 37 51 140 141 147 141 38 51 140 141 147 141 39 51 140 141 147 141 20 139 138 139 138 40 41 42 43 51 140 581 573 44 45 51 140 581 573 46 47 51 140 582 574 48 49 51 140 582 574 446 544 444 140 453 545 444 140 454 546 444 140 455 547 444 140 456 548 444 140 447 549 444 140 448 550 444 140 449 551 444 140 450 552 444 140 451 553 444 140 452 554 444 140 149 50 444 140 445 5 100 139 138 139 138 323 148 140 583 573 325 148 140 583 573 326 148 140 583 573 327 148 140 583 573 328 148 140 583 573 324 148 140 332 573 329 148 140 330 575 331 148 140 333 575 159 334 51 140 141 575 160 335 51 140 141 575 161 336 51 140 141 575 337 51 140 141 575 338 51 140 141 575 339 51 140 141 575 340 51 140 141 575 341 51 140 141 575 342 51 140 141 575 343 51 140 141 575 344 51 140 141 575 345 51 140 141 575 346 51 140 141 575 347 51 140 141 575 348 51 140 141 575 162 349 51 140 141 575 163 350 51 140 141 575 164 351 51 140 141 575 156 565 51 140 584 573 157 352 51 140 585 573 158 353 51 140 585 573 165 354 51 140 141 575 166 355 51 140 141 575 167 357 51 140 141 575 168 356 51 140 141 575 169 358 51 140 141 575 170 359 51 140 141 575 171 360 51 140 457 576 172 361 51 140 141 575 601 324 51 140 141 575 311 362 51 140 141 575 305 308 51 140 586 573 173 363 51 140 141 575 309 310 51 140 141 575 312 364 51 140 141 575 313 365 51 140 141 575 314 366 51 140 141 575 306 307 51 140 586 573 315 367 51 140 586 573 174 368 51 140 141 175 369 51 140 587 573 176 177 51 140 587 573 178 370 51 140 587 573 179 371 51 140 587 573 180 372 51 140 587 573 181 373 51 140 141 182 375 382 140 588 573 376 382 140 588 573 377 382 140 588 573 378 382 140 588 573 379 382 140 588 573 380 382 140 588 573 381 382 140 588 573 381 51 140 141 183 383 51 140 141 184 384 51 140 141 185 385 51 140 141 186 386 51 140 141 387 331 51 140 589 573 187 388 51 140 588 573 188 389 51 140 588 573 189 390 51 140 588 573 190 391 51 140 141 191 392 374 140 141 192 393 51 140 141 193 394 382 140 141 194 395 51 140 141 195 396 374 140 141 196 397 374 140 141 197 398 374 140 141 198 399 374 140 141 199 400 374 140 141 200 401 374 140 141 201 402 374 140 141 202 403 374 140 141 203 404 374 140 141 204 405 374 140 141 205 406 51 140 141 206 407 51 140 141 207 408 51 140 141 208 409 51 140 141 209 410 51 140 141 210 411 51 140 141 211 412 51 140 141 212 413 51 140 141 213 414 51 140 141 214 415 51 140 141 215 416 51 140 141 216 417 51 140 141 217 418 51 140 419 147 420 597 320 421 51 140 590 566 567 150 113 51 140 141 321 114 382 140 590 147 141 567 322 115 51 140 590 566 567 151 435 51 140 141 152 436 51 140 141 424 429 51 140 141 425 430 51 140 141 426 431 51 140 440 568 439 438 51 140 440 568 427 432 51 140 141 153 428 51 140 141 154 434 51 140 141 155 437 51 140 141 423 433 51 140 441 218 442 51 140 441 219 458 51 140 441 220 459 51 140 441 221 460 51 140 441 222 461 51 140 441 223 462 51 140 441 224 463 51 140 441 225 464 51 140 441 226 465 51 140 441 227 466 51 140 441 316 467 51 140 441 317 468 51 140 441 318 469 51 140 441 319 470 51 140 441 228 471 51 140 441 229 472 51 140 441 230 473 51 140 441 536 540 51 140 441 231 474 51 140 441 232 475 51 140 441 233 476 51 140 441 234 477 51 140 441 235 478 51 140 591 5 569 236 479 51 140 141 237 480 51 140 141 238 101 51 140 141 239 102 51 140 141 240 103 51 140 141 241 104 51 140 141 242 105 51 140 141 243 106 51 140 141 244 107 51 140 141 245 108 51 140 141 246 109 51 140 141 247 481 382 140 141 248 482 382 140 141 249 483 382 140 141 250 484 382 140 141 251 485 382 140 141 252 486 382 140 141 253 487 382 140 141 254 89 382 140 141 255 488 382 140 141 256 90 382 140 141 257 489 382 140 141 258 92 382 140 141 259 490 382 140 141 260 491 382 140 141 261 492 382 140 141 262 493 382 140 141 263 494 382 140 141 264 495 382 140 141 265 496 382 140 141 266 498 497 570 267 499 382 140 141 268 500 382 140 141 269 501 382 140 141 270 502 382 140 141 271 503 382 140 141 272 504 382 140 141 273 505 382 140 141 274 96 382 140 141 275 97 382 140 141 276 506 382 140 141 277 98 382 140 141 278 507 51 140 592 569 279 508 51 140 592 569 280 509 382 140 141 281 510 382 140 141 282 511 382 140 141 283 512 382 140 141 537 541 382 140 141 538 542 382 140 141 539 543 382 140 141 284 513 382 140 141 285 514 382 140 141 286 515 382 140 141 287 516 382 140 141 288 517 382 140 141 289 518 382 140 141 290 519 51 140 141 291 520 51 140 141 292 521 51 140 141 293 522 51 140 141 294 524 51 140 591 571 295 525 51 140 591 571 296 526 51 140 141 297 527 51 140 141 298 528 51 140 141 299 529 51 140 141 300 530 51 140 141 301 531 51 140 141 302 532 51 140 141 303 533 51 140 534 304 110 51 140 535 10 11 12 18 139 138 139 138 52 51 140 141 53 51 140 141 74 51 140 141 54 51 140 141 75 51 140 141 55 51 140 141 556 51 140 141 56 51 140 141 57 51 140 141 58 51 140 141 76 51 140 141 59 51 140 141 60 51 140 141 61 51 140 141 62 51 140 141 63 51 140 141 64 51 140 141 65 51 140 141 77 51 140 141 66 51 140 141 67 51 140 141 78 140 141 68 140 141 79 51 140 141 80 51 140 141 69 51 140 141 81 51 140 141 70 51 140 141 82 51 140 141 71 51 140 141 72 51 140 141 72 51 140 141 73 51 140 141 83 557 140 593 598 84 51 140 593 598 85 51 140 593 598 86 51 140 593 598 87 51 140 593 598 555 51 140 141 88 557 593 598 21 22 139 138 139 138 113 51 140 141 114 51 140 141 115 51 140 141 13 139 138 139 138 110 382 140 141 111 112 14 139 138 139 138 101 382 140 141 102 382 140 141 103 382 140 141 104 382 140 141 105 382 140 141 106 382 140 141 107 382 140 141 108 382 140 141 109 382 140 141 15 5 16 558 51 140 593 598 559 51 140 593 598 560 51 140 593 598 561 564 140 593 598 562 564 140 593 598 563 564 140 593 598 5 17 89 422 90 91 92 93 94 95 374 140 594 598 96 97 98 5 523 595 599 600

6 9 99 139 138 139 138 146 118 51 140 145 147 141 119 51 140 145 147 141 120 51 140 145 147 141 121 51 140 145 147 141 117 51 140 577 147 141 572 5 122 51 140 577 147 141 572 123 51 140 578 147 141 596 124 51 140 578 147 141 596 125 51 140 578 147 141 596 126 51 140 578 147 141 596 127 51 140 578 147 141 596 5 128 51 140 578 147 141 596 129 51 140 443 147 141 596 130 51 140 579 147 141 596 131 51 142 141 147 141 132 51 142 141 147 141 133 51 142 141 147 141 134 51 142 141 147 141 135 51 142 141 147 141 136 51 142 141 147 141 137 51 142 141 147 141 19 139 138 139 138 23 51 140 141 147 141 24 51 140 141 147 141 143 144 140 141 147 141 25 51 140 141 147 141 26 51 140 141 147 141 27 51 140 141 147 141 28 51 140 141 147 141 29 51 140 141 147 141 30 51 140 141 147 141 31 148 140 580 147 141 32 51 140 580 147 141 33 51 140 141 147 141 34 51 140 141 147 141 35 51 140 141 147 141 36 51 140 141 147 141 37 51 140 141 147 141 38 51 140 141 147 141 39 51 140 141 147 141 20 139 138 139 138 40 41 42 43 51 140 581 573 44 45 51 140 581 573 46 47 51 140 582 574 48 49 51 140 582 574 446 544 444 140 453 545 444 140 454 546 444 140 455 547 444 140 456 548 444 140 447 549 444 140 448 550 444 140 449 551 444 140 450 552 444 140 451 553 444 140 452 554 444 140 149 50 444 140 445 5 100 139 138 139 138 323 148 140 583 573 325 148 140 583 573 326 148 140 583 573 327 148 140 583 573 328 148 140 583 573 324 148 140 332 573 329 148 140 330 575 331 148 140 333 575 159 334 51 140 141 575 160 335 51 140 141 575 161 336 51 140 141 575 337 51 140 141 575 338 51 140 141 575 339 51 140 141 575 340 51 140 141 575 341 51 140 141 575 342 51 140 141 575 343 51 140 141 575 344 51 140 141 575 345 51 140 141 575 346 51 140 141 575 347 51 140 141 575 348 51 140 141 575 162 349 51 140 141 575 163 350 51 140 141 575 164 351 51 140 141 575 156 565 51 140 584 573 157 352 51 140 585 573 158 353 51 140 585 573 165 354 51 140 141 575 166 355 51 140 141 575 167 357 51 140 141 575 168 356 51 140 141 575 169 358 51 140 141 575 170 359 51 140 141 575 171 360 51 140 457 576 172 361 51 140 141 575 601 324 51 140 141 575 311 362 51 140 141 575 305 308 51 140 586 573 173 363 51 140 141 575 309 310 51 140 141 575 312 364 51 140 141 575 313 365 51 140 141 575 314 366 51 140 141 575 306 307 51 140 586 573 315 367 51 140 586 573 174 368 51 140 141 175 369 51 140 587 573 176 177 51 140 587 573 178 370 51 140 587 573 179 371 51 140 587 573 180 372 51 140 587 573 181 373 51 140 141 182 375 382 140 588 573 376 382 140 588 573 377 382 140 588 573 378 382 140 588 573 379 382 140 588 573 380 382 140 588 573 381 382 140 588 573 381 51 140 141 183 383 51 140 141 184 384 51 140 141 185 385 51 140 141 186 386 51 140 141 387 331 51 140 589 573 187 388 51 140 588 573 188 389 51 140 588 573 189 390 51 140 588 573 190 391 51 140 141 191 392 374 140 141 192 393 51 140 141 193 394 382 140 141 194 395 51 140 141 195 396 374 140 141 196 397 374 140 141 197 398 374 140 141 198 399 374 140 141 199 400 374 140 141 200 401 374 140 141 201 402 374 140 141 202 403 374 140 141 203 404 374 140 141 204 405 374 140 141 205 406 51 140 141 206 407 51 140 141 207 408 51 140 141 208 409 51 140 141 209 410 51 140 141 210 411 51 140 141 211 412 51 140 141 212 413 51 140 141 213 414 51 140 141 214 415 51 140 141 215 416 51 140 141 216 417 51 140 141 217 418 51 140 419 147 420 597 320 421 51 140 590 566 567 150 113 51 140 141 321 114 382 140 590 147 141 567 322 115 51 140 590 566 567 151 435 51 140 141 152 436 51 140 141 424 429 51 140 141 425 430 51 140 141 426 431 51 140 440 568 439 438 51 140 440 568 427 432 51 140 141 153 428 51 140 141 154 434 51 140 141 155 437 51 140 141 423 433 51 140 441 218 442 51 140 441 219 458 51 140 441 220 459 51 140 441 221 460 51 140 441 222 461 51 140 441 223 462 51 140 441 224 463 51 140 441 225 464 51 140 441 226 465 51 140 441 227 466 51 140 441 316 467 51 140 441 317 468 51 140 441 318 469 51 140 441 319 470 51 140 441 228 471 51 140 441 229 472 51 140 441 230 473 51 140 441 536 540 51 140 441 231 474 51 140 441 232 475 51 140 441 233 476 51 140 441 234 477 51 140 441 235 478 51 140 591 5 569 236 479 51 140 141 237 480 51 140 141 238 101 51 140 141 239 102 51 140 141 240 103 51 140 141 241 104 51 140 141 242 105 51 140 141 243 106 51 140 141 244 107 51 140 141 245 108 51 140 141 246 109 51 140 141 247 481 382 140 141 248 482 382 140 141 249 483 382 140 141 250 484 382 140 141 251 485 382 140 141 252 486 382 140 141 253 487 382 140 141 254 89 382 140 141 255 488 382 140 141 256 90 382 140 141 257 489 382 140 141 258 92 382 140 141 259 490 382 140 141 260 491 382 140 141 261 492 382 140 141 262 493 382 140 141 263 494 382 140 141 264 495 382 140 141 265 496 382 140 141 266 498 497 570 267 499 382 140 141 268 500 382 140 141 269 501 382 140 141 270 502 382 140 141 271 503 382 140 141 272 504 382 140 141 273 505 382 140 141 274 96 382 140 141 275 97 382 140 141 276 506 382 140 141 277 98 382 140 141 278 507 51 140 592 569 279 508 51 140 592 569 280 509 382 140 141 281 510 382 140 141 282 511 382 140 141 283 512 382 140 141 537 541 382 140 141 538 542 382 140 141 539 543 382 140 141 284 513 382 140 141 285 514 382 140 141 286 515 382 140 141 287 516 382 140 141 288 517 382 140 141 289 518 382 140 141 290 519 51 140 141 291 520 51 140 141 292 521 51 140 141 293 522 51 140 141 294 524 51 140 591 571 295 525 51 140 591 571 296 526 51 140 141 297 527 51 140 141 298 528 51 140 141 299 529 51 140 141 300 530 51 140 141 301 531 51 140 141 302 532 51 140 141 303 533 51 140 534 304 110 51 140 535 10 11 12 18 139 138 139 138 52 51 140 141 53 51 140 141 74 51 140 141 54 51 140 141 75 51 140 141 55 51 140 141 556 51 140 141 56 51 140 141 57 51 140 141 58 51 140 141 76 51 140 141 59 51 140 141 60 51 140 141 61 51 140 141 62 51 140 141 63 51 140 141 64 51 140 141 65 51 140 141 77 51 140 141 66 51 140 141 67 51 140 141 78 140 141 68 140 141 79 51 140 141 80 51 140 141 69 51 140 141 81 51 140 141 70 51 140 141 82 51 140 141 71 51 140 141 72 51 140 141 72 51 140 141 73 51 140 141 83 557 140 593 598 84 51 140 593 598 85 51 140 593 598 86 51 140 593 598 87 51 140 593 598 555 51 140 141 88 557 593 598 21 22 139 138 139 138 113 51 140 141 114 51 140 141 115 51 140 141 13 139 138 139 138 110 382 140 141 111 112 14 139 138 139 138 101 382 140 141 102 382 140 141 103 382 140 141 104 382 140 141 105 382 140 141 106 382 140 141 107 382 140 141 108 382 140 141 109 382 140 141 15 5 16 558 51 140 593 598 559 51 140 593 598 560 51 140 593 598 561 564 140 593 598 562 564 140 593 598 563 564 140 593 598 5 17 89 422 90 91 92 93 94 95 374 140 594 598 96 97 98 5 523 595 599 600

6 9 99 139 138 139 138 146 118 51 140 145 147 141 119 51 140 145 147 141 120 51 140 145 147 141 121 51 140 145 147 141 117 51 140 577 147 141 572 5 122 51 140 577 147 141 572 123 51 140 578 147 141 596 124 51 140 578 147 141 596 125 51 140 578 147 141 596 126 51 140 578 147 141 596 127 51 140 578 147 141 596 5 128 51 140 578 147 141 596 129 51 140 443 147 141 596 130 51 140 579 147 141 596 131 51 142 141 147 141 132 51 142 141 147 141 133 51 142 141 147 141 134 51 142 141 147 141 135 51 142 141 147 141 136 51 142 141 147 141 137 51 142 141 147 141 19 139 138 139 138 23 51 140 141 147 141 24 51 140 141 147 141 143 144 140 141 147 141 25 51 140 141 147 141 26 51 140 141 147 141 27 51 140 141 147 141 28 51 140 141 147 141 29 51 140 141 147 141 30 51 140 141 147 141 31 148 140 580 147 141 32 51 140 580 147 141 33 51 140 141 147 141 34 51 140 141 147 141 35 51 140 141 147 141 36 51 140 141 147 141 37 51 140 141 147 141 38 51 140 141 147 141 39 51 140 141 147 141 20 139 138 139 138 40 41 42 43 51 140 581 573 44 45 51 140 581 573 46 47 51 140 582 574 48 49 51 140 582 574 446 544 444 140 453 545 444 140 454 546 444 140 455 547 444 140 456 548 444 140 447 549 444 140 448 550 444 140 449 551 444 140 450 552 444 140 451 553 444 140 452 554 444 140 149 50 444 140 445 5 100 139 138 139 138 323 148 140 583 573 325 148 140 583 573 326 148 140 583 573 327 148 140 583 573 328 148 140 583 573 324 148 140 332 573 329 148 140 330 575 331 148 140 333 575 159 334 51 140 141 575 160 335 51 140 141 575 161 336 51 140 141 575 337 51 140 141 575 338 51 140 141 575 339 51 140 141 575 340 51 140 141 575 341 51 140 141 575 342 51 140 141 575 343 51 140 141 575 344 51 140 141 575 345 51 140 141 575 346 51 140 141 575 347 51 140 141 575 348 51 140 141 575 162 349 51 140 141 575 163 350 51 140 141 575 164 351 51 140 141 575 156 565 51 140 584 573 157 352 51 140 585 573 158 353 51 140 585 573 165 354 51 140 141 575 166 355 51 140 141 575 167 357 51 140 141 575 168 356 51 140 141 575 169 358 51 140 141 575 170 359 51 140 141 575 171 360 51 140 457 576 172 361 51 140 141 575 601 324 51 140 141 575 311 362 51 140 141 575 305 308 51 140 586 573 173 363 51 140 141 575 309 310 51 140 141 575 312 364 51 140 141 575 313 365 51 140 141 575 314 366 51 140 141 575 306 307 51 140 586 573 315 367 51 140 586 573 174 368 51 140 141 175 369 51 140 587 573 176 177 51 140 587 573 178 370 51 140 587 573 179 371 51 140 587 573 180 372 51 140 587 573 181 373 51 140 141 182 375 382 140 588 573 376 382 140 588 573 377 382 140 588 573 378 382 140 588 573 379 382 140 588 573 380 382 140 588 573 381 382 140 588 573 381 51 140 141 183 383 51 140 141 184 384 51 140 141 185 385 51 140 141 186 386 51 140 141 387 331 51 140 589 573 187 388 51 140 588 573 188 389 51 140 588 573 189 390 51 140 588 573 190 391 51 140 141 191 392 374 140 141 192 393 51 140 141 193 394 382 140 141 194 395 51 140 141 195 396 374 140 141 196 397 374 140 141 197 398 374 140 141 198 399 374 140 141 199 400 374 140 141 200 401 374 140 141 201 402 374 140 141 202 403 374 140 141 203 404 374 140 141 204 405 374 140 141 205 406 51 140 141 206 407 51 140 141 207 408 51 140 141 208 409 51 140 141 209 410 51 140 141 210 411 51 140 141 211 412 51 140 141 212 413 51 140 141 213 414 51 140 141 214 415 51 140 141 215 416 51 140 141 216 417 51 140 141 217 418 51 140 419 147 420 597 320 421 51 140 590 566 567 150 113 51 140 141 321 114 382 140 590 147 141 567 322 115 51 140 590 566 567 151 435 51 140 141 152 436 51 140 141 424 429 51 140 141 425 430 51 140 141 426 431 51 140 440 568 439 438 51 140 440 568 427 432 51 140 141 153 428 51 140 141 154 434 51 140 141 155 437 51 140 141 423 433 51 140 441 218 442 51 140 441 219 458 51 140 441 220 459 51 140 441 221 460 51 140 441 222 461 51 140 441 223 462 51 140 441 224 463 51 140 441 225 464 51 140 441 226 465 51 140 441 227 466 51 140 441 316 467 51 140 441 317 468 51 140 441 318 469 51 140 441 319 470 51 140 441 228 471 51 140 441 229 472 51 140 441 230 473 51 140 441 536 540 51 140 441 231 474 51 140 441 232 475 51 140 441 233 476 51 140 441 234 477 51 140 441 235 478 51 140 591 5 569 236 479 51 140 141 237 480 51 140 141 238 101 51 140 141 239 102 51 140 141 240 103 51 140 141 241 104 51 140 141 242 105 51 140 141 243 106 51 140 141 244 107 51 140 141 245 108 51 140 141 246 109 51 140 141 247 481 382 140 141 248 482 382 140 141 249 483 382 140 141 250 484 382 140 141 251 485 382 140 141 252 486 382 140 141 253 487 382 140 141 254 89 382 140 141 255 488 382 140 141 256 90 382 140 141 257 489 382 140 141 258 92 382 140 141 259 490 382 140 141 260 491 382 140 141 261 492 382 140 141 262 493 382 140 141 263 494 382 140 141 264 495 382 140 141 265 496 382 140 141 266 498 497 570 267 499 382 140 141 268 500 382 140 141 269 501 382 140 141 270 502 382 140 141 271 503 382 140 141 272 504 382 140 141 273 505 382 140 141 274 96 382 140 141 275 97 382 140 141 276 506 382 140 141 277 98 382 140 141 278 507 51 140 592 569 279 508 51 140 592 569 280 509 382 140 141 281 510 382 140 141 282 511 382 140 141 283 512 382 140 141 537 541 382 140 141 538 542 382 140 141 539 543 382 140 141 284 513 382 140 141 285 514 382 140 141 286 515 382 140 141 287 516 382 140 141 288 517 382 140 141 289 518 382 140 141 290 519 51 140 141 291 520 51 140 141 292 521 51 140 141 293 522 51 140 141 294 524 51 140 591 571 295 525 51 140 591 571 296 526 51 140 141 297 527 51 140 141 298 528 51 140 141 299 529 51 140 141 300 530 51 140 141 301 531 51 140 141 302 532 51 140 141 303 533 51 140 534 304 110 51 140 535 10 11 12 18 139 138 139 138 52 51 140 141 53 51 140 141 74 51 140 141 54 51 140 141 75 51 140 141 55 51 140 141 556 51 140 141 56 51 140 141 57 51 140 141 58 51 140 141 76 51 140 141 59 51 140 141 60 51 140 141 61 51 140 141 62 51 140 141 63 51 140 141 64 51 140 141 65 51 140 141 77 51 140 141 66 51 140 141 67 51 140 141 78 140 141 68 140 141 79 51 140 141 80 51 140 141 69 51 140 141 81 51 140 141 70 51 140 141 82 51 140 141 71 51 140 141 72 51 140 141 72 51 140 141 73 51 140 141 83 557 140 593 598 84 51 140 593 598 85 51 140 593 598 86 51 140 593 598 87 51 140 593 598 555 51 140 141 88 557 593 598 21 22 139 138 139 138 113 51 140 141 114 51 140 141 115 51 140 141 13 139 138 139 138 110 382 140 141 111 112 14 139 138 139 138 101 382 140 141 102 382 140 141 103 382 140 141 104 382 140 141 105 382 140 141 106 382 140 141 107 382 140 141 108 382 140 141 109 382 140 141 15 5 16 558 51 140 593 598 559 51 140 593 598 560 51 140 593 598 561 564 140 593 598 562 564 140 593 598 563 564 140 593 598 5 17 89 422 90 91 92 93 94 95 374 140 594 598 96 97 98 5 523 595 599 600

6 9 99 139 138 139 138 146 118 51 140 145 147 141 119 51 140 145 147 141 120 51 140 145 147 141 121 51 140 145 147 141 117 51 140 577 147 141 572 5 122 51 140 577 147 141 572 123 51 140 578 147 141 596 124 51 140 578 147 141 596 125 51 140 578 147 141 596 126 51 140 578 147 141 596 127 51 140 578 147 141 596 5 128 51 140 578 147 141 596 129 51 140 443 147 141 596 130 51 140 579 147 141 596 131 51 142 141 147 141 132 51 142 141 147 141 133 51 142 141 147 141 134 51 142 141 147 141 135 51 142 141 147 141 136 51 142 141 147 141 137 51 142 141 147 141 19 139 138 139 138 23 51 140 141 147 141 24 51 140 141 147 141 143 144 140 141 147 141 25 51 140 141 147 141 26 51 140 141 147 141 27 51 140 141 147 141 28 51 140 141 147 141 29 51 140 141 147 141 30 51 140 141 147 141 31 148 140 580 147 141 32 51 140 580 147 141 33 51 140 141 147 141 34 51 140 141 147 141 35 51 140 141 147 141 36 51 140 141 147 141 37 51 140 141 147 141 38 51 140 141 147 141 39 51 140 141 147 141 20 139 138 139 138 40 41 42 43 51 140 581 573 44 45 51 140 581 573 46 47 51 140 582 574 48 49 51 140 582 574 446 544 444 140 453 545 444 140 454 546 444 140 455 547 444 140 456 548 444 140 447 549 444 140 448 550 444 140 449 551 444 140 450 552 444 140 451 553 444 140 452 554 444 140 149 50 444 140 445 5 100 139 138 139 138 323 148 140 583 573 325 148 140 583 573 326 148 140 583 573 327 148 140 583 573 328 148 140 583 573 324 148 140 332 573 329 148 140 330 575 331 148 140 333 575 159 334 51 140 141 575 160 335 51 140 141 575 161 336 51 140 141 575 337 51 140 141 575 338 51 140 141 575 339 51 140 141 575 340 51 140 141 575 341 51 140 141 575 342 51 140 141 575 343 51 140 141 575 344 51 140 141 575 345 51 140 141 575 346 51 140 141 575 347 51 140 141 575 348 51 140 141 575 162 349 51 140 141 575 163 350 51 140 141 575 164 351 51 140 141 575 156 565 51 140 584 573 157 352 51 140 585 573 158 353 51 140 585 573 165 354 51 140 141 575 166 355 51 140 141 575 167 357 51 140 141 575 168 356 51 140 141 575 169 358 51 140 141 575 170 359 51 140 141 575 171 360 51 140 457 576 172 361 51 140 141 575 601 324 51 140 141 575 311 362 51 140 141 575 305 308 51 140 586 573 173 363 51 140 141 575 309 310 51 140 141 575 312 364 51 140 141 575 313 365 51 140 141 575 314 366 51 140 141 575 306 307 51 140 586 573 315 367 51 140 586 573 174 368 51 140 141 175 369 51 140 587 573 176 177 51 140 587 573 178 370 51 140 587 573 179 371 51 140 587 573 180 372 51 140 587 573 181 373 51 140 141 182 375 382 140 588 573 376 382 140 588 573 377 382 140 588 573 378 382 140 588 573 379 382 140 588 573 380 382 140 588 573 381 382 140 588 573 381 51 140 141 183 383 51 140 141 184 384 51 140 141 185 385 51 140 141 186 386 51 140 141 387 331 51 140 589 573 187 388 51 140 588 573 188 389 51 140 588 573 189 390 51 140 588 573 190 391 51 140 141 191 392 374 140 141 192 393 51 140 141 193 394 382 140 141 194 395 51 140 141 195 396 374 140 141 196 397 374 140 141 197 398 374 140 141 198 399 374 140 141 199 400 374 140 141 200 401 374 140 141 201 402 374 140 141 202 403 374 140 141 203 404 374 140 141 204 405 374 140 141 205 406 51 140 141 206 407 51 140 141 207 408 51 140 141 208 409 51 140 141 209 410 51 140 141 210 411 51 140 141 211 412 51 140 141 212 413 51 140 141 213 414 51 140 141 214 415 51 140 141 215 416 51 140 141 216 417 51 140 141 217 418 51 140 419 147 420 597 320 421 51 140 590 566 567 150 113 51 140 141 321 114 382 140 590 147 141 567 322 115 51 140 590 566 567 151 435 51 140 141 152 436 51 140 141 424 429 51 140 141 425 430 51 140 141 426 431 51 140 440 568 439 438 51 140 440 568 427 432 51 140 141 153 428 51 140 141 154 434 51 140 141 155 437 51 140 141 423 433 51 140 441 218 442 51 140 441 219 458 51 140 441 220 459 51 140 441 221 460 51 140 441 222 461 51 140 441 223 462 51 140 441 224 463 51 140 441 225 464 51 140 441 226 465 51 140 441 227 466 51 140 441 316 467 51 140 441 317 468 51 140 441 318 469 51 140 441 319 470 51 140 441 228 471 51 140 441 229 472 51 140 441 230 473 51 140 441 536 540 51 140 441 231 474 51 140 441 232 475 51 140 441 233 476 51 140 441 234 477 51 140 441 235 478 51 140 591 5 569 236 479 51 140 141 237 480 51 140 141 238 101 51 140 141 239 102 51 140 141 240 103 51 140 141 241 104 51 140 141 242 105 51 140 141 243 106 51 140 141 244 107 51 140 141 245 108 51 140 141 246 109 51 140 141 247 481 382 140 141 248 482 382 140 141 249 483 382 140 141 250 484 382 140 141 251 485 382 140 141 252 486 382 140 141 253 487 382 140 141 254 89 382 140 141 255 488 382 140 141 256 90 382 140 141 257 489 382 140 141 258 92 382 140 141 259 490 382 140 141 260 491 382 140 141 261 492 382 140 141 262 493 382 140 141 263 494 382 140 141 264 495 382 140 141 265 496 382 140 141 266 498 497 570 267 499 382 140 141 268 500 382 140 141 269 501 382 140 141 270 502 382 140 141 271 503 382 140 141 272 504 382 140 141 273 505 382 140 141 274 96 382 140 141 275 97 382 140 141 276 506 382 140 141 277 98 382 140 141 278 507 51 140 592 569 279 508 51 140 592 569 280 509 382 140 141 281 510 382 140 141 282 511 382 140 141 283 512 382 140 141 537 541 382 140 141 538 542 382 140 141 539 543 382 140 141 284 513 382 140 141 285 514 382 140 141 286 515 382 140 141 287 516 382 140 141 288 517 382 140 141 289 518 382 140 141 290 519 51 140 141 291 520 51 140 141 292 521 51 140 141 293 522 51 140 141 294 524 51 140 591 571 295 525 51 140 591 571 296 526 51 140 141 297 527 51 140 141 298 528 51 140 141 299 529 51 140 141 300 530 51 140 141 301 531 51 140 141 302 532 51 140 141 303 533 51 140 534 304 110 51 140 535 10 11 12 18 139 138 139 138 52 51 140 141 53 51 140 141 74 51 140 141 54 51 140 141 75 51 140 141 55 51 140 141 556 51 140 141 56 51 140 141 57 51 140 141 58 51 140 141 76 51 140 141 59 51 140 141 60 51 140 141 61 51 140 141 62 51 140 141 63 51 140 141 64 51 140 141 65 51 140 141 77 51 140 141 66 51 140 141 67 51 140 141 78 140 141 68 140 141 79 51 140 141 80 51 140 141 69 51 140 141 81 51 140 141 70 51 140 141 82 51 140 141 71 51 140 141 72 51 140 141 72 51 140 141 73 51 140 141 83 557 140 593 598 84 51 140 593 598 85 51 140 593 598 86 51 140 593 598 87 51 140 593 598 555 51 140 141 88 557 593 598 21 22 139 138 139 138 113 51 140 141 114 51 140 141 115 51 140 141 13 139 138 139 138 110 382 140 141 111 112 14 139 138 139 138 101 382 140 141 102 382 140 141 103 382 140 141 104 382 140 141 105 382 140 141 106 382 140 141 107 382 140 141 108 382 140 141 109 382 140 141 15 5 16 558 51 140 593 598 559 51 140 593 598 560 51 140 593 598 561 564 140 593 598 562 564 140 593 598 563 564 140 593 598 5 17 89 422 90 91 92 93 94 95 374 140 594 598 96 97 98 5 523 595 599 600

6 9 99 139 138 139 138 146 118 51 140 145 147 141 119 51 140 145 147 141 120 51 140 145 147 141 121 51 140 145 147 141 117 51 140 577 147 141 572 5 122 51 140 577 147 141 572 123 51 140 578 147 141 596 124 51 140 578 147 141 596 125 51 140 578 147 141 596 126 51 140 578 147 141 596 127 51 140 578 147 141 596 5 128 51 140 578 147 141 596 129 51 140 443 147 141 596 130 51 140 579 147 141 596 131 51 142 141 147 141 132 51 142 141 147 141 133 51 142 141 147 141 134 51 142 141 147 141 135 51 142 141 147 141 136 51 142 141 147 141 137 51 142 141 147 141 19 139 138 139 138 23 51 140 141 147 141 24 51 140 141 147 141 143 144 140 141 147 141 25 51 140 141 147 141 26 51 140 141 147 141 27 51 140 141 147 141 28 51 140 141 147 141 29 51 140 141 147 141 30 51 140 141 147 141 31 148 140 580 147 141 32 51 140 580 147 141 33 51 140 141 147 141 34 51 140 141 147 141 35 51 140 141 147 141 36 51 140 141 147 141 37 51 140 141 147 141 38 51 140 141 147 141 39 51 140 141 147 141 20 139 138 139 138 40 41 42 43 51 140 581 573 44 45 51 140 581 573 46 47 51 140 582 574 48 49 51 140 582 574 446 544 444 140 453 545 444 140 454 546 444 140 455 547 444 140 456 548 444 140 447 549 444 140 448 550 444 140 449 551 444 140 450 552 444 140 451 553 444 140 452 554 444 140 149 50 444 140 445 5 100 139 138 139 138 323 148 140 583 573 325 148 140 583 573 326 148 140 583 573 327 148 140 583 573 328 148 140 583 573 324 148 140 332 573 329 148 140 330 575 331 148 140 333 575 159 334 51 140 141 575 160 335 51 140 141 575 161 336 51 140 141 575 337 51 140 141 575 338 51 140 141 575 339 51 140 141 575 340 51 140 141 575 341 51 140 141 575 342 51 140 141 575 343 51 140 141 575 344 51 140 141 575 345 51 140 141 575 346 51 140 141 575 347 51 140 141 575 348 51 140 141 575 162 349 51 140 141 575 163 350 51 140 141 575 164 351 51 140 141 575 156 565 51 140 584 573 157 352 51 140 585 573 158 353 51 140 585 573 165 354 51 140 141 575 166 355 51 140 141 575 167 357 51 140 141 575 168 356 51 140 141 575 169 358 51 140 141 575 170 359 51 140 141 575 171 360 51 140 457 576 172 361 51 140 141 575 601 324 51 140 141 575 311 362 51 140 141 575 305 308 51 140 586 573 173 363 51 140 141 575 309 310 51 140 141 575 312 364 51 140 141 575 313 365 51 140 141 575 314 366 51 140 141 575 306 307 51 140 586 573 315 367 51 140 586 573 174 368 51 140 141 175 369 51 140 587 573 176 177 51 140 587 573 178 370 51 140 587 573 179 371 51 140 587 573 180 372 51 140 587 573 181 373 51 140 141 182 375 382 140 588 573 376 382 140 588 573 377 382 140 588 573 378 382 140 588 573 379 382 140 588 573 380 382 140 588 573 381 382 140 588 573 381 51 140 141 183 383 51 140 141 184 384 51 140 141 185 385 51 140 141 186 386 51 140 141 387 331 51 140 589 573 187 388 51 140 588 573 188 389 51 140 588 573 189 390 51 140 588 573 190 391 51 140 141 191 392 374 140 141 192 393 51 140 141 193 394 382 140 141 194 395 51 140 141 195 396 374 140 141 196 397 374 140 141 197 398 374 140 141 198 399 374 140 141 199 400 374 140 141 200 401 374 140 141 201 402 374 140 141 202 403 374 140 141 203 404 374 140 141 204 405 374 140 141 205 406 51 140 141 206 407 51 140 141 207 408 51 140 141 208 409 51 140 141 209 410 51 140 141 210 411 51 140 141 211 412 51 140 141 212 413 51 140 141 213 414 51 140 141 214 415 51 140 141 215 416 51 140 141 216 417 51 140 141 217 418 51 140 419 147 420 597 320 421 51 140 590 566 567 150 113 51 140 141 321 114 382 140 590 147 141 567 322 115 51 140 590 566 567 151 435 51 140 141 152 436 51 140 141 424 429 51 140 141 425 430 51 140 141 426 431 51 140 440 568 439 438 51 140 440 568 427 432 51 140 141 153 428 51 140 141 154 434 51 140 141 155 437 51 140 141 423 433 51 140 441 218 442 51 140 441 219 458 51 140 441 220 459 51 140 441 221 460 51 140 441 222 461 51 140 441 223 462 51 140 441 224 463 51 140 441 225 464 51 140 441 226 465 51 140 441 227 466 51 140 441 316 467 51 140 441 317 468 51 140 441 318 469 51 140 441 319 470 51 140 441 228 471 51 140 441 229 472 51 140 441 230 473 51 140 441 536 540 51 140 441 231 474 51 140 441 232 475 51 140 441 233 476 51 140 441 234 477 51 140 441 235 478 51 140 591 5 569 236 479 51 140 141 237 480 51 140 141 238 101 51 140 141 239 102 51 140 141 240 103 51 140 141 241 104 51 140 141 242 105 51 140 141 243 106 51 140 141 244 107 51 140 141 245 108 51 140 141 246 109 51 140 141 247 481 382 140 141 248 482 382 140 141 249 483 382 140 141 250 484 382 140 141 251 485 382 140 141 252 486 382 140 141 253 487 382 140 141 254 89 382 140 141 255 488 382 140 141 256 90 382 140 141 257 489 382 140 141 258 92 382 140 141 259 490 382 140 141 260 491 382 140 141 261 492 382 140 141 262 493 382 140 141 263 494 382 140 141 264 495 382 140 141 265 496 382 140 141 266 498 497 570 267 499 382 140 141 268 500 382 140 141 269 501 382 140 141 270 502 382 140 141 271 503 382 140 141 272 504 382 140 141 273 505 382 140 141 274 96 382 140 141 275 97 382 140 141 276 506 382 140 141 277 98 382 140 141 278 507 51 140 592 569 279 508 51 140 592 569 280 509 382 140 141 281 510 382 140 141 282 511 382 140 141 283 512 382 140 141 537 541 382 140 141 538 542 382 140 141 539 543 382 140 141 284 513 382 140 141 285 514 382 140 141 286 515 382 140 141 287 516 382 140 141 288 517 382 140 141 289 518 382 140 141 290 519 51 140 141 291 520 51 140 141 292 521 51 140 141 293 522 51 140 141 294 524 51 140 591 571 295 525 51 140 591 571 296 526 51 140 141 297 527 51 140 141 298 528 51 140 141 299 529 51 140 141 300 530 51 140 141 301 531 51 140 141 302 532 51 140 141 303 533 51 140 534 304 110 51 140 535 10 11 12 18 139 138 139 138 52 51 140 141 53 51 140 141 74 51 140 141 54 51 140 141 75 51 140 141 55 51 140 141 556 51 140 141 56 51 140 141 57 51 140 141 58 51 140 141 76 51 140 141 59 51 140 141 60 51 140 141 61 51 140 141 62 51 140 141 63 51 140 141 64 51 140 141 65 51 140 141 77 51 140 141 66 51 140 141 67 51 140 141 78 140 141 68 140 141 79 51 140 141 80 51 140 141 69 51 140 141 81 51 140 141 70 51 140 141 82 51 140 141 71 51 140 141 72 51 140 141 72 51 140 141 73 51 140 141 83 557 140 593 598 84 51 140 593 598 85 51 140 593 598 86 51 140 593 598 87 51 140 593 598 555 51 140 141 88 557 593 598 21 22 139 138 139 138 113 51 140 141 114 51 140 141 115 51 140 141 13 139 138 139 138 110 382 140 141 111 112 14 139 138 139 138 101 382 140 141 102 382 140 141 103 382 140 141 104 382 140 141 105 382 140 141 106 382 140 141 107 382 140 141 108 382 140 141 109 382 140 141 15 5 16 558 51 140 593 598 559 51 140 593 598 560 51 140 593 598 561 564 140 593 598 562 564 140 593 598 563 564 140 593 598 5 17 89 422 90 91 92 93 94 95 374 140 594 598 96 97 98 5 523 595 599 600

6 9 99 139 138 139 138 146 118 51 140 145 147 141 119 51 140 145 147 141 120 51 140 145 147 141 121 51 140 145 147 141 117 51 140 577 147 141 572 5 122 51 140 577 147 141 572 123 51 140 578 147 141 596 124 51 140 578 147 141 596 125 51 140 578 147 141 596 126 51 140 578 147 141 596 127 51 140 578 147 141 596 5 128 51 140 578 147 141 596 129 51 140 443 147 141 596 130 51 140 579 147 141 596 131 51 142 141 147 141 132 51 142 141 147 141 133 51 142 141 147 141 134 51 142 141 147 141 135 51 142 141 147 141 136 51 142 141 147 141 137 51 142 141 147 141 19 139 138 139 138 23 51 140 141 147 141 24 51 140 141 147 141 143 144 140 141 147 141 25 51 140 141 147 141 26 51 140 141 147 141 27 51 140 141 147 141 28 51 140 141 147 141 29 51 140 141 147 141 30 51 140 141 147 141 31 148 140 580 147 141 32 51 140 580 147 141 33 51 140 141 147 141 34 51 140 141 147 141 35 51 140 141 147 141 36 51 140 141 147 141 37 51 140 141 147 141 38 51 140 141 147 141 39 51 140 141 147 141 20 139 138 139 138 40 41 42 43 51 140 581 573 44 45 51 140 581 573 46 47 51 140 582 574 48 49 51 140 582 574 446 544 444 140 453 545 444 140 454 546 444 140 455 547 444 140 456 548 444 140 447 549 444 140 448 550 444 140 449 551 444 140 450 552 444 140 451 553 444 140 452 554 444 140 149 50 444 140 445 5 100 139 138 139 138 323 148 140 583 573 325 148 140 583 573 326 148 140 583 573 327 148 140 583 573 328 148 140 583 573 324 148 140 332 573 329 148 140 330 575 331 148 140 333 575 159 334 51 140 141 575 160 335 51 140 141 575 161 336 51 140 141 575 337 51 140 141 575 338 51 140 141 575 339 51 140 141 575 340 51 140 141 575 341 51 140 141 575 342 51 140 141 575 343 51 140 141 575 344 51 140 141 575 345 51 140 141 575 346 51 140 141 575 347 51 140 141 575 348 51 140 141 575 162 349 51 140 141 575 163 350 51 140 141 575 164 351 51 140 141 575 156 565 51 140 584 573 157 352 51 140 585 573 158 353 51 140 585 573 165 354 51 140 141 575 166 355 51 140 141 575 167 357 51 140 141 575 168 356 51 140 141 575 169 358 51 140 141 575 170 359 51 140 141 575 171 360 51 140 457 576 172 361 51 140 141 575 601 324 51 140 141 575 311 362 51 140 141 575 305 308 51 140 586 573 173 363 51 140 141 575 309 310 51 140 141 575 312 364 51 140 141 575 313 365 51 140 141 575 314 366 51 140 141 575 306 307 51 140 586 573 315 367 51 140 586 573 174 368 51 140 141 175 369 51 140 587 573 176 177 51 140 587 573 178 370 51 140 587 573 179 371 51 140 587 573 180 372 51 140 587 573 181 373 51 140 141 182 375 382 140 588 573 376 382 140 588 573 377 382 140 588 573 378 382 140 588 573 379 382 140 588 573 380 382 140 588 573 381 382 140 588 573 381 51 140 141 183 383 51 140 141 184 384 51 140 141 185 385 51 140 141 186 386 51 140 141 387 331 51 140 589 573 187 388 51 140 588 573 188 389 51 140 588 573 189 390 51 140 588 573 190 391 51 140 141 191 392 374 140 141 192 393 51 140 141 193 394 382 140 141 194 395 51 140 141 195 396 374 140 141 196 397 374 140 141 197 398 374 140 141 198 399 374 140 141 199 400 374 140 141 200 401 374 140 141 201 402 374 140 141 202 403 374 140 141 203 404 374 140 141 204 405 374 140 141 205 406 51 140 141 206 407 51 140 141 207 408 51 140 141 208 409 51 140 141 209 410 51 140 141 210 411 51 140 141 211 412 51 140 141 212 413 51 140 141 213 414 51 140 141 214 415 51 140 141 215 416 51 140 141 216 417 51 140 141 217 418 51 140 419 147 420 597 320 421 51 140 590 566 567 150 113 51 140 141 321 114 382 140 590 147 141 567 322 115 51 140 590 566 567 151 435 51 140 141 152 436 51 140 141 424 429 51 140 141 425 430 51 140 141 426 431 51 140 440 568 439 438 51 140 440 568 427 432 51 140 141 153 428 51 140 141 154 434 51 140 141 155 437 51 140 141 423 433 51 140 441 218 442 51 140 441 219 458 51 140 441 220 459 51 140 441 221 460 51 140 441 222 461 51 140 441 223 462 51 140 441 224 463 51 140 441 225 464 51 140 441 226 465 51 140 441 227 466 51 140 441 316 467 51 140 441 317 468 51 140 441 318 469 51 140 441 319 470 51 140 441 228 471 51 140 441 229 472 51 140 441 230 473 51 140 441 536 540 51 140 441 231 474 51 140 441 232 475 51 140 441 233 476 51 140 441 234 477 51 140 441 235 478 51 140 591 5 569 236 479 51 140 141 237 480 51 140 141 238 101 51 140 141 239 102 51 140 141 240 103 51 140 141 241 104 51 140 141 242 105 51 140 141 243 106 51 140 141 244 107 51 140 141 245 108 51 140 141 246 109 51 140 141 247 481 382 140 141 248 482 382 140 141 249 483 382 140 141 250 484 382 140 141 251 485 382 140 141 252 486 382 140 141 253 487 382 140 141 254 89 382 140 141 255 488 382 140 141 256 90 382 140 141 257 489 382 140 141 258 92 382 140 141 259 490 382 140 141 260 491 382 140 141 261 492 382 140 141 262 493 382 140 141 263 494 382 140 141 264 495 382 140 141 265 496 382 140 141 266 498 497 570 267 499 382 140 141 268 500 382 140 141 269 501 382 140 141 270 502 382 140 141 271 503 382 140 141 272 504 382 140 141 273 505 382 140 141 274 96 382 140 141 275 97 382 140 141 276 506 382 140 141 277 98 382 140 141 278 507 51 140 592 569 279 508 51 140 592 569 280 509 382 140 141 281 510 382 140 141 282 511 382 140 141 283 512 382 140 141 537 541 382 140 141 538 542 382 140 141 539 543 382 140 141 284 513 382 140 141 285 514 382 140 141 286 515 382 140 141 287 516 382 140 141 288 517 382 140 141 289 518 382 140 141 290 519 51 140 141 291 520 51 140 141 292 521 51 140 141 293 522 51 140 141 294 524 51 140 591 571 295 525 51 140 591 571 296 526 51 140 141 297 527 51 140 141 298 528 51 140 141 299 529 51 140 141 300 530 51 140 141 301 531 51 140 141 302 532 51 140 141 303 533 51 140 534 304 110 51 140 535 10 11 12 18 139 138 139 138 52 51 140 141 53 51 140 141 74 51 140 141 54 51 140 141 75 51 140 141 55 51 140 141 556 51 140 141 56 51 140 141 57 51 140 141 58 51 140 141 76 51 140 141 59 51 140 141 60 51 140 141 61 51 140 141 62 51 140 141 63 51 140 141 64 51 140 141 65 51 140 141 77 51 140 141 66 51 140 141 67 51 140 141 78 140 141 68 140 141 79 51 140 141 80 51 140 141 69 51 140 141 81 51 140 141 70 51 140 141 82 51 140 141 71 51 140 141 72 51 140 141 72 51 140 141 73 51 140 141 83 557 140 593 598 84 51 140 593 598 85 51 140 593 598 86 51 140 593 598 87 51 140 593 598 555 51 140 141 88 557 593 598 21 22 139 138 139 138 113 51 140 141 114 51 140 141 115 51 140 141 13 139 138 139 138 110 382 140 141 111 112 14 139 138 139 138 101 382 140 141 102 382 140 141 103 382 140 141 104 382 140 141 105 382 140 141 106 382 140 141 107 382 140 141 108 382 140 141 109 382 140 141 15 5 16 558 51 140 593 598 559 51 140 593 598 560 51 140 593 598 561 564 140 593 598 562 564 140 593 598 563 564 140 593 598 5 17 89 422 90 91 92 93 94 95 374 140 594 598 96 97 98 5 523 595 599 600

6 9 99 139 138 139 138 146 118 51 140 145 147 141 119 51 140 145 147 141 120 51 140 145 147 141 121 51 140 145 147 141 117 51 140 577 147 141 572 5 122 51 140 577 147 141 572 123 51 140 578 147 141 596 124 51 140 578 147 141 596 125 51 140 578 147 141 596 126 51 140 578 147 141 596 127 51 140 578 147 141 596 5 128 51 140 578 147 141 596 129 51 140 443 147 141 596 130 51 140 579 147 141 596 131 51 142 141 147 141 132 51 142 141 147 141 133 51 142 141 147 141 134 51 142 141 147 141 135 51 142 141 147 141 136 51 142 141 147 141 137 51 142 141 147 141 19 139 138 139 138 23 51 140 141 147 141 24 51 140 141 147 141 143 144 140 141 147 141 25 51 140 141 147 141 26 51 140 141 147 141 27 51 140 141 147 141 28 51 140 141 147 141 29 51 140 141 147 141 30 51 140 141 147 141 31 148 140 580 147 141 32 51 140 580 147 141 33 51 140 141 147 141 34 51 140 141 147 141 35 51 140 141 147 141 36 51 140 141 147 141 37 51 140 141 147 141 38 51 140 141 147 141 39 51 140 141 147 141 20 139 138 139 138 40 41 42 43 51 140 581 573 44 45 51 140 581 573 46 47 51 140 582 574 48 49 51 140 582 574 446 544 444 140 453 545 444 140 454 546 444 140 455 547 444 140 456 548 444 140 447 549 444 140 448 550 444 140 449 551 444 140 450 552 444 140 451 553 444 140 452 554 444 140 149 50 444 140 445 5 100 139 138 139 138 323 148 140 583 573 325 148 140 583 573 326 148 140 583 573 327 148 140 583 573 328 148 140 583 573 324 148 140 332 573 329 148 140 330 575 331 148 140 333 575 159 334 51 140 141 575 160 335 51 140 141 575 161 336 51 140 141 575 337 51 140 141 575 338 51 140 141 575 339 51 140 141 575 340 51 140 141 575 341 51 140 141 575 342 51 140 141 575 343 51 140 141 575 344 51 140 141 575 345 51 140 141 575 346 51 140 141 575 347 51 140 141 575 348 51 140 141 575 162 349 51 140 141 575 163 350 51 140 141 575 164 351 51 140 141 575 156 565 51 140 584 573 157 352 51 140 585 573 158 353 51 140 585 573 165 354 51 140 141 575 166 355 51 140 141 575 167 357 51 140 141 575 168 356 51 140 141 575 169 358 51 140 141 575 170 359 51 140 141 575 171 360 51 140 457 576 172 361 51 140 141 575 601 324 51 140 141 575 311 362 51 140 141 575 305 308 51 140 586 573 173 363 51 140 141 575 309 310 51 140 141 575 312 364 51 140 141 575 313 365 51 140 141 575 314 366 51 140 141 575 306 307 51 140 586 573 315 367 51 140 586 573 174 368 51 140 141 175 369 51 140 587 573 176 177 51 140 587 573 178 370 51 140 587 573 179 371 51 140 587 573 180 372 51 140 587 573 181 373 51 140 141 182 375 382 140 588 573 376 382 140 588 573 377 382 140 588 573 378 382 140 588 573 379 382 140 588 573 380 382 140 588 573 381 382 140 588 573 381 51 140 141 183 383 51 140 141 184 384 51 140 141 185 385 51 140 141 186 386 51 140 141 387 331 51 140 589 573 187 388 51 140 588 573 188 389 51 140 588 573 189 390 51 140 588 573 190 391 51 140 141 191 392 374 140 141 192 393 51 140 141 193 394 382 140 141 194 395 51 140 141 195 396 374 140 141 196 397 374 140 141 197 398 374 140 141 198 399 374 140 141 199 400 374 140 141 200 401 374 140 141 201 402 374 140 141 202 403 374 140 141 203 404 374 140 141 204 405 374 140 141 205 406 51 140 141 206 407 51 140 141 207 408 51 140 141 208 409 51 140 141 209 410 51 140 141 210 411 51 140 141 211 412 51 140 141 212 413 51 140 141 213 414 51 140 141 214 415 51 140 141 215 416 51 140 141 216 417 51 140 141 217 418 51 140 419 147 420 597 320 421 51 140 590 566 567 150 113 51 140 141 321 114 382 140 590 147 141 567 322 115 51 140 590 566 567 151 435 51 140 141 152 436 51 140 141 424 429 51 140 141 425 430 51 140 141 426 431 51 140 440 568 439 438 51 140 440 568 427 432 51 140 141 153 428 51 140 141 154 434 51 140 141 155 437 51 140 141 423 433 51 140 441 218 442 51 140 441 219 458 51 140 441 220 459 51 140 441 221 460 51 140 441 222 461 51 140 441 223 462 51 140 441 224 463 51 140 441 225 464 51 140 441 226 465 51 140 441 227 466 51 140 441 316 467 51 140 441 317 468 51 140 441 318 469 51 140 441 319 470 51 140 441 228 471 51 140 441 229 472 51 140 441 230 473 51 140 441 536 540 51 140 441 231 474 51 140 441 232 475 51 140 441 233 476 51 140 441 234 477 51 140 441 235 478 51 140 591 5 569 236 479 51 140 141 237 480 51 140 141 238 101 51 140 141 239 102 51 140 141 240 103 51 140 141 241 104 51 140 141 242 105 51 140 141 243 106 51 140 141 244 107 51 140 141 245 108 51 140 141 246 109 51 140 141 247 481 382 140 141 248 482 382 140 141 249 483 382 140 141 250 484 382 140 141 251 485 382 140 141 252 486 382 140 141 253 487 382 140 141 254 89 382 140 141 255 488 382 140 141 256 90 382 140 141 257 489 382 140 141 258 92 382 140 141 259 490 382 140 141 260 491 382 140 141 261 492 382 140 141 262 493 382 140 141 263 494 382 140 141 264 495 382 140 141 265 496 382 140 141 266 498 497 570 267 499 382 140 141 268 500 382 140 141 269 501 382 140 141 270 502 382 140 141 271 503 382 140 141 272 504 382 140 141 273 505 382 140 141 274 96 382 140 141 275 97 382 140 141 276 506 382 140 141 277 98 382 140 141 278 507 51 140 592 569 279 508 51 140 592 569 280 509 382 140 141 281 510 382 140 141 282 511 382 140 141 283 512 382 140 141 537 541 382 140 141 538 542 382 140 141 539 543 382 140 141 284 513 382 140 141 285 514 382 140 141 286 515 382 140 141 287 516 382 140 141 288 517 382 140 141 289 518 382 140 141 290 519 51 140 141 291 520 51 140 141 292 521 51 140 141 293 522 51 140 141 294 524 51 140 591 571 295 525 51 140 591 571 296 526 51 140 141 297 527 51 140 141 298 528 51 140 141 299 529 51 140 141 300 530 51 140 141 301 531 51 140 141 302 532 51 140 141 303 533 51 140 534 304 110 51 140 535 10 11 12 18 139 138 139 138 52 51 140 141 53 51 140 141 74 51 140 141 54 51 140 141 75 51 140 141 55 51 140 141 556 51 140 141 56 51 140 141 57 51 140 141 58 51 140 141 76 51 140 141 59 51 140 141 60 51 140 141 61 51 140 141 62 51 140 141 63 51 140 141 64 51 140 141 65 51 140 141 77 51 140 141 66 51 140 141 67 51 140 141 78 140 141 68 140 141 79 51 140 141 80 51 140 141 69 51 140 141 81 51 140 141 70 51 140 141 82 51 140 141 71 51 140 141 72 51 140 141 72 51 140 141 73 51 140 141 83 557 140 593 598 84 51 140 593 598 85 51 140 593 598 86 51 140 593 598 87 51 140 593 598 555 51 140 141 88 557 593 598 21 22 139 138 139 138 113 51 140 141 114 51 140 141 115 51 140 141 13 139 138 139 138 110 382 140 141 111 112 14 139 138 139 138 101 382 140 141 102 382 140 141 103 382 140 141 104 382 140 141 105 382 140 141 106 382 140 141 107 382 140 141 108 382 140 141 109 382 140 141 15 5 16 558 51 140 593 598 559 51 140 593 598 560 51 140 593 598 561 564 140 593 598 562 564 140 593 598 563 564 140 593 598 5 17 89 422 90 91 92 93 94 95 374 140 594 598 96 97 98 5 523 595 599 600

6 9 99 139 138 139 138 146 118 51 140 145 147 141 119 51 140 145 147 141 120 51 140 145 147 141 121 51 140 145 147 141 117 51 140 577 147 141 572 5 122 51 140 577 147 141 572 123 51 140 578 147 141 596 124 51 140 578 147 141 596 125 51 140 578 147 141 596 126 51 140 578 147 141 596 127 51 140 578 147 141 596 5 128 51 140 578 147 141 596 129 51 140 443 147 141 596 130 51 140 579 147 141 596 131 51 142 141 147 141 132 51 142 141 147 141 133 51 142 141 147 141 134 51 142 141 147 141 135 51 142 141 147 141 136 51 142 141 147 141 137 51 142 141 147 141 19 139 138 139 138 23 51 140 141 147 141 24 51 140 141 147 141 143 144 140 141 147 141 25 51 140 141 147 141 26 51 140 141 147 141 27 51 140 141 147 141 28 51 140 141 147 141 29 51 140 141 147 141 30 51 140 141 147 141 31 148 140 580 147 141 32 51 140 580 147 141 33 51 140 141 147 141 34 51 140 141 147 141 35 51 140 141 147 141 36 51 140 141 147 141 37 51 140 141 147 141 38 51 140 141 147 141 39 51 140 141 147 141 20 139 138 139 138 40 41 42 43 51 140 581 573 44 45 51 140 581 573 46 47 51 140 582 574 48 49 51 140 582 574 446 544 444 140 453 545 444 140 454 546 444 140 455 547 444 140 456 548 444 140 447 549 444 140 448 550 444 140 449 551 444 140 450 552 444 140 451 553 444 140 452 554 444 140 149 50 444 140 445 5 100 139 138 139 138 323 148 140 583 573 325 148 140 583 573 326 148 140 583 573 327 148 140 583 573 328 148 140 583 573 324 148 140 332 573 329 148 140 330 575 331 148 140 333 575 159 334 51 140 141 575 160 335 51 140 141 575 161 336 51 140 141 575 337 51 140 141 575 338 51 140 141 575 339 51 140 141 575 340 51 140 141 575 341 51 140 141 575 342 51 140 141 575 343 51 140 141 575 344 51 140 141 575 345 51 140 141 575 346 51 140 141 575 347 51 140 141 575 348 51 140 141 575 162 349 51 140 141 575 163 350 51 140 141 575 164 351 51 140 141 575 156 565 51 140 584 573 157 352 51 140 585 573 158 353 51 140 585 573 165 354 51 140 141 575 166 355 51 140 141 575 167 357 51 140 141 575 168 356 51 140 141 575 169 358 51 140 141 575 170 359 51 140 141 575 171 360 51 140 457 576 172 361 51 140 141 575 601 324 51 140 141 575 311 362 51 140 141 575 305 308 51 140 586 573 173 363 51 140 141 575 309 310 51 140 141 575 312 364 51 140 141 575 313 365 51 140 141 575 314 366 51 140 141 575 306 307 51 140 586 573 315 367 51 140 586 573 174 368 51 140 141 175 369 51 140 587 573 176 177 51 140 587 573 178 370 51 140 587 573 179 371 51 140 587 573 180 372 51 140 587 573 181 373 51 140 141 182 375 382 140 588 573 376 382 140 588 573 377 382 140 588 573 378 382 140 588 573 379 382 140 588 573 380 382 140 588 573 381 382 140 588 573 381 51 140 141 183 383 51 140 141 184 384 51 140 141 185 385 51 140 141 186 386 51 140 141 387 331 51 140 589 573 187 388 51 140 588 573 188 389 51 140 588 573 189 390 51 140 588 573 190 391 51 140 141 191 392 374 140 141 192 393 51 140 141 193 394 382 140 141 194 395 51 140 141 195 396 374 140 141 196 397 374 140 141 197 398 374 140 141 198 399 374 140 141 199 400 374 140 141 200 401 374 140 141 201 402 374 140 141 202 403 374 140 141 203 404 374 140 141 204 405 374 140 141 205 406 51 140 141 206 407 51 140 141 207 408 51 140 141 208 409 51 140 141 209 410 51 140 141 210 411 51 140 141 211 412 51 140 141 212 413 51 140 141 213 414 51 140 141 214 415 51 140 141 215 416 51 140 141 216 417 51 140 141 217 418 51 140 419 147 420 597 320 421 51 140 590 566 567 150 113 51 140 141 321 114 382 140 590 147 141 567 322 115 51 140 590 566 567 151 435 51 140 141 152 436 51 140 141 424 429 51 140 141 425 430 51 140 141 426 431 51 140 440 568 439 438 51 140 440 568 427 432 51 140 141 153 428 51 140 141 154 434 51 140 141 155 437 51 140 141 423 433 51 140 441 218 442 51 140 441 219 458 51 140 441 220 459 51 140 441 221 460 51 140 441 222 461 51 140 441 223 462 51 140 441 224 463 51 140 441 225 464 51 140 441 226 465 51 140 441 227 466 51 140 441 316 467 51 140 441 317 468 51 140 441 318 469 51 140 441 319 470 51 140 441 228 471 51 140 441 229 472 51 140 441 230 473 51 140 441 536 540 51 140 441 231 474 51 140 441 232 475 51 140 441 233 476 51 140 441 234 477 51 140 441 235 478 51 140 591 5 569 236 479 51 140 141 237 480 51 140 141 238 101 51 140 141 239 102 51 140 141 240 103 51 140 141 241 104 51 140 141 242 105 51 140 141 243 106 51 140 141 244 107 51 140 141 245 108 51 140 141 246 109 51 140 141 247 481 382 140 141 248 482 382 140 141 249 483 382 140 141 250 484 382 140 141 251 485 382 140 141 252 486 382 140 141 253 487 382 140 141 254 89 382 140 141 255 488 382 140 141 256 90 382 140 141 257 489 382 140 141 258 92 382 140 141 259 490 382 140 141 260 491 382 140 141 261 492 382 140 141 262 493 382 140 141 263 494 382 140 141 264 495 382 140 141 265 496 382 140 141 266 498 497 570 267 499 382 140 141 268 500 382 140 141 269 501 382 140 141 270 502 382 140 141 271 503 382 140 141 272 504 382 140 141 273 505 382 140 141 274 96 382 140 141 275 97 382 140 141 276 506 382 140 141 277 98 382 140 141 278 507 51 140 592 569 279 508 51 140 592 569 280 509 382 140 141 281 510 382 140 141 282 511 382 140 141 283 512 382 140 141 537 541 382 140 141 538 542 382 140 141 539 543 382 140 141 284 513 382 140 141 285 514 382 140 141 286 515 382 140 141 287 516 382 140 141 288 517 382 140 141 289 518 382 140 141 290 519 51 140 141 291 520 51 140 141 292 521 51 140 141 293 522 51 140 141 294 524 51 140 591 571 295 525 51 140 591 571 296 526 51 140 141 297 527 51 140 141 298 528 51 140 141 299 529 51 140 141 300 530 51 140 141 301 531 51 140 141 302 532 51 140 141 303 533 51 140 534 304 110 51 140 535 10 11 12 18 139 138 139 138 52 51 140 141 53 51 140 141 74 51 140 141 54 51 140 141 75 51 140 141 55 51 140 141 556 51 140 141 56 51 140 141 57 51 140 141 58 51 140 141 76 51 140 141 59 51 140 141 60 51 140 141 61 51 140 141 62 51 140 141 63 51 140 141 64 51 140 141 65 51 140 141 77 51 140 141 66 51 140 141 67 51 140 141 78 140 141 68 140 141 79 51 140 141 80 51 140 141 69 51 140 141 81 51 140 141 70 51 140 141 82 51 140 141 71 51 140 141 72 51 140 141 72 51 140 141 73 51 140 141 83 557 140 593 598 84 51 140 593 598 85 51 140 593 598 86 51 140 593 598 87 51 140 593 598 555 51 140 141 88 557 593 598 21 22 139 138 139 138 113 51 140 141 114 51 140 141 115 51 140 141 13 139 138 139 138 110 382 140 141 111 112 14 139 138 139 138 101 382 140 141 102 382 140 141 103 382 140 141 104 382 140 141 105 382 140 141 106 382 140 141 107 382 140 141 108 382 140 141 109 382 140 141 15 5 16 558 51 140 593 598 559 51 140 593 598 560 51 140 593 598 561 564 140 593 598 562 564 140 593 598 563 564 140 593 598 5 17 89 422 90 91 92 93 94 95 374 140 594 598 96 97 98 5 523 595 599 600

6 9 99 139 138 139 138 146 118 51 140 145 147 141 119 51 140 145 147 141 120 51 140 145 147 141 121 51 140 145 147 141 117 51 140 577 147 141 572 5 122 51 140 577 147 141 572 123 51 140 578 147 141 596 124 51 140 578 147 141 596 125 51 140 578 147 141 596 126 51 140 578 147 141 596 127 51 140 578 147 141 596 5 128 51 140 578 147 141 596 129 51 140 443 147 141 596 130 51 140 579 147 141 596 131 51 142 141 147 141 132 51 142 141 147 141 133 51 142 141 147 141 134 51 142 141 147 141 135 51 142 141 147 141 136 51 142 141 147 141 137 51 142 141 147 141 19 139 138 139 138 23 51 140 141 147 141 24 51 140 141 147 141 143 144 140 141 147 141 25 51 140 141 147 141 26 51 140 141 147 141 27 51 140 141 147 141 28 51 140 141 147 141 29 51 140 141 147 141 30 51 140 141 147 141 31 148 140 580 147 141 32 51 140 580 147 141 33 51 140 141 147 141 34 51 140 141 147 141 35 51 140 141 147 141 36 51 140 141 147 141 37 51 140 141 147 141 38 51 140 141 147 141 39 51 140 141 147 141 20 139 138 139 138 40 41 42 43 51 140 581 573 44 45 51 140 581 573 46 47 51 140 582 574 48 49 51 140 582 574 446 544 444 140 453 545 444 140 454 546 444 140 455 547 444 140 456 548 444 140 447 549 444 140 448 550 444 140 449 551 444 140 450 552 444 140 451 553 444 140 452 554 444 140 149 50 444 140 445 5 100 139 138 139 138 323 148 140 583 573 325 148 140 583 573 326 148 140 583 573 327 148 140 583 573 328 148 140 583 573 324 148 140 332 573 329 148 140 330 575 331 148 140 333 575 159 334 51 140 141 575 160 335 51 140 141 575 161 336 51 140 141 575 337 51 140 141 575 338 51 140 141 575 339 51 140 141 575 340 51 140 141 575 341 51 140 141 575 342 51 140 141 575 343 51 140 141 575 344 51 140 141 575 345 51 140 141 575 346 51 140 141 575 347 51 140 141 575 348 51 140 141 575 162 349 51 140 141 575 163 350 51 140 141 575 164 351 51 140 141 575 156 565 51 140 584 573 157 352 51 140 585 573 158 353 51 140 585 573 165 354 51 140 141 575 166 355 51 140 141 575 167 357 51 140 141 575 168 356 51 140 141 575 169 358 51 140 141 575 170 359 51 140 141 575 171 360 51 140 457 576 172 361 51 140 141 575 601 324 51 140 141 575 311 362 51 140 141 575 305 308 51 140 586 573 173 363 51 140 141 575 309 310 51 140 141 575 312 364 51 140 141 575 313 365 51 140 141 575 314 366 51 140 141 575 306 307 51 140 586 573 315 367 51 140 586 573 174 368 51 140 141 175 369 51 140 587 573 176 177 51 140 587 573 178 370 51 140 587 573 179 371 51 140 587 573 180 372 51 140 587 573 181 373 51 140 141 182 375 382 140 588 573 376 382 140 588 573 377 382 140 588 573 378 382 140 588 573 379 382 140 588 573 380 382 140 588 573 381 382 140 588 573 381 51 140 141 183 383 51 140 141 184 384 51 140 141 185 385 51 140 141 186 386 51 140 141 387 331 51 140 589 573 187 388 51 140 588 573 188 389 51 140 588 573 189 390 51 140 588 573 190 391 51 140 141 191 392 374 140 141 192 393 51 140 141 193 394 382 140 141 194 395 51 140 141 195 396 374 140 141 196 397 374 140 141 197 398 374 140 141 198 399 374 140 141 199 400 374 140 141 200 401 374 140 141 201 402 374 140 141 202 403 374 140 141 203 404 374 140 141 204 405 374 140 141 205 406 51 140 141 206 407 51 140 141 207 408 51 140 141 208 409 51 140 141 209 410 51 140 141 210 411 51 140 141 211 412 51 140 141 212 413 51 140 141 213 414 51 140 141 214 415 51 140 141 215 416 51 140 141 216 417 51 140 141 217 418 51 140 419 147 420 597 320 421 51 140 590 566 567 150 113 51 140 141 321 114 382 140 590 147 141 567 322 115 51 140 590 566 567 151 435 51 140 141 152 436 51 140 141 424 429 51 140 141 425 430 51 140 141 426 431 51 140 440 568 439 438 51 140 440 568 427 432 51 140 141 153 428 51 140 141 154 434 51 140 141 155 437 51 140 141 423 433 51 140 441 218 442 51 140 441 219 458 51 140 441 220 459 51 140 441 221 460 51 140 441 222 461 51 140 441 223 462 51 140 441 224 463 51 140 441 225 464 51 140 441 226 465 51 140 441 227 466 51 140 441 316 467 51 140 441 317 468 51 140 441 318 469 51 140 441 319 470 51 140 441 228 471 51 140 441 229 472 51 140 441 230 473 51 140 441 536 540 51 140 441 231 474 51 140 441 232 475 51 140 441 233 476 51 140 441 234 477 51 140 441 235 478 51 140 591 5 569 236 479 51 140 141 237 480 51 140 141 238 101 51 140 141 239 102 51 140 141 240 103 51 140 141 241 104 51 140 141 242 105 51 140 141 243 106 51 140 141 244 107 51 140 141 245 108 51 140 141 246 109 51 140 141 247 481 382 140 141 248 482 382 140 141 249 483 382 140 141 250 484 382 140 141 251 485 382 140 141 252 486 382 140 141 253 487 382 140 141 254 89 382 140 141 255 488 382 140 141 256 90 382 140 141 257 489 382 140 141 258 92 382 140 141 259 490 382 140 141 260 491 382 140 141 261 492 382 140 141 262 493 382 140 141 263 494 382 140 141 264 495 382 140 141 265 496 382 140 141 266 498 497 570 267 499 382 140 141 268 500 382 140 141 269 501 382 140 141 270 502 382 140 141 271 503 382 140 141 272 504 382 140 141 273 505 382 140 141 274 96 382 140 141 275 97 382 140 141 276 506 382 140 141 277 98 382 140 141 278 507 51 140 592 569 279 508 51 140 592 569 280 509 382 140 141 281 510 382 140 141 282 511 382 140 141 283 512 382 140 141 537 541 382 140 141 538 542 382 140 141 539 543 382 140 141 284 513 382 140 141 285 514 382 140 141 286 515 382 140 141 287 516 382 140 141 288 517 382 140 141 289 518 382 140 141 290 519 51 140 141 291 520 51 140 141 292 521 51 140 141 293 522 51 140 141 294 524 51 140 591 571 295 525 51 140 591 571 296 526 51 140 141 297 527 51 140 141 298 528 51 140 141 299 529 51 140 141 300 530 51 140 141 301 531 51 140 141 302 532 51 140 141 303 533 51 140 534 304 110 51 140 535 10 11 12 18 139 138 139 138 52 51 140 141 53 51 140 141 74 51 140 141 54 51 140 141 75 51 140 141 55 51 140 141 556 51 140 141 56 51 140 141 57 51 140 141 58 51 140 141 76 51 140 141 59 51 140 141 60 51 140 141 61 51 140 141 62 51 140 141 63 51 140 141 64 51 140 141 65 51 140 141 77 51 140 141 66 51 140 141 67 51 140 141 78 140 141 68 140 141 79 51 140 141 80 51 140 141 69 51 140 141 81 51 140 141 70 51 140 141 82 51 140 141 71 51 140 141 72 51 140 141 72 51 140 141 73 51 140 141 83 557 140 593 598 84 51 140 593 598 85 51 140 593 598 86 51 140 593 598 87 51 140 593 598 555 51 140 141 88 557 593 598 21 22 139 138 139 138 113 51 140 141 114 51 140 141 115 51 140 141 13 139 138 139 138 110 382 140 141 111 112 14 139 138 139 138 101 382 140 141 102 382 140 141 103 382 140 141 104 382 140 141 105 382 140 141 106 382 140 141 107 382 140 141 108 382 140 141 109 382 140 141 15 5 16 558 51 140 593 598 559 51 140 593 598 560 51 140 593 598 561 564 140 593 598 562 564 140 593 598 563 564 140 593 598 5 17 89 422 90 91 92 93 94 95 374 140 594 598 96 97 98 5 523 595 599 600

6 9 99 139 138 139 138 146 118 51 140 145 147 141 119 51 140 145 147 141 120 51 140 145 147 141 121 51 140 145 147 141 117 51 140 577 147 141 572 5 122 51 140 577 147 141 572 123 51 140 578 147 141 596 124 51 140 578 147 141 596 125 51 140 578 147 141 596 126 51 140 578 147 141 596 127 51 140 578 147 141 596 5 128 51 140 578 147 141 596 129 51 140 443 147 141 596 130 51 140 579 147 141 596 131 51 142 141 147 141 132 51 142 141 147 141 133 51 142 141 147 141 134 51 142 141 147 141 135 51 142 141 147 141 136 51 142 141 147 141 137 51 142 141 147 141 19 139 138 139 138 23 51 140 141 147 141 24 51 140 141 147 141 143 144 140 141 147 141 25 51 140 141 147 141 26 51 140 141 147 141 27 51 140 141 147 141 28 51 140 141 147 141 29 51 140 141 147 141 30 51 140 141 147 141 31 148 140 580 147 141 32 51 140 580 147 141 33 51 140 141 147 141 34 51 140 141 147 141 35 51 140 141 147 141 36 51 140 141 147 141 37 51 140 141 147 141 38 51 140 141 147 141 39 51 140 141 147 141 20 139 138 139 138 40 41 42 43 51 140 581 573 44 45 51 140 581 573 46 47 51 140 582 574 48 49 51 140 582 574 446 544 444 140 453 545 444 140 454 546 444 140 455 547 444 140 456 548 444 140 447 549 444 140 448 550 444 140 449 551 444 140 450 552 444 140 451 553 444 140 452 554 444 140 149 50 444 140 445 5 100 139 138 139 138 323 148 140 583 573 325 148 140 583 573 326 148 140 583 573 327 148 140 583 573 328 148 140 583 573 324 148 140 332 573 329 148 140 330 575 331 148 140 333 575 159 334 51 140 141 575 160 335 51 140 141 575 161 336 51 140 141 575 337 51 140 141 575 338 51 140 141 575 339 51 140 141 575 340 51 140 141 575 341 51 140 141 575 342 51 140 141 575 343 51 140 141 575 344 51 140 141 575 345 51 140 141 575 346 51 140 141 575 347 51 140 141 575 348 51 140 141 575 162 349 51 140 141 575 163 350 51 140 141 575 164 351 51 140 141 575 156 565 51 140 584 573 157 352 51 140 585 573 158 353 51 140 585 573 165 354 51 140 141 575 166 355 51 140 141 575 167 357 51 140 141 575 168 356 51 140 141 575 169 358 51 140 141 575 170 359 51 140 141 575 171 360 51 140 457 576 172 361 51 140 141 575 601 324 51 140 141 575 311 362 51 140 141 575 305 308 51 140 586 573 173 363 51 140 141 575 309 310 51 140 141 575 312 364 51 140 141 575 313 365 51 140 141 575 314 366 51 140 141 575 306 307 51 140 586 573 315 367 51 140 586 573 174 368 51 140 141 175 369 51 140 587 573 176 177 51 140 587 573 178 370 51 140 587 573 179 371 51 140 587 573 180 372 51 140 587 573 181 373 51 140 141 182 375 382 140 588 573 376 382 140 588 573 377 382 140 588 573 378 382 140 588 573 379 382 140 588 573 380 382 140 588 573 381 382 140 588 573 381 51 140 141 183 383 51 140 141 184 384 51 140 141 185 385 51 140 141 186 386 51 140 141 387 331 51 140 589 573 187 388 51 140 588 573 188 389 51 140 588 573 189 390 51 140 588 573 190 391 51 140 141 191 392 374 140 141 192 393 51 140 141 193 394 382 140 141 194 395 51 140 141 195 396 374 140 141 196 397 374 140 141 197 398 374 140 141 198 399 374 140 141 199 400 374 140 141 200 401 374 140 141 201 402 374 140 141 202 403 374 140 141 203 404 374 140 141 204 405 374 140 141 205 406 51 140 141 206 407 51 140 141 207 408 51 140 141 208 409 51 140 141 209 410 51 140 141 210 411 51 140 141 211 412 51 140 141 212 413 51 140 141 213 414 51 140 141 214 415 51 140 141 215 416 51 140 141 216 417 51 140 141 217 418 51 140 419 147 420 597 320 421 51 140 590 566 567 150 113 51 140 141 321 114 382 140 590 147 141 567 322 115 51 140 590 566 567 151 435 51 140 141 152 436 51 140 141 424 429 51 140 141 425 430 51 140 141 426 431 51 140 440 568 439 438 51 140 440 568 427 432 51 140 141 153 428 51 140 141 154 434 51 140 141 155 437 51 140 141 423 433 51 140 441 218 442 51 140 441 219 458 51 140 441 220 459 51 140 441 221 460 51 140 441 222 461 51 140 441 223 462 51 140 441 224 463 51 140 441 225 464 51 140 441 226 465 51 140 441 227 466 51 140 441 316 467 51 140 441 317 468 51 140 441 318 469 51 140 441 319 470 51 140 441 228 471 51 140 441 229 472 51 140 441 230 473 51 140 441 536 540 51 140 441 231 474 51 140 441 232 475 51 140 441 233 476 51 140 441 234 477 51 140 441 235 478 51 140 591 5 569 236 479 51 140 141 237 480 51 140 141 238 101 51 140 141 239 102 51 140 141 240 103 51 140 141 241 104 51 140 141 242 105 51 140 141 243 106 51 140 141 244 107 51 140 141 245 108 51 140 141 246 109 51 140 141 247 481 382 140 141 248 482 382 140 141 249 483 382 140 141 250 484 382 140 141 251 485 382 140 141 252 486 382 140 141 253 487 382 140 141 254 89 382 140 141 255 488 382 140 141 256 90 382 140 141 257 489 382 140 141 258 92 382 140 141 259 490 382 140 141 260 491 382 140 141 261 492 382 140 141 262 493 382 140 141 263 494 382 140 141 264 495 382 140 141 265 496 382 140 141 266 498 497 570 267 499 382 140 141 268 500 382 140 141 269 501 382 140 141 270 502 382 140 141 271 503 382 140 141 272 504 382 140 141 273 505 382 140 141 274 96 382 140 141 275 97 382 140 141 276 506 382 140 141 277 98 382 140 141 278 507 51 140 592 569 279 508 51 140 592 569 280 509 382 140 141 281 510 382 140 141 282 511 382 140 141 283 512 382 140 141 537 541 382 140 141 538 542 382 140 141 539 543 382 140 141 284 513 382 140 141 285 514 382 140 141 286 515 382 140 141 287 516 382 140 141 288 517 382 140 141 289 518 382 140 141 290 519 51 140 141 291 520 51 140 141 292 521 51 140 141 293 522 51 140 141 294 524 51 140 591 571 295 525 51 140 591 571 296 526 51 140 141 297 527 51 140 141 298 528 51 140 141 299 529 51 140 141 300 530 51 140 141 301 531 51 140 141 302 532 51 140 141 303 533 51 140 534 304 110 51 140 535 10 11 12 18 139 138 139 138 52 51 140 141 53 51 140 141 74 51 140 141 54 51 140 141 75 51 140 141 55 51 140 141 556 51 140 141 56 51 140 141 57 51 140 141 58 51 140 141 76 51 140 141 59 51 140 141 60 51 140 141 61 51 140 141 62 51 140 141 63 51 140 141 64 51 140 141 65 51 140 141 77 51 140 141 66 51 140 141 67 51 140 141 78 140 141 68 140 141 79 51 140 141 80 51 140 141 69 51 140 141 81 51 140 141 70 51 140 141 82 51 140 141 71 51 140 141 72 51 140 141 72 51 140 141 73 51 140 141 83 557 140 593 598 84 51 140 593 598 85 51 140 593 598 86 51 140 593 598 87 51 140 593 598 555 51 140 141 88 557 593 598 21 22 139 138 139 138 113 51 140 141 114 51 140 141 115 51 140 141 13 139 138 139 138 110 382 140 141 111 112 14 139 138 139 138 101 382 140 141 102 382 140 141 103 382 140 141 104 382 140 141 105 382 140 141 106 382 140 141 107 382 140 141 108 382 140 141 109 382 140 141 15 5 16 558 51 140 593 598 559 51 140 593 598 560 51 140 593 598 561 564 140 593 598 562 564 140 593 598 563 564 140 593 598 5 17 89 422 90 91 92 93 94 95 374 140 594 598 96 97 98 5 523 595 599 600

6 9 99 139 138 139 138 146 118 51 140 145 147 141 119 51 140 145 147 141 120 51 140 145 147 141 121 51 140 145 147 141 117 51 140 577 147 141 572 5 122 51 140 577 147 141 572 123 51 140 578 147 141 596 124 51 140 578 147 141 596 125 51 140 578 147 141 596 126 51 140 578 147 141 596 127 51 140 578 147 141 596 5 128 51 140 578 147 141 596 129 51 140 443 147 141 596 130 51 140 579 147 141 596 131 51 142 141 147 141 132 51 142 141 147 141 133 51 142 141 147 141 134 51 142 141 147 141 135 51 142 141 147 141 136 51 142 141 147 141 137 51 142 141 147 141 19 139 138 139 138 23 51 140 141 147 141 24 51 140 141 147 141 143 144 140 141 147 141 25 51 140 141 147 141 26 51 140 141 147 141 27 51 140 141 147 141 28 51 140 141 147 141 29 51 140 141 147 141 30 51 140 141 147 141 31 148 140 580 147 141 32 51 140 580 147 141 33 51 140 141 147 141 34 51 140 141 147 141 35 51 140 141 147 141 36 51 140 141 147 141 37 51 140 141 147 141 38 51 140 141 147 141 39 51 140 141 147 141 20 139 138 139 138 40 41 42 43 51 140 581 573 44 45 51 140 581 573 46 47 51 140 582 574 48 49 51 140 582 574 446 544 444 140 453 545 444 140 454 546 444 140 455 547 444 140 456 548 444 140 447 549 444 140 448 550 444 140 449 551 444 140 450 552 444 140 451 553 444 140 452 554 444 140 149 50 444 140 445 5 100 139 138 139 138 323 148 140 583 573 325 148 140 583 573 326 148 140 583 573 327 148 140 583 573 328 148 140 583 573 324 148 140 332 573 329 148 140 330 575 331 148 140 333 575 159 334 51 140 141 575 160 335 51 140 141 575 161 336 51 140 141 575 337 51 140 141 575 338 51 140 141 575 339 51 140 141 575 340 51 140 141 575 341 51 140 141 575 342 51 140 141 575 343 51 140 141 575 344 51 140 141 575 345 51 140 141 575 346 51 140 141 575 347 51 140 141 575 348 51 140 141 575 162 349 51 140 141 575 163 350 51 140 141 575 164 351 51 140 141 575 156 565 51 140 584 573 157 352 51 140 585 573 158 353 51 140 585 573 165 354 51 140 141 575 166 355 51 140 141 575 167 357 51 140 141 575 168 356 51 140 141 575 169 358 51 140 141 575 170 359 51 140 141 575 171 360 51 140 457 576 172 361 51 140 141 575 601 324 51 140 141 575 311 362 51 140 141 575 305 308 51 140 586 573 173 363 51 140 141 575 309 310 51 140 141 575 312 364 51 140 141 575 313 365 51 140 141 575 314 366 51 140 141 575 306 307 51 140 586 573 315 367 51 140 586 573 174 368 51 140 141 175 369 51 140 587 573 176 177 51 140 587 573 178 370 51 140 587 573 179 371 51 140 587 573 180 372 51 140 587 573 181 373 51 140 141 182 375 382 140 588 573 376 382 140 588 573 377 382 140 588 573 378 382 140 588 573 379 382 140 588 573 380 382 140 588 573 381 382 140 588 573 381 51 140 141 183 383 51 140 141 184 384 51 140 141 185 385 51 140 141 186 386 51 140 141 387 331 51 140 589 573 187 388 51 140 588 573 188 389 51 140 588 573 189 390 51 140 588 573 190 391 51 140 141 191 392 374 140 141 192 393 51 140 141 193 394 382 140 141 194 395 51 140 141 195 396 374 140 141 196 397 374 140 141 197 398 374 140 141 198 399 374 140 141 199 400 374 140 141 200 401 374 140 141 201 402 374 140 141 202 403 374 140 141 203 404 374 140 141 204 405 374 140 141 205 406 51 140 141 206 407 51 140 141 207 408 51 140 141 208 409 51 140 141 209 410 51 140 141 210 411 51 140 141 211 412 51 140 141 212 413 51 140 141 213 414 51 140 141 214 415 51 140 141 215 416 51 140 141 216 417 51 140 141 217 418 51 140 419 147 420 597 320 421 51 140 590 566 567 150 113 51 140 141 321 114 382 140 590 147 141 567 322 115 51 140 590 566 567 151 435 51 140 141 152 436 51 140 141 424 429 51 140 141 425 430 51 140 141 426 431 51 140 440 568 439 438 51 140 440 568 427 432 51 140 141 153 428 51 140 141 154 434 51 140 141 155 437 51 140 141 423 433 51 140 441 218 442 51 140 441 219 458 51 140 441 220 459 51 140 441 221 460 51 140 441 222 461 51 140 441 223 462 51 140 441 224 463 51 140 441 225 464 51 140 441 226 465 51 140 441 227 466 51 140 441 316 467 51 140 441 317 468 51 140 441 318 469 51 140 441 319 470 51 140 441 228 471 51 140 441 229 472 51 140 441 230 473 51 140 441 536 540 51 140 441 231 474 51 140 441 232 475 51 140 441 233 476 51 140 441 234 477 51 140 441 235 478 51 140 591 5 569 236 479 51 140 141 237 480 51 140 141 238 101 51 140 141 239 102 51 140 141 240 103 51 140 141 241 104 51 140 141 242 105 51 140 141 243 106 51 140 141 244 107 51 140 141 245 108 51 140 141 246 109 51 140 141 247 481 382 140 141 248 482 382 140 141 249 483 382 140 141 250 484 382 140 141 251 485 382 140 141 252 486 382 140 141 253 487 382 140 141 254 89 382 140 141 255 488 382 140 141 256 90 382 140 141 257 489 382 140 141 258 92 382 140 141 259 490 382 140 141 260 491 382 140 141 261 492 382 140 141 262 493 382 140 141 263 494 382 140 141 264 495 382 140 141 265 496 382 140 141 266 498 497 570 267 499 382 140 141 268 500 382 140 141 269 501 382 140 141 270 502 382 140 141 271 503 382 140 141 272 504 382 140 141 273 505 382 140 141 274 96 382 140 141 275 97 382 140 141 276 506 382 140 141 277 98 382 140 141 278 507 51 140 592 569 279 508 51 140 592 569 280 509 382 140 141 281 510 382 140 141 282 511 382 140 141 283 512 382 140 141 537 541 382 140 141 538 542 382 140 141 539 543 382 140 141 284 513 382 140 141 285 514 382 140 141 286 515 382 140 141 287 516 382 140 141 288 517 382 140 141 289 518 382 140 141 290 519 51 140 141 291 520 51 140 141 292 521 51 140 141 293 522 51 140 141 294 524 51 140 591 571 295 525 51 140 591 571 296 526 51 140 141 297 527 51 140 141 298 528 51 140 141 299 529 51 140 141 300 530 51 140 141 301 531 51 140 141 302 532 51 140 141 303 533 51 140 534 304 110 51 140 535 10 11 12 18 139 138 139 138 52 51 140 141 53 51 140 141 74 51 140 141 54 51 140 141 75 51 140 141 55 51 140 141 556 51 140 141 56 51 140 141 57 51 140 141 58 51 140 141 76 51 140 141 59 51 140 141 60 51 140 141 61 51 140 141 62 51 140 141 63 51 140 141 64 51 140 141 65 51 140 141 77 51 140 141 66 51 140 141 67 51 140 141 78 140 141 68 140 141 79 51 140 141 80 51 140 141 69 51 140 141 81 51 140 141 70 51 140 141 82 51 140 141 71 51 140 141 72 51 140 141 72 51 140 141 73 51 140 141 83 557 140 593 598 84 51 140 593 598 85 51 140 593 598 86 51 140 593 598 87 51 140 593 598 555 51 140 141 88 557 593 598 21 22 139 138 139 138 113 51 140 141 114 51 140 141 115 51 140 141 13 139 138 139 138 110 382 140 141 111 112 14 139 138 139 138 101 382 140 141 102 382 140 141 103 382 140 141 104 382 140 141 105 382 140 141 106 382 140 141 107 382 140 141 108 382 140 141 109 382 140 141 15 5 16 558 51 140 593 598 559 51 140 593 598 560 51 140 593 598 561 564 140 593 598 562 564 140 593 598 563 564 140 593 598 5 17 89 422 90 91 92 93 94 95 374 140 594 598 96 97 98 5 523 595 599 600

6 9 99 139 138 139 138 146 118 51 140 145 147 141 119 51 140 145 147 141 120 51 140 145 147 141 121 51 140 145 147 141 117 51 140 577 147 141 572 5 122 51 140 577 147 141 572 123 51 140 578 147 141 596 124 51 140 578 147 141 596 125 51 140 578 147 141 596 126 51 140 578 147 141 596 127 51 140 578 147 141 596 5 128 51 140 578 147 141 596 129 51 140 443 147 141 596 130 51 140 579 147 141 596 131 51 142 141 147 141 132 51 142 141 147 141 133 51 142 141 147 141 134 51 142 141 147 141 135 51 142 141 147 141 136 51 142 141 147 141 137 51 142 141 147 141 19 139 138 139 138 23 51 140 141 147 141 24 51 140 141 147 141 143 144 140 141 147 141 25 51 140 141 147 141 26 51 140 141 147 141 27 51 140 141 147 141 28 51 140 141 147 141 29 51 140 141 147 141 30 51 140 141 147 141 31 148 140 580 147 141 32 51 140 580 147 141 33 51 140 141 147 141 34 51 140 141 147 141 35 51 140 141 147 141 36 51 140 141 147 141 37 51 140 141 147 141 38 51 140 141 147 141 39 51 140 141 147 141 20 139 138 139 138 40 41 42 43 51 140 581 573 44 45 51 140 581 573 46 47 51 140 582 574 48 49 51 140 582 574 446 544 444 140 453 545 444 140 454 546 444 140 455 547 444 140 456 548 444 140 447 549 444 140 448 550 444 140 449 551 444 140 450 552 444 140 451 553 444 140 452 554 444 140 149 50 444 140 445 5 100 139 138 139 138 323 148 140 583 573 325 148 140 583 573 326 148 140 583 573 327 148 140 583 573 328 148 140 583 573 324 148 140 332 573 329 148 140 330 575 331 148 140 333 575 159 334 51 140 141 575 160 335 51 140 141 575 161 336 51 140 141 575 337 51 140 141 575 338 51 140 141 575 339 51 140 141 575 340 51 140 141 575 341 51 140 141 575 342 51 140 141 575 343 51 140 141 575 344 51 140 141 575 345 51 140 141 575 346 51 140 141 575 347 51 140 141 575 348 51 140 141 575 162 349 51 140 141 575 163 350 51 140 141 575 164 351 51 140 141 575 156 565 51 140 584 573 157 352 51 140 585 573 158 353 51 140 585 573 165 354 51 140 141 575 166 355 51 140 141 575 167 357 51 140 141 575 168 356 51 140 141 575 169 358 51 140 141 575 170 359 51 140 141 575 171 360 51 140 457 576 172 361 51 140 141 575 601 324 51 140 141 575 311 362 51 140 141 575 305 308 51 140 586 573 173 363 51 140 141 575 309 310 51 140 141 575 312 364 51 140 141 575 313 365 51 140 141 575 314 366 51 140 141 575 306 307 51 140 586 573 315 367 51 140 586 573 174 368 51 140 141 175 369 51 140 587 573 176 177 51 140 587 573 178 370 51 140 587 573 179 371 51 140 587 573 180 372 51 140 587 573 181 373 51 140 141 182 375 382 140 588 573 376 382 140 588 573 377 382 140 588 573 378 382 140 588 573 379 382 140 588 573 380 382 140 588 573 381 382 140 588 573 381 51 140 141 183 383 51 140 141 184 384 51 140 141 185 385 51 140 141 186 386 51 140 141 387 331 51 140 589 573 187 388 51 140 588 573 188 389 51 140 588 573 189 390 51 140 588 573 190 391 51 140 141 191 392 374 140 141 192 393 51 140 141 193 394 382 140 141 194 395 51 140 141 195 396 374 140 141 196 397 374 140 141 197 398 374 140 141 198 399 374 140 141 199 400 374 140 141 200 401 374 140 141 201 402 374 140 141 202 403 374 140 141 203 404 374 140 141 204 405 374 140 141 205 406 51 140 141 206 407 51 140 141 207 408 51 140 141 208 409 51 140 141 209 410 51 140 141 210 411 51 140 141 211 412 51 140 141 212 413 51 140 141 213 414 51 140 141 214 415 51 140 141 215 416 51 140 141 216 417 51 140 141 217 418 51 140 419 147 420 597 320 421 51 140 590 566 567 150 113 51 140 141 321 114 382 140 590 147 141 567 322 115 51 140 590 566 567 151 435 51 140 141 152 436 51 140 141 424 429 51 140 141 425 430 51 140 141 426 431 51 140 440 568 439 438 51 140 440 568 427 432 51 140 141 153 428 51 140 141 154 434 51 140 141 155 437 51 140 141 423 433 51 140 441 218 442 51 140 441 219 458 51 140 441 220 459 51 140 441 221 460 51 140 441 222 461 51 140 441 223 462 51 140 441 224 463 51 140 441 225 464 51 140 441 226 465 51 140 441 227 466 51 140 441 316 467 51 140 441 317 468 51 140 441 318 469 51 140 441 319 470 51 140 441 228 471 51 140 441 229 472 51 140 441 230 473 51 140 441 536 540 51 140 441 231 474 51 140 441 232 475 51 140 441 233 476 51 140 441 234 477 51 140 441 235 478 51 140 591 5 569 236 479 51 140 141 237 480 51 140 141 238 101 51 140 141 239 102 51 140 141 240 103 51 140 141 241 104 51 140 141 242 105 51 140 141 243 106 51 140 141 244 107 51 140 141 245 108 51 140 141 246 109 51 140 141 247 481 382 140 141 248 482 382 140 141 249 483 382 140 141 250 484 382 140 141 251 485 382 140 141 252 486 382 140 141 253 487 382 140 141 254 89 382 140 141 255 488 382 140 141 256 90 382 140 141 257 489 382 140 141 258 92 382 140 141 259 490 382 140 141 260 491 382 140 141 261 492 382 140 141 262 493 382 140 141 263 494 382 140 141 264 495 382 140 141 265 496 382 140 141 266 498 497 570 267 499 382 140 141 268 500 382 140 141 269 501 382 140 141 270 502 382 140 141 271 503 382 140 141 272 504 382 140 141 273 505 382 140 141 274 96 382 140 141 275 97 382 140 141 276 506 382 140 141 277 98 382 140 141 278 507 51 140 592 569 279 508 51 140 592 569 280 509 382 140 141 281 510 382 140 141 282 511 382 140 141 283 512 382 140 141 537 541 382 140 141 538 542 382 140 141 539 543 382 140 141 284 513 382 140 141 285 514 382 140 141 286 515 382 140 141 287 516 382 140 141 288 517 382 140 141 289 518 382 140 141 290 519 51 140 141 291 520 51 140 141 292 521 51 140 141 293 522 51 140 141 294 524 51 140 591 571 295 525 51 140 591 571 296 526 51 140 141 297 527 51 140 141 298 528 51 140 141 299 529 51 140 141 300 530 51 140 141 301 531 51 140 141 302 532 51 140 141 303 533 51 140 534 304 110 51 140 535 10 11 12 18 139 138 139 138 52 51 140 141 53 51 140 141 74 51 140 141 54 51 140 141 75 51 140 141 55 51 140 141 556 51 140 141 56 51 140 141 57 51 140 141 58 51 140 141 76 51 140 141 59 51 140 141 60 51 140 141 61 51 140 141 62 51 140 141 63 51 140 141 64 51 140 141 65 51 140 141 77 51 140 141 66 51 140 141 67 51 140 141 78 140 141 68 140 141 79 51 140 141 80 51 140 141 69 51 140 141 81 51 140 141 70 51 140 141 82 51 140 141 71 51 140 141 72 51 140 141 72 51 140 141 73 51 140 141 83 557 140 593 598 84 51 140 593 598 85 51 140 593 598 86 51 140 593 598 87 51 140 593 598 555 51 140 141 88 557 593 598 21 22 139 138 139 138 113 51 140 141 114 51 140 141 115 51 140 141 13 139 138 139 138 110 382 140 141 111 112 14 139 138 139 138 101 382 140 141 102 382 140 141 103 382 140 141 104 382 140 141 105 382 140 141 106 382 140 141 107 382 140 141 108 382 140 141 109 382 140 141 15 5 16 558 51 140 593 598 559 51 140 593 598 560 51 140 593 598 561 564 140 593 598 562 564 140 593 598 563 564 140 593 598 5 17 89 422 90 91 92 93 94 95 374 140 594 598 96 97 98 5 523 595 599 600

6 9 99 139 138 139 138 146 118 51 140 145 147 141 119 51 140 145 147 141 120 51 140 145 147 141 121 51 140 145 147 141 117 51 140 577 147 141 572 5 122 51 140 577 147 141 572 123 51 140 578 147 141 596 124 51 140 578 147 141 596 125 51 140 578 147 141 596 126 51 140 578 147 141 596 127 51 140 578 147 141 596 5 128 51 140 578 147 141 596 129 51 140 443 147 141 596 130 51 140 579 147 141 596 131 51 142 141 147 141 132 51 142 141 147 141 133 51 142 141 147 141 134 51 142 141 147 141 135 51 142 141 147 141 136 51 142 141 147 141 137 51 142 141 147 141 19 139 138 139 138 23 51 140 141 147 141 24 51 140 141 147 141 143 144 140 141 147 141 25 51 140 141 147 141 26 51 140 141 147 141 27 51 140 141 147 141 28 51 140 141 147 141 29 51 140 141 147 141 30 51 140 141 147 141 31 148 140 580 147 141 32 51 140 580 147 141 33 51 140 141 147 141 34 51 140 141 147 141 35 51 140 141 147 141 36 51 140 141 147 141 37 51 140 141 147 141 38 51 140 141 147 141 39 51 140 141 147 141 20 139 138 139 138 40 41 42 43 51 140 581 573 44 45 51 140 581 573 46 47 51 140 582 574 48 49 51 140 582 574 446 544 444 140 453 545 444 140 454 546 444 140 455 547 444 140 456 548 444 140 447 549 444 140 448 550 444 140 449 551 444 140 450 552 444 140 451 553 444 140 452 554 444 140 149 50 444 140 445 5 100 139 138 139 138 323 148 140 583 573 325 148 140 583 573 326 148 140 583 573 327 148 140 583 573 328 148 140 583 573 324 148 140 332 573 329 148 140 330 575 331 148 140 333 575 159 334 51 140 141 575 160 335 51 140 141 575 161 336 51 140 141 575 337 51 140 141 575 338 51 140 141 575 339 51 140 141 575 340 51 140 141 575 341 51 140 141 575 342 51 140 141 575 343 51 140 141 575 344 51 140 141 575 345 51 140 141 575 346 51 140 141 575 347 51 140 141 575 348 51 140 141 575 162 349 51 140 141 575 163 350 51 140 141 575 164 351 51 140 141 575 156 565 51 140 584 573 157 352 51 140 585 573 158 353 51 140 585 573 165 354 51 140 141 575 166 355 51 140 141 575 167 357 51 140 141 575 168 356 51 140 141 575 169 358 51 140 141 575 170 359 51 140 141 575 171 360 51 140 457 576 172 361 51 140 141 575 601 324 51 140 141 575 311 362 51 140 141 575 305 308 51 140 586 573 173 363 51 140 141 575 309 310 51 140 141 575 312 364 51 140 141 575 313 365 51 140 141 575 314 366 51 140 141 575 306 307 51 140 586 573 315 367 51 140 586 573 174 368 51 140 141 175 369 51 140 587 573 176 177 51 140 587 573 178 370 51 140 587 573 179 371 51 140 587 573 180 372 51 140 587 573 181 373 51 140 141 182 375 382 140 588 573 376 382 140 588 573 377 382 140 588 573 378 382 140 588 573 379 382 140 588 573 380 382 140 588 573 381 382 140 588 573 381 51 140 141 183 383 51 140 141 184 384 51 140 141 185 385 51 140 141 186 386 51 140 141 387 331 51 140 589 573 187 388 51 140 588 573 188 389 51 140 588 573 189 390 51 140 588 573 190 391 51 140 141 191 392 374 140 141 192 393 51 140 141 193 394 382 140 141 194 395 51 140 141 195 396 374 140 141 196 397 374 140 141 197 398 374 140 141 198 399 374 140 141 199 400 374 140 141 200 401 374 140 141 201 402 374 140 141 202 403 374 140 141 203 404 374 140 141 204 405 374 140 141 205 406 51 140 141 206 407 51 140 141 207 408 51 140 141 208 409 51 140 141 209 410 51 140 141 210 411 51 140 141 211 412 51 140 141 212 413 51 140 141 213 414 51 140 141 214 415 51 140 141 215 416 51 140 141 216 417 51 140 141 217 418 51 140 419 147 420 597 320 421 51 140 590 566 567 150 113 51 140 141 321 114 382 140 590 147 141 567 322 115 51 140 590 566 567 151 435 51 140 141 152 436 51 140 141 424 429 51 140 141 425 430 51 140 141 426 431 51 140 440 568 439 438 51 140 440 568 427 432 51 140 141 153 428 51 140 141 154 434 51 140 141 155 437 51 140 141 423 433 51 140 441 218 442 51 140 441 219 458 51 140 441 220 459 51 140 441 221 460 51 140 441 222 461 51 140 441 223 462 51 140 441 224 463 51 140 441 225 464 51 140 441 226 465 51 140 441 227 466 51 140 441 316 467 51 140 441 317 468 51 140 441 318 469 51 140 441 319 470 51 140 441 228 471 51 140 441 229 472 51 140 441 230 473 51 140 441 536 540 51 140 441 231 474 51 140 441 232 475 51 140 441 233 476 51 140 441 234 477 51 140 441 235 478 51 140 591 5 569 236 479 51 140 141 237 480 51 140 141 238 101 51 140 141 239 102 51 140 141 240 103 51 140 141 241 104 51 140 141 242 105 51 140 141 243 106 51 140 141 244 107 51 140 141 245 108 51 140 141 246 109 51 140 141 247 481 382 140 141 248 482 382 140 141 249 483 382 140 141 250 484 382 140 141 251 485 382 140 141 252 486 382 140 141 253 487 382 140 141 254 89 382 140 141 255 488 382 140 141 256 90 382 140 141 257 489 382 140 141 258 92 382 140 141 259 490 382 140 141 260 491 382 140 141 261 492 382 140 141 262 493 382 140 141 263 494 382 140 141 264 495 382 140 141 265 496 382 140 141 266 498 497 570 267 499 382 140 141 268 500 382 140 141 269 501 382 140 141 270 502 382 140 141 271 503 382 140 141 272 504 382 140 141 273 505 382 140 141 274 96 382 140 141 275 97 382 140 141 276 506 382 140 141 277 98 382 140 141 278 507 51 140 592 569 279 508 51 140 592 569 280 509 382 140 141 281 510 382 140 141 282 511 382 140 141 283 512 382 140 141 537 541 382 140 141 538 542 382 140 141 539 543 382 140 141 284 513 382 140 141 285 514 382 140 141 286 515 382 140 141 287 516 382 140 141 288 517 382 140 141 289 518 382 140 141 290 519 51 140 141 291 520 51 140 141 292 521 51 140 141 293 522 51 140 141 294 524 51 140 591 571 295 525 51 140 591 571 296 526 51 140 141 297 527 51 140 141 298 528 51 140 141 299 529 51 140 141 300 530 51 140 141 301 531 51 140 141 302 532 51 140 141 303 533 51 140 534 304 110 51 140 535 10 11 12 18 139 138 139 138 52 51 140 141 53 51 140 141 74 51 140 141 54 51 140 141 75 51 140 141 55 51 140 141 556 51 140 141 56 51 140 141 57 51 140 141 58 51 140 141 76 51 140 141 59 51 140 141 60 51 140 141 61 51 140 141 62 51 140 141 63 51 140 141 64 51 140 141 65 51 140 141 77 51 140 141 66 51 140 141 67 51 140 141 78 140 141 68 140 141 79 51 140 141 80 51 140 141 69 51 140 141 81 51 140 141 70 51 140 141 82 51 140 141 71 51 140 141 72 51 140 141 72 51 140 141 73 51 140 141 83 557 140 593 598 84 51 140 593 598 85 51 140 593 598 86 51 140 593 598 87 51 140 593 598 555 51 140 141 88 557 593 598 21 22 139 138 139 138 113 51 140 141 114 51 140 141 115 51 140 141 13 139 138 139 138 110 382 140 141 111 112 14 139 138 139 138 101 382 140 141 102 382 140 141 103 382 140 141 104 382 140 141 105 382 140 141 106 382 140 141 107 382 140 141 108 382 140 141 109 382 140 141 15 5 16 558 51 140 593 598 559 51 140 593 598 560 51 140 593 598 561 564 140 593 598 562 564 140 593 598 563 564 140 593 598 5 17 89 422 90 91 92 93 94 95 374 140 594 598 96 97 98 5 523 595 599 600

6 9 99 139 138 139 138 146 118 51 140 145 147 141 119 51 140 145 147 141 120 51 140 145 147 141 121 51 140 145 147 141 117 51 140 577 147 141 572 5 122 51 140 577 147 141 572 123 51 140 578 147 141 596 124 51 140 578 147 141 596 125 51 140 578 147 141 596 126 51 140 578 147 141 596 127 51 140 578 147 141 596 5 128 51 140 578 147 141 596 129 51 140 443 147 141 596 130 51 140 579 147 141 596 131 51 142 141 147 141 132 51 142 141 147 141 133 51 142 141 147 141 134 51 142 141 147 141 135 51 142 141 147 141 136 51 142 141 147 141 137 51 142 141 147 141 19 139 138 139 138 23 51 140 141 147 141 24 51 140 141 147 141 143 144 140 141 147 141 25 51 140 141 147 141 26 51 140 141 147 141 27 51 140 141 147 141 28 51 140 141 147 141 29 51 140 141 147 141 30 51 140 141 147 141 31 148 140 580 147 141 32 51 140 580 147 141 33 51 140 141 147 141 34 51 140 141 147 141 35 51 140 141 147 141 36 51 140 141 147 141 37 51 140 141 147 141 38 51 140 141 147 141 39 51 140 141 147 141 20 139 138 139 138 40 41 42 43 51 140 581 573 44 45 51 140 581 573 46 47 51 140 582 574 48 49 51 140 582 574 446 544 444 140 453 545 444 140 454 546 444 140 455 547 444 140 456 548 444 140 447 549 444 140 448 550 444 140 449 551 444 140 450 552 444 140 451 553 444 140 452 554 444 140 149 50 444 140 445 5 100 139 138 139 138 323 148 140 583 573 325 148 140 583 573 326 148 140 583 573 327 148 140 583 573 328 148 140 583 573 324 148 140 332 573 329 148 140 330 575 331 148 140 333 575 159 334 51 140 141 575 160 335 51 140 141 575 161 336 51 140 141 575 337 51 140 141 575 338 51 140 141 575 339 51 140 141 575 340 51 140 141 575 341 51 140 141 575 342 51 140 141 575 343 51 140 141 575 344 51 140 141 575 345 51 140 141 575 346 51 140 141 575 347 51 140 141 575 348 51 140 141 575 162 349 51 140 141 575 163 350 51 140 141 575 164 351 51 140 141 575 156 565 51 140 584 573 157 352 51 140 585 573 158 353 51 140 585 573 165 354 51 140 141 575 166 355 51 140 141 575 167 357 51 140 141 575 168 356 51 140 141 575 169 358 51 140 141 575 170 359 51 140 141 575 171 360 51 140 457 576 172 361 51 140 141 575 601 324 51 140 141 575 311 362 51 140 141 575 305 308 51 140 586 573 173 363 51 140 141 575 309 310 51 140 141 575 312 364 51 140 141 575 313 365 51 140 141 575 314 366 51 140 141 575 306 307 51 140 586 573 315 367 51 140 586 573 174 368 51 140 141 175 369 51 140 587 573 176 177 51 140 587 573 178 370 51 140 587 573 179 371 51 140 587 573 180 372 51 140 587 573 181 373 51 140 141 182 375 382 140 588 573 376 382 140 588 573 377 382 140 588 573 378 382 140 588 573 379 382 140 588 573 380 382 140 588 573 381 382 140 588 573 381 51 140 141 183 383 51 140 141 184 384 51 140 141 185 385 51 140 141 186 386 51 140 141 387 331 51 140 589 573 187 388 51 140 588 573 188 389 51 140 588 573 189 390 51 140 588 573 190 391 51 140 141 191 392 374 140 141 192 393 51 140 141 193 394 382 140 141 194 395 51 140 141 195 396 374 140 141 196 397 374 140 141 197 398 374 140 141 198 399 374 140 141 199 400 374 140 141 200 401 374 140 141 201 402 374 140 141 202 403 374 140 141 203 404 374 140 141 204 405 374 140 141 205 406 51 140 141 206 407 51 140 141 207 408 51 140 141 208 409 51 140 141 209 410 51 140 141 210 411 51 140 141 211 412 51 140 141 212 413 51 140 141 213 414 51 140 141 214 415 51 140 141 215 416 51 140 141 216 417 51 140 141 217 418 51 140 419 147 420 597 320 421 51 140 590 566 567 150 113 51 140 141 321 114 382 140 590 147 141 567 322 115 51 140 590 566 567 151 435 51 140 141 152 436 51 140 141 424 429 51 140 141 425 430 51 140 141 426 431 51 140 440 568 439 438 51 140 440 568 427 432 51 140 141 153 428 51 140 141 154 434 51 140 141 155 437 51 140 141 423 433 51 140 441 218 442 51 140 441 219 458 51 140 441 220 459 51 140 441 221 460 51 140 441 222 461 51 140 441 223 462 51 140 441 224 463 51 140 441 225 464 51 140 441 226 465 51 140 441 227 466 51 140 441 316 467 51 140 441 317 468 51 140 441 318 469 51 140 441 319 470 51 140 441 228 471 51 140 441 229 472 51 140 441 230 473 51 140 441 536 540 51 140 441 231 474 51 140 441 232 475 51 140 441 233 476 51 140 441 234 477 51 140 441 235 478 51 140 591 5 569 236 479 51 140 141 237 480 51 140 141 238 101 51 140 141 239 102 51 140 141 240 103 51 140 141 241 104 51 140 141 242 105 51 140 141 243 106 51 140 141 244 107 51 140 141 245 108 51 140 141 246 109 51 140 141 247 481 382 140 141 248 482 382 140 141 249 483 382 140 141 250 484 382 140 141 251 485 382 140 141 252 486 382 140 141 253 487 382 140 141 254 89 382 140 141 255 488 382 140 141 256 90 382 140 141 257 489 382 140 141 258 92 382 140 141 259 490 382 140 141 260 491 382 140 141 261 492 382 140 141 262 493 382 140 141 263 494 382 140 141 264 495 382 140 141 265 496 382 140 141 266 498 497 570 267 499 382 140 141 268 500 382 140 141 269 501 382 140 141 270 502 382 140 141 271 503 382 140 141 272 504 382 140 141 273 505 382 140 141 274 96 382 140 141 275 97 382 140 141 276 506 382 140 141 277 98 382 140 141 278 507 51 140 592 569 279 508 51 140 592 569 280 509 382 140 141 281 510 382 140 141 282 511 382 140 141 283 512 382 140 141 537 541 382 140 141 538 542 382 140 141 539 543 382 140 141 284 513 382 140 141 285 514 382 140 141 286 515 382 140 141 287 516 382 140 141 288 517 382 140 141 289 518 382 140 141 290 519 51 140 141 291 520 51 140 141 292 521 51 140 141 293 522 51 140 141 294 524 51 140 591 571 295 525 51 140 591 571 296 526 51 140 141 297 527 51 140 141 298 528 51 140 141 299 529 51 140 141 300 530 51 140 141 301 531 51 140 141 302 532 51 140 141 303 533 51 140 534 304 110 51 140 535 10 11 12 18 139 138 139 138 52 51 140 141 53 51 140 141 74 51 140 141 54 51 140 141 75 51 140 141 55 51 140 141 556 51 140 141 56 51 140 141 57 51 140 141 58 51 140 141 76 51 140 141 59 51 140 141 60 51 140 141 61 51 140 141 62 51 140 141 63 51 140 141 64 51 140 141 65 51 140 141 77 51 140 141 66 51 140 141 67 51 140 141 78 140 141 68 140 141 79 51 140 141 80 51 140 141 69 51 140 141 81 51 140 141 70 51 140 141 82 51 140 141 71 51 140 141 72 51 140 141 72 51 140 141 73 51 140 141 83 557 140 593 598 84 51 140 593 598 85 51 140 593 598 86 51 140 593 598 87 51 140 593 598 555 51 140 141 88 557 593 598 21 22 139 138 139 138 113 51 140 141 114 51 140 141 115 51 140 141 13 139 138 139 138 110 382 140 141 111 112 14 139 138 139 138 101 382 140 141 102 382 140 141 103 382 140 141 104 382 140 141 105 382 140 141 106 382 140 141 107 382 140 141 108 382 140 141 109 382 140 141 15 5 16 558 51 140 593 598 559 51 140 593 598 560 51 140 593 598 561 564 140 593 598 562 564 140 593 598 563 564 140 593 598 5 17 89 422 90 91 92 93 94 95 374 140 594 598 96 97 98 5 523 595 599 600

6 9 99 139 138 139 138 146 118 51 140 145 147 141 119 51 140 145 147 141 120 51 140 145 147 141 121 51 140 145 147 141 117 51 140 577 147 141 572 5 122 51 140 577 147 141 572 123 51 140 578 147 141 596 124 51 140 578 147 141 596 125 51 140 578 147 141 596 126 51 140 578 147 141 596 127 51 140 578 147 141 596 5 128 51 140 578 147 141 596 129 51 140 443 147 141 596 130 51 140 579 147 141 596 131 51 142 141 147 141 132 51 142 141 147 141 133 51 142 141 147 141 134 51 142 141 147 141 135 51 142 141 147 141 136 51 142 141 147 141 137 51 142 141 147 141 19 139 138 139 138 23 51 140 141 147 141 24 51 140 141 147 141 143 144 140 141 147 141 25 51 140 141 147 141 26 51 140 141 147 141 27 51 140 141 147 141 28 51 140 141 147 141 29 51 140 141 147 141 30 51 140 141 147 141 31 148 140 580 147 141 32 51 140 580 147 141 33 51 140 141 147 141 34 51 140 141 147 141 35 51 140 141 147 141 36 51 140 141 147 141 37 51 140 141 147 141 38 51 140 141 147 141 39 51 140 141 147 141 20 139 138 139 138 40 41 42 43 51 140 581 573 44 45 51 140 581 573 46 47 51 140 582 574 48 49 51 140 582 574 446 544 444 140 453 545 444 140 454 546 444 140 455 547 444 140 456 548 444 140 447 549 444 140 448 550 444 140 449 551 444 140 450 552 444 140 451 553 444 140 452 554 444 140 149 50 444 140 445 5 100 139 138 139 138 323 148 140 583 573 325 148 140 583 573 326 148 140 583 573 327 148 140 583 573 328 148 140 583 573 324 148 140 332 573 329 148 140 330 575 331 148 140 333 575 159 334 51 140 141 575 160 335 51 140 141 575 161 336 51 140 141 575 337 51 140 141 575 338 51 140 141 575 339 51 140 141 575 340 51 140 141 575 341 51 140 141 575 342 51 140 141 575 343 51 140 141 575 344 51 140 141 575 345 51 140 141 575 346 51 140 141 575 347 51 140 141 575 348 51 140 141 575 162 349 51 140 141 575 163 350 51 140 141 575 164 351 51 140 141 575 156 565 51 140 584 573 157 352 51 140 585 573 158 353 51 140 585 573 165 354 51 140 141 575 166 355 51 140 141 575 167 357 51 140 141 575 168 356 51 140 141 575 169 358 51 140 141 575 170 359 51 140 141 575 171 360 51 140 457 576 172 361 51 140 141 575 601 324 51 140 141 575 311 362 51 140 141 575 305 308 51 140 586 573 173 363 51 140 141 575 309 310 51 140 141 575 312 364 51 140 141 575 313 365 51 140 141 575 314 366 51 140 141 575 306 307 51 140 586 573 315 367 51 140 586 573 174 368 51 140 141 175 369 51 140 587 573 176 177 51 140 587 573 178 370 51 140 587 573 179 371 51 140 587 573 180 372 51 140 587 573 181 373 51 140 141 182 375 382 140 588 573 376 382 140 588 573 377 382 140 588 573 378 382 140 588 573 379 382 140 588 573 380 382 140 588 573 381 382 140 588 573 381 51 140 141 183 383 51 140 141 184 384 51 140 141 185 385 51 140 141 186 386 51 140 141 387 331 51 140 589 573 187 388 51 140 588 573 188 389 51 140 588 573 189 390 51 140 588 573 190 391 51 140 141 191 392 374 140 141 192 393 51 140 141 193 394 382 140 141 194 395 51 140 141 195 396 374 140 141 196 397 374 140 141 197 398 374 140 141 198 399 374 140 141 199 400 374 140 141 200 401 374 140 141 201 402 374 140 141 202 403 374 140 141 203 404 374 140 141 204 405 374 140 141 205 406 51 140 141 206 407 51 140 141 207 408 51 140 141 208 409 51 140 141 209 410 51 140 141 210 411 51 140 141 211 412 51 140 141 212 413 51 140 141 213 414 51 140 141 214 415 51 140 141 215 416 51 140 141 216 417 51 140 141 217 418 51 140 419 147 420 597 320 421 51 140 590 566 567 150 113 51 140 141 321 114 382 140 590 147 141 567 322 115 51 140 590 566 567 151 435 51 140 141 152 436 51 140 141 424 429 51 140 141 425 430 51 140 141 426 431 51 140 440 568 439 438 51 140 440 568 427 432 51 140 141 153 428 51 140 141 154 434 51 140 141 155 437 51 140 141 423 433 51 140 441 218 442 51 140 441 219 458 51 140 441 220 459 51 140 441 221 460 51 140 441 222 461 51 140 441 223 462 51 140 441 224 463 51 140 441 225 464 51 140 441 226 465 51 140 441 227 466 51 140 441 316 467 51 140 441 317 468 51 140 441 318 469 51 140 441 319 470 51 140 441 228 471 51 140 441 229 472 51 140 441 230 473 51 140 441 536 540 51 140 441 231 474 51 140 441 232 475 51 140 441 233 476 51 140 441 234 477 51 140 441 235 478 51 140 591 5 569 236 479 51 140 141 237 480 51 140 141 238 101 51 140 141 239 102 51 140 141 240 103 51 140 141 241 104 51 140 141 242 105 51 140 141 243 106 51 140 141 244 107 51 140 141 245 108 51 140 141 246 109 51 140 141 247 481 382 140 141 248 482 382 140 141 249 483 382 140 141 250 484 382 140 141 251 485 382 140 141 252 486 382 140 141 253 487 382 140 141 254 89 382 140 141 255 488 382 140 141 256 90 382 140 141 257 489 382 140 141 258 92 382 140 141 259 490 382 140 141 260 491 382 140 141 261 492 382 140 141 262 493 382 140 141 263 494 382 140 141 264 495 382 140 141 265 496 382 140 141 266 498 497 570 267 499 382 140 141 268 500 382 140 141 269 501 382 140 141 270 502 382 140 141 271 503 382 140 141 272 504 382 140 141 273 505 382 140 141 274 96 382 140 141 275 97 382 140 141 276 506 382 140 141 277 98 382 140 141 278 507 51 140 592 569 279 508 51 140 592 569 280 509 382 140 141 281 510 382 140 141 282 511 382 140 141 283 512 382 140 141 537 541 382 140 141 538 542 382 140 141 539 543 382 140 141 284 513 382 140 141 285 514 382 140 141 286 515 382 140 141 287 516 382 140 141 288 517 382 140 141 289 518 382 140 141 290 519 51 140 141 291 520 51 140 141 292 521 51 140 141 293 522 51 140 141 294 524 51 140 591 571 295 525 51 140 591 571 296 526 51 140 141 297 527 51 140 141 298 528 51 140 141 299 529 51 140 141 300 530 51 140 141 301 531 51 140 141 302 532 51 140 141 303 533 51 140 534 304 110 51 140 535 10 11 12 18 139 138 139 138 52 51 140 141 53 51 140 141 74 51 140 141 54 51 140 141 75 51 140 141 55 51 140 141 556 51 140 141 56 51 140 141 57 51 140 141 58 51 140 141 76 51 140 141 59 51 140 141 60 51 140 141 61 51 140 141 62 51 140 141 63 51 140 141 64 51 140 141 65 51 140 141 77 51 140 141 66 51 140 141 67 51 140 141 78 140 141 68 140 141 79 51 140 141 80 51 140 141 69 51 140 141 81 51 140 141 70 51 140 141 82 51 140 141 71 51 140 141 72 51 140 141 72 51 140 141 73 51 140 141 83 557 140 593 598 84 51 140 593 598 85 51 140 593 598 86 51 140 593 598 87 51 140 593 598 555 51 140 141 88 557 593 598 21 22 139 138 139 138 113 51 140 141 114 51 140 141 115 51 140 141 13 139 138 139 138 110 382 140 141 111 112 14 139 138 139 138 101 382 140 141 102 382 140 141 103 382 140 141 104 382 140 141 105 382 140 141 106 382 140 141 107 382 140 141 108 382 140 141 109 382 140 141 15 5 16 558 51 140 593 598 559 51 140 593 598 560 51 140 593 598 561 564 140 593 598 562 564 140 593 598 563 564 140 593 598 5 17 89 422 90 91 92 93 94 95 374 140 594 598 96 97 98 5 523 595 599 600

6 9 99 139 138 139 138 146 118 51 140 145 147 141 119 51 140 145 147 141 120 51 140 145 147 141 121 51 140 145 147 141 117 51 140 577 147 141 572 5 122 51 140 577 147 141 572 123 51 140 578 147 141 596 124 51 140 578 147 141 596 125 51 140 578 147 141 596 126 51 140 578 147 141 596 127 51 140 578 147 141 596 5 128 51 140 578 147 141 596 129 51 140 443 147 141 596 130 51 140 579 147 141 596 131 51 142 141 147 141 132 51 142 141 147 141 133 51 142 141 147 141 134 51 142 141 147 141 135 51 142 141 147 141 136 51 142 141 147 141 137 51 142 141 147 141 19 139 138 139 138 23 51 140 141 147 141 24 51 140 141 147 141 143 144 140 141 147 141 25 51 140 141 147 141 26 51 140 141 147 141 27 51 140 141 147 141 28 51 140 141 147 141 29 51 140 141 147 141 30 51 140 141 147 141 31 148 140 580 147 141 32 51 140 580 147 141 33 51 140 141 147 141 34 51 140 141 147 141 35 51 140 141 147 141 36 51 140 141 147 141 37 51 140 141 147 141 38 51 140 141 147 141 39 51 140 141 147 141 20 139 138 139 138 40 41 42 43 51 140 581 573 44 45 51 140 581 573 46 47 51 140 582 574 48 49 51 140 582 574 446 544 444 140 453 545 444 140 454 546 444 140 455 547 444 140 456 548 444 140 447 549 444 140 448 550 444 140 449 551 444 140 450 552 444 140 451 553 444 140 452 554 444 140 149 50 444 140 445 5 100 139 138 139 138 323 148 140 583 573 325 148 140 583 573 326 148 140 583 573 327 148 140 583 573 328 148 140 583 573 324 148 140 332 573 329 148 140 330 575 331 148 140 333 575 159 334 51 140 141 575 160 335 51 140 141 575 161 336 51 140 141 575 337 51 140 141 575 338 51 140 141 575 339 51 140 141 575 340 51 140 141 575 341 51 140 141 575 342 51 140 141 575 343 51 140 141 575 344 51 140 141 575 345 51 140 141 575 346 51 140 141 575 347 51 140 141 575 348 51 140 141 575 162 349 51 140 141 575 163 350 51 140 141 575 164 351 51 140 141 575 156 565 51 140 584 573 157 352 51 140 585 573 158 353 51 140 585 573 165 354 51 140 141 575 166 355 51 140 141 575 167 357 51 140 141 575 168 356 51 140 141 575 169 358 51 140 141 575 170 359 51 140 141 575 171 360 51 140 457 576 172 361 51 140 141 575 601 324 51 140 141 575 311 362 51 140 141 575 305 308 51 140 586 573 173 363 51 140 141 575 309 310 51 140 141 575 312 364 51 140 141 575 313 365 51 140 141 575 314 366 51 140 141 575 306 307 51 140 586 573 315 367 51 140 586 573 174 368 51 140 141 175 369 51 140 587 573 176 177 51 140 587 573 178 370 51 140 587 573 179 371 51 140 587 573 180 372 51 140 587 573 181 373 51 140 141 182 375 382 140 588 573 376 382 140 588 573 377 382 140 588 573 378 382 140 588 573 379 382 140 588 573 380 382 140 588 573 381 382 140 588 573 381 51 140 141 183 383 51 140 141 184 384 51 140 141 185 385 51 140 141 186 386 51 140 141 387 331 51 140 589 573 187 388 51 140 588 573 188 389 51 140 588 573 189 390 51 140 588 573 190 391 51 140 141 191 392 374 140 141 192 393 51 140 141 193 394 382 140 141 194 395 51 140 141 195 396 374 140 141 196 397 374 140 141 197 398 374 140 141 198 399 374 140 141 199 400 374 140 141 200 401 374 140 141 201 402 374 140 141 202 403 374 140 141 203 404 374 140 141 204 405 374 140 141 205 406 51 140 141 206 407 51 140 141 207 408 51 140 141 208 409 51 140 141 209 410 51 140 141 210 411 51 140 141 211 412 51 140 141 212 413 51 140 141 213 414 51 140 141 214 415 51 140 141 215 416 51 140 141 216 417 51 140 141 217 418 51 140 419 147 420 597 320 421 51 140 590 566 567 150 113 51 140 141 321 114 382 140 590 147 141 567 322 115 51 140 590 566 567 151 435 51 140 141 152 436 51 140 141 424 429 51 140 141 425 430 51 140 141 426 431 51 140 440 568 439 438 51 140 440 568 427 432 51 140 141 153 428 51 140 141 154 434 51 140 141 155 437 51 140 141 423 433 51 140 441 218 442 51 140 441 219 458 51 140 441 220 459 51 140 441 221 460 51 140 441 222 461 51 140 441 223 462 51 140 441 224 463 51 140 441 225 464 51 140 441 226 465 51 140 441 227 466 51 140 441 316 467 51 140 441 317 468 51 140 441 318 469 51 140 441 319 470 51 140 441 228 471 51 140 441 229 472 51 140 441 230 473 51 140 441 536 540 51 140 441 231 474 51 140 441 232 475 51 140 441 233 476 51 140 441 234 477 51 140 441 235 478 51 140 591 5 569 236 479 51 140 141 237 480 51 140 141 238 101 51 140 141 239 102 51 140 141 240 103 51 140 141 241 104 51 140 141 242 105 51 140 141 243 106 51 140 141 244 107 51 140 141 245 108 51 140 141 246 109 51 140 141 247 481 382 140 141 248 482 382 140 141 249 483 382 140 141 250 484 382 140 141 251 485 382 140 141 252 486 382 140 141 253 487 382 140 141 254 89 382 140 141 255 488 382 140 141 256 90 382 140 141 257 489 382 140 141 258 92 382 140 141 259 490 382 140 141 260 491 382 140 141 261 492 382 140 141 262 493 382 140 141 263 494 382 140 141 264 495 382 140 141 265 496 382 140 141 266 498 497 570 267 499 382 140 141 268 500 382 140 141 269 501 382 140 141 270 502 382 140 141 271 503 382 140 141 272 504 382 140 141 273 505 382 140 141 274 96 382 140 141 275 97 382 140 141 276 506 382 140 141 277 98 382 140 141 278 507 51 140 592 569 279 508 51 140 592 569 280 509 382 140 141 281 510 382 140 141 282 511 382 140 141 283 512 382 140 141 537 541 382 140 141 538 542 382 140 141 539 543 382 140 141 284 513 382 140 141 285 514 382 140 141 286 515 382 140 141 287 516 382 140 141 288 517 382 140 141 289 518 382 140 141 290 519 51 140 141 291 520 51 140 141 292 521 51 140 141 293 522 51 140 141 294 524 51 140 591 571 295 525 51 140 591 571 296 526 51 140 141 297 527 51 140 141 298 528 51 140 141 299 529 51 140 141 300 530 51 140 141 301 531 51 140 141 302 532 51 140 141 303 533 51 140 534 304 110 51 140 535 10 11 12 18 139 138 139 138 52 51 140 141 53 51 140 141 74 51 140 141 54 51 140 141 75 51 140 141 55 51 140 141 556 51 140 141 56 51 140 141 57 51 140 141 58 51 140 141 76 51 140 141 59 51 140 141 60 51 140 141 61 51 140 141 62 51 140 141 63 51 140 141 64 51 140 141 65 51 140 141 77 51 140 141 66 51 140 141 67 51 140 141 78 140 141 68 140 141 79 51 140 141 80 51 140 141 69 51 140 141 81 51 140 141 70 51 140 141 82 51 140 141 71 51 140 141 72 51 140 141 72 51 140 141 73 51 140 141 83 557 140 593 598 84 51 140 593 598 85 51 140 593 598 86 51 140 593 598 87 51 140 593 598 555 51 140 141 88 557 593 598 21 22 139 138 139 138 113 51 140 141 114 51 140 141 115 51 140 141 13 139 138 139 138 110 382 140 141 111 112 14 139 138 139 138 101 382 140 141 102 382 140 141 103 382 140 141 104 382 140 141 105 382 140 141 106 382 140 141 107 382 140 141 108 382 140 141 109 382 140 141 15 5 16 558 51 140 593 598 559 51 140 593 598 560 51 140 593 598 561 564 140 593 598 562 564 140 593 598 563 564 140 593 598 5 17 89 422 90 91 92 93 94 95 374 140 594 598 96 97 98 5 523 595 599 600

6 9 99 139 138 139 138 146 118 51 140 145 147 141 119 51 140 145 147 141 120 51 140 145 147 141 121 51 140 145 147 141 117 51 140 577 147 141 572 5 122 51 140 577 147 141 572 123 51 140 578 147 141 596 124 51 140 578 147 141 596 125 51 140 578 147 141 596 126 51 140 578 147 141 596 127 51 140 578 147 141 596 5 128 51 140 578 147 141 596 129 51 140 443 147 141 596 130 51 140 579 147 141 596 131 51 142 141 147 141 132 51 142 141 147 141 133 51 142 141 147 141 134 51 142 141 147 141 135 51 142 141 147 141 136 51 142 141 147 141 137 51 142 141 147 141 19 139 138 139 138 23 51 140 141 147 141 24 51 140 141 147 141 143 144 140 141 147 141 25 51 140 141 147 141 26 51 140 141 147 141 27 51 140 141 147 141 28 51 140 141 147 141 29 51 140 141 147 141 30 51 140 141 147 141 31 148 140 580 147 141 32 51 140 580 147 141 33 51 140 141 147 141 34 51 140 141 147 141 35 51 140 141 147 141 36 51 140 141 147 141 37 51 140 141 147 141 38 51 140 141 147 141 39 51 140 141 147 141 20 139 138 139 138 40 41 42 43 51 140 581 573 44 45 51 140 581 573 46 47 51 140 582 574 48 49 51 140 582 574 446 544 444 140 453 545 444 140 454 546 444 140 455 547 444 140 456 548 444 140 447 549 444 140 448 550 444 140 449 551 444 140 450 552 444 140 451 553 444 140 452 554 444 140 149 50 444 140 445 5 100 139 138 139 138 323 148 140 583 573 325 148 140 583 573 326 148 140 583 573 327 148 140 583 573 328 148 140 583 573 324 148 140 332 573 329 148 140 330 575 331 148 140 333 575 159 334 51 140 141 575 160 335 51 140 141 575 161 336 51 140 141 575 337 51 140 141 575 338 51 140 141 575 339 51 140 141 575 340 51 140 141 575 341 51 140 141 575 342 51 140 141 575 343 51 140 141 575 344 51 140 141 575 345 51 140 141 575 346 51 140 141 575 347 51 140 141 575 348 51 140 141 575 162 349 51 140 141 575 163 350 51 140 141 575 164 351 51 140 141 575 156 565 51 140 584 573 157 352 51 140 585 573 158 353 51 140 585 573 165 354 51 140 141 575 166 355 51 140 141 575 167 357 51 140 141 575 168 356 51 140 141 575 169 358 51 140 141 575 170 359 51 140 141 575 171 360 51 140 457 576 172 361 51 140 141 575 601 324 51 140 141 575 311 362 51 140 141 575 305 308 51 140 586 573 173 363 51 140 141 575 309 310 51 140 141 575 312 364 51 140 141 575 313 365 51 140 141 575 314 366 51 140 141 575 306 307 51 140 586 573 315 367 51 140 586 573 174 368 51 140 141 175 369 51 140 587 573 176 177 51 140 587 573 178 370 51 140 587 573 179 371 51 140 587 573 180 372 51 140 587 573 181 373 51 140 141 182 375 382 140 588 573 376 382 140 588 573 377 382 140 588 573 378 382 140 588 573 379 382 140 588 573 380 382 140 588 573 381 382 140 588 573 381 51 140 141 183 383 51 140 141 184 384 51 140 141 185 385 51 140 141 186 386 51 140 141 387 331 51 140 589 573 187 388 51 140 588 573 188 389 51 140 588 573 189 390 51 140 588 573 190 391 51 140 141 191 392 374 140 141 192 393 51 140 141 193 394 382 140 141 194 395 51 140 141 195 396 374 140 141 196 397 374 140 141 197 398 374 140 141 198 399 374 140 141 199 400 374 140 141 200 401 374 140 141 201 402 374 140 141 202 403 374 140 141 203 404 374 140 141 204 405 374 140 141 205 406 51 140 141 206 407 51 140 141 207 408 51 140 141 208 409 51 140 141 209 410 51 140 141 210 411 51 140 141 211 412 51 140 141 212 413 51 140 141 213 414 51 140 141 214 415 51 140 141 215 416 51 140 141 216 417 51 140 141 217 418 51 140 419 147 420 597 320 421 51 140 590 566 567 150 113 51 140 141 321 114 382 140 590 147 141 567 322 115 51 140 590 566 567 151 435 51 140 141 152 436 51 140 141 424 429 51 140 141 425 430 51 140 141 426 431 51 140 440 568 439 438 51 140 440 568 427 432 51 140 141 153 428 51 140 141 154 434 51 140 141 155 437 51 140 141 423 433 51 140 441 218 442 51 140 441 219 458 51 140 441 220 459 51 140 441 221 460 51 140 441 222 461 51 140 441 223 462 51 140 441 224 463 51 140 441 225 464 51 140 441 226 465 51 140 441 227 466 51 140 441 316 467 51 140 441 317 468 51 140 441 318 469 51 140 441 319 470 51 140 441 228 471 51 140 441 229 472 51 140 441 230 473 51 140 441 536 540 51 140 441 231 474 51 140 441 232 475 51 140 441 233 476 51 140 441 234 477 51 140 441 235 478 51 140 591 5 569 236 479 51 140 141 237 480 51 140 141 238 101 51 140 141 239 102 51 140 141 240 103 51 140 141 241 104 51 140 141 242 105 51 140 141 243 106 51 140 141 244 107 51 140 141 245 108 51 140 141 246 109 51 140 141 247 481 382 140 141 248 482 382 140 141 249 483 382 140 141 250 484 382 140 141 251 485 382 140 141 252 486 382 140 141 253 487 382 140 141 254 89 382 140 141 255 488 382 140 141 256 90 382 140 141 257 489 382 140 141 258 92 382 140 141 259 490 382 140 141 260 491 382 140 141 261 492 382 140 141 262 493 382 140 141 263 494 382 140 141 264 495 382 140 141 265 496 382 140 141 266 498 497 570 267 499 382 140 141 268 500 382 140 141 269 501 382 140 141 270 502 382 140 141 271 503 382 140 141 272 504 382 140 141 273 505 382 140 141 274 96 382 140 141 275 97 382 140 141 276 506 382 140 141 277 98 382 140 141 278 507 51 140 592 569 279 508 51 140 592 569 280 509 382 140 141 281 510 382 140 141 282 511 382 140 141 283 512 382 140 141 537 541 382 140 141 538 542 382 140 141 539 543 382 140 141 284 513 382 140 141 285 514 382 140 141 286 515 382 140 141 287 516 382 140 141 288 517 382 140 141 289 518 382 140 141 290 519 51 140 141 291 520 51 140 141 292 521 51 140 141 293 522 51 140 141 294 524 51 140 591 571 295 525 51 140 591 571 296 526 51 140 141 297 527 51 140 141 298 528 51 140 141 299 529 51 140 141 300 530 51 140 141 301 531 51 140 141 302 532 51 140 141 303 533 51 140 534 304 110 51 140 535 10 11 12 18 139 138 139 138 52 51 140 141 53 51 140 141 74 51 140 141 54 51 140 141 75 51 140 141 55 51 140 141 556 51 140 141 56 51 140 141 57 51 140 141 58 51 140 141 76 51 140 141 59 51 140 141 60 51 140 141 61 51 140 141 62 51 140 141 63 51 140 141 64 51 140 141 65 51 140 141 77 51 140 141 66 51 140 141 67 51 140 141 78 140 141 68 140 141 79 51 140 141 80 51 140 141 69 51 140 141 81 51 140 141 70 51 140 141 82 51 140 141 71 51 140 141 72 51 140 141 72 51 140 141 73 51 140 141 83 557 140 593 598 84 51 140 593 598 85 51 140 593 598 86 51 140 593 598 87 51 140 593 598 555 51 140 141 88 557 593 598 21 22 139 138 139 138 113 51 140 141 114 51 140 141 115 51 140 141 13 139 138 139 138 110 382 140 141 111 112 14 139 138 139 138 101 382 140 141 102 382 140 141 103 382 140 141 104 382 140 141 105 382 140 141 106 382 140 141 107 382 140 141 108 382 140 141 109 382 140 141 15 5 16 558 51 140 593 598 559 51 140 593 598 560 51 140 593 598 561 564 140 593 598 562 564 140 593 598 563 564 140 593 598 5 17 89 422 90 91 92 93 94 95 374 140 594 598 96 97 98 5 523 595 599 600

6 9 99 139 138 139 138 146 118 51 140 145 147 141 119 51 140 145 147 141 120 51 140 145 147 141 121 51 140 145 147 141 117 51 140 577 147 141 572 5 122 51 140 577 147 141 572 123 51 140 578 147 141 596 124 51 140 578 147 141 596 125 51 140 578 147 141 596 126 51 140 578 147 141 596 127 51 140 578 147 141 596 5 128 51 140 578 147 141 596 129 51 140 443 147 141 596 130 51 140 579 147 141 596 131 51 142 141 147 141 132 51 142 141 147 141 133 51 142 141 147 141 134 51 142 141 147 141 135 51 142 141 147 141 136 51 142 141 147 141 137 51 142 141 147 141 19 139 138 139 138 23 51 140 141 147 141 24 51 140 141 147 141 143 144 140 141 147 141 25 51 140 141 147 141 26 51 140 141 147 141 27 51 140 141 147 141 28 51 140 141 147 141 29 51 140 141 147 141 30 51 140 141 147 141 31 148 140 580 147 141 32 51 140 580 147 141 33 51 140 141 147 141 34 51 140 141 147 141 35 51 140 141 147 141 36 51 140 141 147 141 37 51 140 141 147 141 38 51 140 141 147 141 39 51 140 141 147 141 20 139 138 139 138 40 41 42 43 51 140 581 573 44 45 51 140 581 573 46 47 51 140 582 574 48 49 51 140 582 574 446 544 444 140 453 545 444 140 454 546 444 140 455 547 444 140 456 548 444 140 447 549 444 140 448 550 444 140 449 551 444 140 450 552 444 140 451 553 444 140 452 554 444 140 149 50 444 140 445 5 100 139 138 139 138 323 148 140 583 573 325 148 140 583 573 326 148 140 583 573 327 148 140 583 573 328 148 140 583 573 324 148 140 332 573 329 148 140 330 575 331 148 140 333 575 159 334 51 140 141 575 160 335 51 140 141 575 161 336 51 140 141 575 337 51 140 141 575 338 51 140 141 575 339 51 140 141 575 340 51 140 141 575 341 51 140 141 575 342 51 140 141 575 343 51 140 141 575 344 51 140 141 575 345 51 140 141 575 346 51 140 141 575 347 51 140 141 575 348 51 140 141 575 162 349 51 140 141 575 163 350 51 140 141 575 164 351 51 140 141 575 156 565 51 140 584 573 157 352 51 140 585 573 158 353 51 140 585 573 165 354 51 140 141 575 166 355 51 140 141 575 167 357 51 140 141 575 168 356 51 140 141 575 169 358 51 140 141 575 170 359 51 140 141 575 171 360 51 140 457 576 172 361 51 140 141 575 601 324 51 140 141 575 311 362 51 140 141 575 305 308 51 140 586 573 173 363 51 140 141 575 309 310 51 140 141 575 312 364 51 140 141 575 313 365 51 140 141 575 314 366 51 140 141 575 306 307 51 140 586 573 315 367 51 140 586 573 174 368 51 140 141 175 369 51 140 587 573 176 177 51 140 587 573 178 370 51 140 587 573 179 371 51 140 587 573 180 372 51 140 587 573 181 373 51 140 141 182 375 382 140 588 573 376 382 140 588 573 377 382 140 588 573 378 382 140 588 573 379 382 140 588 573 380 382 140 588 573 381 382 140 588 573 381 51 140 141 183 383 51 140 141 184 384 51 140 141 185 385 51 140 141 186 386 51 140 141 387 331 51 140 589 573 187 388 51 140 588 573 188 389 51 140 588 573 189 390 51 140 588 573 190 391 51 140 141 191 392 374 140 141 192 393 51 140 141 193 394 382 140 141 194 395 51 140 141 195 396 374 140 141 196 397 374 140 141 197 398 374 140 141 198 399 374 140 141 199 400 374 140 141 200 401 374 140 141 201 402 374 140 141 202 403 374 140 141 203 404 374 140 141 204 405 374 140 141 205 406 51 140 141 206 407 51 140 141 207 408 51 140 141 208 409 51 140 141 209 410 51 140 141 210 411 51 140 141 211 412 51 140 141 212 413 51 140 141 213 414 51 140 141 214 415 51 140 141 215 416 51 140 141 216 417 51 140 141 217 418 51 140 419 147 420 597 320 421 51 140 590 566 567 150 113 51 140 141 321 114 382 140 590 147 141 567 322 115 51 140 590 566 567 151 435 51 140 141 152 436 51 140 141 424 429 51 140 141 425 430 51 140 141 426 431 51 140 440 568 439 438 51 140 440 568 427 432 51 140 141 153 428 51 140 141 154 434 51 140 141 155 437 51 140 141 423 433 51 140 441 218 442 51 140 441 219 458 51 140 441 220 459 51 140 441 221 460 51 140 441 222 461 51 140 441 223 462 51 140 441 224 463 51 140 441 225 464 51 140 441 226 465 51 140 441 227 466 51 140 441 316 467 51 140 441 317 468 51 140 441 318 469 51 140 441 319 470 51 140 441 228 471 51 140 441 229 472 51 140 441 230 473 51 140 441 536 540 51 140 441 231 474 51 140 441 232 475 51 140 441 233 476 51 140 441 234 477 51 140 441 235 478 51 140 591 5 569 236 479 51 140 141 237 480 51 140 141 238 101 51 140 141 239 102 51 140 141 240 103 51 140 141 241 104 51 140 141 242 105 51 140 141 243 106 51 140 141 244 107 51 140 141 245 108 51 140 141 246 109 51 140 141 247 481 382 140 141 248 482 382 140 141 249 483 382 140 141 250 484 382 140 141 251 485 382 140 141 252 486 382 140 141 253 487 382 140 141 254 89 382 140 141 255 488 382 140 141 256 90 382 140 141 257 489 382 140 141 258 92 382 140 141 259 490 382 140 141 260 491 382 140 141 261 492 382 140 141 262 493 382 140 141 263 494 382 140 141 264 495 382 140 141 265 496 382 140 141 266 498 497 570 267 499 382 140 141 268 500 382 140 141 269 501 382 140 141 270 502 382 140 141 271 503 382 140 141 272 504 382 140 141 273 505 382 140 141 274 96 382 140 141 275 97 382 140 141 276 506 382 140 141 277 98 382 140 141 278 507 51 140 592 569 279 508 51 140 592 569 280 509 382 140 141 281 510 382 140 141 282 511 382 140 141 283 512 382 140 141 537 541 382 140 141 538 542 382 140 141 539 543 382 140 141 284 513 382 140 141 285 514 382 140 141 286 515 382 140 141 287 516 382 140 141 288 517 382 140 141 289 518 382 140 141 290 519 51 140 141 291 520 51 140 141 292 521 51 140 141 293 522 51 140 141 294 524 51 140 591 571 295 525 51 140 591 571 296 526 51 140 141 297 527 51 140 141 298 528 51 140 141 299 529 51 140 141 300 530 51 140 141 301 531 51 140 141 302 532 51 140 141 303 533 51 140 534 304 110 51 140 535 10 11 12 18 139 138 139 138 52 51 140 141 53 51 140 141 74 51 140 141 54 51 140 141 75 51 140 141 55 51 140 141 556 51 140 141 56 51 140 141 57 51 140 141 58 51 140 141 76 51 140 141 59 51 140 141 60 51 140 141 61 51 140 141 62 51 140 141 63 51 140 141 64 51 140 141 65 51 140 141 77 51 140 141 66 51 140 141 67 51 140 141 78 140 141 68 140 141 79 51 140 141 80 51 140 141 69 51 140 141 81 51 140 141 70 51 140 141 82 51 140 141 71 51 140 141 72 51 140 141 72 51 140 141 73 51 140 141 83 557 140 593 598 84 51 140 593 598 85 51 140 593 598 86 51 140 593 598 87 51 140 593 598 555 51 140 141 88 557 593 598 21 22 139 138 139 138 113 51 140 141 114 51 140 141 115 51 140 141 13 139 138 139 138 110 382 140 141 111 112 14 139 138 139 138 101 382 140 141 102 382 140 141 103 382 140 141 104 382 140 141 105 382 140 141 106 382 140 141 107 382 140 141 108 382 140 141 109 382 140 141 15 5 16 558 51 140 593 598 559 51 140 593 598 560 51 140 593 598 561 564 140 593 598 562 564 140 593 598 563 564 140 593 598 5 17 89 422 90 91 92 93 94 95 374 140 594 598 96 97 98 5 523 595 599 600

6 9 99 139 138 139 138 146 118 51 140 145 147 141 119 51 140 145 147 141 120 51 140 145 147 141 121 51 140 145 147 141 117 51 140 577 147 141 572 5 122 51 140 577 147 141 572 123 51 140 578 147 141 596 124 51 140 578 147 141 596 125 51 140 578 147 141 596 126 51 140 578 147 141 596 127 51 140 578 147 141 596 5 128 51 140 578 147 141 596 129 51 140 443 147 141 596 130 51 140 579 147 141 596 131 51 142 141 147 141 132 51 142 141 147 141 133 51 142 141 147 141 134 51 142 141 147 141 135 51 142 141 147 141 136 51 142 141 147 141 137 51 142 141 147 141 19 139 138 139 138 23 51 140 141 147 141 24 51 140 141 147 141 143 144 140 141 147 141 25 51 140 141 147 141 26 51 140 141 147 141 27 51 140 141 147 141 28 51 140 141 147 141 29 51 140 141 147 141 30 51 140 141 147 141 31 148 140 580 147 141 32 51 140 580 147 141 33 51 140 141 147 141 34 51 140 141 147 141 35 51 140 141 147 141 36 51 140 141 147 141 37 51 140 141 147 141 38 51 140 141 147 141 39 51 140 141 147 141 20 139 138 139 138 40 41 42 43 51 140 581 573 44 45 51 140 581 573 46 47 51 140 582 574 48 49 51 140 582 574 446 544 444 140 453 545 444 140 454 546 444 140 455 547 444 140 456 548 444 140 447 549 444 140 448 550 444 140 449 551 444 140 450 552 444 140 451 553 444 140 452 554 444 140 149 50 444 140 445 5 100 139 138 139 138 323 148 140 583 573 325 148 140 583 573 326 148 140 583 573 327 148 140 583 573 328 148 140 583 573 324 148 140 332 573 329 148 140 330 575 331 148 140 333 575 159 334 51 140 141 575 160 335 51 140 141 575 161 336 51 140 141 575 337 51 140 141 575 338 51 140 141 575 339 51 140 141 575 340 51 140 141 575 341 51 140 141 575 342 51 140 141 575 343 51 140 141 575 344 51 140 141 575 345 51 140 141 575 346 51 140 141 575 347 51 140 141 575 348 51 140 141 575 162 349 51 140 141 575 163 350 51 140 141 575 164 351 51 140 141 575 156 565 51 140 584 573 157 352 51 140 585 573 158 353 51 140 585 573 165 354 51 140 141 575 166 355 51 140 141 575 167 357 51 140 141 575 168 356 51 140 141 575 169 358 51 140 141 575 170 359 51 140 141 575 171 360 51 140 457 576 172 361 51 140 141 575 601 324 51 140 141 575 311 362 51 140 141 575 305 308 51 140 586 573 173 363 51 140 141 575 309 310 51 140 141 575 312 364 51 140 141 575 313 365 51 140 141 575 314 366 51 140 141 575 306 307 51 140 586 573 315 367 51 140 586 573 174 368 51 140 141 175 369 51 140 587 573 176 177 51 140 587 573 178 370 51 140 587 573 179 371 51 140 587 573 180 372 51 140 587 573 181 373 51 140 141 182 375 382 140 588 573 376 382 140 588 573 377 382 140 588 573 378 382 140 588 573 379 382 140 588 573 380 382 140 588 573 381 382 140 588 573 381 51 140 141 183 383 51 140 141 184 384 51 140 141 185 385 51 140 141 186 386 51 140 141 387 331 51 140 589 573 187 388 51 140 588 573 188 389 51 140 588 573 189 390 51 140 588 573 190 391 51 140 141 191 392 374 140 141 192 393 51 140 141 193 394 382 140 141 194 395 51 140 141 195 396 374 140 141 196 397 374 140 141 197 398 374 140 141 198 399 374 140 141 199 400 374 140 141 200 401 374 140 141 201 402 374 140 141 202 403 374 140 141 203 404 374 140 141 204 405 374 140 141 205 406 51 140 141 206 407 51 140 141 207 408 51 140 141 208 409 51 140 141 209 410 51 140 141 210 411 51 140 141 211 412 51 140 141 212 413 51 140 141 213 414 51 140 141 214 415 51 140 141 215 416 51 140 141 216 417 51 140 141 217 418 51 140 419 147 420 597 320 421 51 140 590 566 567 150 113 51 140 141 321 114 382 140 590 147 141 567 322 115 51 140 590 566 567 151 435 51 140 141 152 436 51 140 141 424 429 51 140 141 425 430 51 140 141 426 431 51 140 440 568 439 438 51 140 440 568 427 432 51 140 141 153 428 51 140 141 154 434 51 140 141 155 437 51 140 141 423 433 51 140 441 218 442 51 140 441 219 458 51 140 441 220 459 51 140 441 221 460 51 140 441 222 461 51 140 441 223 462 51 140 441 224 463 51 140 441 225 464 51 140 441 226 465 51 140 441 227 466 51 140 441 316 467 51 140 441 317 468 51 140 441 318 469 51 140 441 319 470 51 140 441 228 471 51 140 441 229 472 51 140 441 230 473 51 140 441 536 540 51 140 441 231 474 51 140 441 232 475 51 140 441 233 476 51 140 441 234 477 51 140 441 235 478 51 140 591 5 569 236 479 51 140 141 237 480 51 140 141 238 101 51 140 141 239 102 51 140 141 240 103 51 140 141 241 104 51 140 141 242 105 51 140 141 243 106 51 140 141 244 107 51 140 141 245 108 51 140 141 246 109 51 140 141 247 481 382 140 141 248 482 382 140 141 249 483 382 140 141 250 484 382 140 141 251 485 382 140 141 252 486 382 140 141 253 487 382 140 141 254 89 382 140 141 255 488 382 140 141 256 90 382 140 141 257 489 382 140 141 258 92 382 140 141 259 490 382 140 141 260 491 382 140 141 261 492 382 140 141 262 493 382 140 141 263 494 382 140 141 264 495 382 140 141 265 496 382 140 141 266 498 497 570 267 499 382 140 141 268 500 382 140 141 269 501 382 140 141 270 502 382 140 141 271 503 382 140 141 272 504 382 140 141 273 505 382 140 141 274 96 382 140 141 275 97 382 140 141 276 506 382 140 141 277 98 382 140 141 278 507 51 140 592 569 279 508 51 140 592 569 280 509 382 140 141 281 510 382 140 141 282 511 382 140 141 283 512 382 140 141 537 541 382 140 141 538 542 382 140 141 539 543 382 140 141 284 513 382 140 141 285 514 382 140 141 286 515 382 140 141 287 516 382 140 141 288 517 382 140 141 289 518 382 140 141 290 519 51 140 141 291 520 51 140 141 292 521 51 140 141 293 522 51 140 141 294 524 51 140 591 571 295 525 51 140 591 571 296 526 51 140 141 297 527 51 140 141 298 528 51 140 141 299 529 51 140 141 300 530 51 140 141 301 531 51 140 141 302 532 51 140 141 303 533 51 140 534 304 110 51 140 535 10 11 12 18 139 138 139 138 52 51 140 141 53 51 140 141 74 51 140 141 54 51 140 141 75 51 140 141 55 51 140 141 556 51 140 141 56 51 140 141 57 51 140 141 58 51 140 141 76 51 140 141 59 51 140 141 60 51 140 141 61 51 140 141 62 51 140 141 63 51 140 141 64 51 140 141 65 51 140 141 77 51 140 141 66 51 140 141 67 51 140 141 78 140 141 68 140 141 79 51 140 141 80 51 140 141 69 51 140 141 81 51 140 141 70 51 140 141 82 51 140 141 71 51 140 141 72 51 140 141 72 51 140 141 73 51 140 141 83 557 140 593 598 84 51 140 593 598 85 51 140 593 598 86 51 140 593 598 87 51 140 593 598 555 51 140 141 88 557 593 598 21 22 139 138 139 138 113 51 140 141 114 51 140 141 115 51 140 141 13 139 138 139 138 110 382 140 141 111 112 14 139 138 139 138 101 382 140 141 102 382 140 141 103 382 140 141 104 382 140 141 105 382 140 141 106 382 140 141 107 382 140 141 108 382 140 141 109 382 140 141 15 5 16 558 51 140 593 598 559 51 140 593 598 560 51 140 593 598 561 564 140 593 598 562 564 140 593 598 563 564 140 593 598 5 17 89 422 90 91 92 93 94 95 374 140 594 598 96 97 98 5 523 595 599 600

6 9 99 139 138 139 138 146 118 51 140 145 147 141 119 51 140 145 147 141 120 51 140 145 147 141 121 51 140 145 147 141 117 51 140 577 147 141 572 5 122 51 140 577 147 141 572 123 51 140 578 147 141 596 124 51 140 578 147 141 596 125 51 140 578 147 141 596 126 51 140 578 147 141 596 127 51 140 578 147 141 596 5 128 51 140 578 147 141 596 129 51 140 443 147 141 596 130 51 140 579 147 141 596 131 51 142 141 147 141 132 51 142 141 147 141 133 51 142 141 147 141 134 51 142 141 147 141 135 51 142 141 147 141 136 51 142 141 147 141 137 51 142 141 147 141 19 139 138 139 138 23 51 140 141 147 141 24 51 140 141 147 141 143 144 140 141 147 141 25 51 140 141 147 141 26 51 140 141 147 141 27 51 140 141 147 141 28 51 140 141 147 141 29 51 140 141 147 141 30 51 140 141 147 141 31 148 140 580 147 141 32 51 140 580 147 141 33 51 140 141 147 141 34 51 140 141 147 141 35 51 140 141 147 141 36 51 140 141 147 141 37 51 140 141 147 141 38 51 140 141 147 141 39 51 140 141 147 141 20 139 138 139 138 40 41 42 43 51 140 581 573 44 45 51 140 581 573 46 47 51 140 582 574 48 49 51 140 582 574 446 544 444 140 453 545 444 140 454 546 444 140 455 547 444 140 456 548 444 140 447 549 444 140 448 550 444 140 449 551 444 140 450 552 444 140 451 553 444 140 452 554 444 140 149 50 444 140 445 5 100 139 138 139 138 323 148 140 583 573 325 148 140 583 573 326 148 140 583 573 327 148 140 583 573 328 148 140 583 573 324 148 140 332 573 329 148 140 330 575 331 148 140 333 575 159 334 51 140 141 575 160 335 51 140 141 575 161 336 51 140 141 575 337 51 140 141 575 338 51 140 141 575 339 51 140 141 575 340 51 140 141 575 341 51 140 141 575 342 51 140 141 575 343 51 140 141 575 344 51 140 141 575 345 51 140 141 575 346 51 140 141 575 347 51 140 141 575 348 51 140 141 575 162 349 51 140 141 575 163 350 51 140 141 575 164 351 51 140 141 575 156 565 51 140 584 573 157 352 51 140 585 573 158 353 51 140 585 573 165 354 51 140 141 575 166 355 51 140 141 575 167 357 51 140 141 575 168 356 51 140 141 575 169 358 51 140 141 575 170 359 51 140 141 575 171 360 51 140 457 576 172 361 51 140 141 575 601 324 51 140 141 575 311 362 51 140 141 575 305 308 51 140 586 573 173 363 51 140 141 575 309 310 51 140 141 575 312 364 51 140 141 575 313 365 51 140 141 575 314 366 51 140 141 575 306 307 51 140 586 573 315 367 51 140 586 573 174 368 51 140 141 175 369 51 140 587 573 176 177 51 140 587 573 178 370 51 140 587 573 179 371 51 140 587 573 180 372 51 140 587 573 181 373 51 140 141 182 375 382 140 588 573 376 382 140 588 573 377 382 140 588 573 378 382 140 588 573 379 382 140 588 573 380 382 140 588 573 381 382 140 588 573 381 51 140 141 183 383 51 140 141 184 384 51 140 141 185 385 51 140 141 186 386 51 140 141 387 331 51 140 589 573 187 388 51 140 588 573 188 389 51 140 588 573 189 390 51 140 588 573 190 391 51 140 141 191 392 374 140 141 192 393 51 140 141 193 394 382 140 141 194 395 51 140 141 195 396 374 140 141 196 397 374 140 141 197 398 374 140 141 198 399 374 140 141 199 400 374 140 141 200 401 374 140 141 201 402 374 140 141 202 403 374 140 141 203 404 374 140 141 204 405 374 140 141 205 406 51 140 141 206 407 51 140 141 207 408 51 140 141 208 409 51 140 141 209 410 51 140 141 210 411 51 140 141 211 412 51 140 141 212 413 51 140 141 213 414 51 140 141 214 415 51 140 141 215 416 51 140 141 216 417 51 140 141 217 418 51 140 419 147 420 597 320 421 51 140 590 566 567 150 113 51 140 141 321 114 382 140 590 147 141 567 322 115 51 140 590 566 567 151 435 51 140 141 152 436 51 140 141 424 429 51 140 141 425 430 51 140 141 426 431 51 140 440 568 439 438 51 140 440 568 427 432 51 140 141 153 428 51 140 141 154 434 51 140 141 155 437 51 140 141 423 433 51 140 441 218 442 51 140 441 219 458 51 140 441 220 459 51 140 441 221 460 51 140 441 222 461 51 140 441 223 462 51 140 441 224 463 51 140 441 225 464 51 140 441 226 465 51 140 441 227 466 51 140 441 316 467 51 140 441 317 468 51 140 441 318 469 51 140 441 319 470 51 140 441 228 471 51 140 441 229 472 51 140 441 230 473 51 140 441 536 540 51 140 441 231 474 51 140 441 232 475 51 140 441 233 476 51 140 441 234 477 51 140 441 235 478 51 140 591 5 569 236 479 51 140 141 237 480 51 140 141 238 101 51 140 141 239 102 51 140 141 240 103 51 140 141 241 104 51 140 141 242 105 51 140 141 243 106 51 140 141 244 107 51 140 141 245 108 51 140 141 246 109 51 140 141 247 481 382 140 141 248 482 382 140 141 249 483 382 140 141 250 484 382 140 141 251 485 382 140 141 252 486 382 140 141 253 487 382 140 141 254 89 382 140 141 255 488 382 140 141 256 90 382 140 141 257 489 382 140 141 258 92 382 140 141 259 490 382 140 141 260 491 382 140 141 261 492 382 140 141 262 493 382 140 141 263 494 382 140 141 264 495 382 140 141 265 496 382 140 141 266 498 497 570 267 499 382 140 141 268 500 382 140 141 269 501 382 140 141 270 502 382 140 141 271 503 382 140 141 272 504 382 140 141 273 505 382 140 141 274 96 382 140 141 275 97 382 140 141 276 506 382 140 141 277 98 382 140 141 278 507 51 140 592 569 279 508 51 140 592 569 280 509 382 140 141 281 510 382 140 141 282 511 382 140 141 283 512 382 140 141 537 541 382 140 141 538 542 382 140 141 539 543 382 140 141 284 513 382 140 141 285 514 382 140 141 286 515 382 140 141 287 516 382 140 141 288 517 382 140 141 289 518 382 140 141 290 519 51 140 141 291 520 51 140 141 292 521 51 140 141 293 522 51 140 141 294 524 51 140 591 571 295 525 51 140 591 571 296 526 51 140 141 297 527 51 140 141 298 528 51 140 141 299 529 51 140 141 300 530 51 140 141 301 531 51 140 141 302 532 51 140 141 303 533 51 140 534 304 110 51 140 535 10 11 12 18 139 138 139 138 52 51 140 141 53 51 140 141 74 51 140 141 54 51 140 141 75 51 140 141 55 51 140 141 556 51 140 141 56 51 140 141 57 51 140 141 58 51 140 141 76 51 140 141 59 51 140 141 60 51 140 141 61 51 140 141 62 51 140 141 63 51 140 141 64 51 140 141 65 51 140 141 77 51 140 141 66 51 140 141 67 51 140 141 78 140 141 68 140 141 79 51 140 141 80 51 140 141 69 51 140 141 81 51 140 141 70 51 140 141 82 51 140 141 71 51 140 141 72 51 140 141 72 51 140 141 73 51 140 141 83 557 140 593 598 84 51 140 593 598 85 51 140 593 598 86 51 140 593 598 87 51 140 593 598 555 51 140 141 88 557 593 598 21 22 139 138 139 138 113 51 140 141 114 51 140 141 115 51 140 141 13 139 138 139 138 110 382 140 141 111 112 14 139 138 139 138 101 382 140 141 102 382 140 141 103 382 140 141 104 382 140 141 105 382 140 141 106 382 140 141 107 382 140 141 108 382 140 141 109 382 140 141 15 5 16 558 51 140 593 598 559 51 140 593 598 560 51 140 593 598 561 564 140 593 598 562 564 140 593 598 563 564 140 593 598 5 17 89 422 90 91 92 93 94 95 374 140 594 598 96 97 98 5 523 595 599 600

6 9 99 139 138 139 138 146 118 51 140 145 147 141 119 51 140 145 147 141 120 51 140 145 147 141 121 51 140 145 147 141 117 51 140 577 147 141 572 5 122 51 140 577 147 141 572 123 51 140 578 147 141 596 124 51 140 578 147 141 596 125 51 140 578 147 141 596 126 51 140 578 147 141 596 127 51 140 578 147 141 596 5 128 51 140 578 147 141 596 129 51 140 443 147 141 596 130 51 140 579 147 141 596 131 51 142 141 147 141 132 51 142 141 147 141 133 51 142 141 147 141 134 51 142 141 147 141 135 51 142 141 147 141 136 51 142 141 147 141 137 51 142 141 147 141 19 139 138 139 138 23 51 140 141 147 141 24 51 140 141 147 141 143 144 140 141 147 141 25 51 140 141 147 141 26 51 140 141 147 141 27 51 140 141 147 141 28 51 140 141 147 141 29 51 140 141 147 141 30 51 140 141 147 141 31 148 140 580 147 141 32 51 140 580 147 141 33 51 140 141 147 141 34 51 140 141 147 141 35 51 140 141 147 141 36 51 140 141 147 141 37 51 140 141 147 141 38 51 140 141 147 141 39 51 140 141 147 141 20 139 138 139 138 40 41 42 43 51 140 581 573 44 45 51 140 581 573 46 47 51 140 582 574 48 49 51 140 582 574 446 544 444 140 453 545 444 140 454 546 444 140 455 547 444 140 456 548 444 140 447 549 444 140 448 550 444 140 449 551 444 140 450 552 444 140 451 553 444 140 452 554 444 140 149 50 444 140 445 5 100 139 138 139 138 323 148 140 583 573 325 148 140 583 573 326 148 140 583 573 327 148 140 583 573 328 148 140 583 573 324 148 140 332 573 329 148 140 330 575 331 148 140 333 575 159 334 51 140 141 575 160 335 51 140 141 575 161 336 51 140 141 575 337 51 140 141 575 338 51 140 141 575 339 51 140 141 575 340 51 140 141 575 341 51 140 141 575 342 51 140 141 575 343 51 140 141 575 344 51 140 141 575 345 51 140 141 575 346 51 140 141 575 347 51 140 141 575 348 51 140 141 575 162 349 51 140 141 575 163 350 51 140 141 575 164 351 51 140 141 575 156 565 51 140 584 573 157 352 51 140 585 573 158 353 51 140 585 573 165 354 51 140 141 575 166 355 51 140 141 575 167 357 51 140 141 575 168 356 51 140 141 575 169 358 51 140 141 575 170 359 51 140 141 575 171 360 51 140 457 576 172 361 51 140 141 575 601 324 51 140 141 575 311 362 51 140 141 575 305 308 51 140 586 573 173 363 51 140 141 575 309 310 51 140 141 575 312 364 51 140 141 575 313 365 51 140 141 575 314 366 51 140 141 575 306 307 51 140 586 573 315 367 51 140 586 573 174 368 51 140 141 175 369 51 140 587 573 176 177 51 140 587 573 178 370 51 140 587 573 179 371 51 140 587 573 180 372 51 140 587 573 181 373 51 140 141 182 375 382 140 588 573 376 382 140 588 573 377 382 140 588 573 378 382 140 588 573 379 382 140 588 573 380 382 140 588 573 381 382 140 588 573 381 51 140 141 183 383 51 140 141 184 384 51 140 141 185 385 51 140 141 186 386 51 140 141 387 331 51 140 589 573 187 388 51 140 588 573 188 389 51 140 588 573 189 390 51 140 588 573 190 391 51 140 141 191 392 374 140 141 192 393 51 140 141 193 394 382 140 141 194 395 51 140 141 195 396 374 140 141 196 397 374 140 141 197 398 374 140 141 198 399 374 140 141 199 400 374 140 141 200 401 374 140 141 201 402 374 140 141 202 403 374 140 141 203 404 374 140 141 204 405 374 140 141 205 406 51 140 141 206 407 51 140 141 207 408 51 140 141 208 409 51 140 141 209 410 51 140 141 210 411 51 140 141 211 412 51 140 141 212 413 51 140 141 213 414 51 140 141 214 415 51 140 141 215 416 51 140 141 216 417 51 140 141 217 418 51 140 419 147 420 597 320 421 51 140 590 566 567 150 113 51 140 141 321 114 382 140 590 147 141 567 322 115 51 140 590 566 567 151 435 51 140 141 152 436 51 140 141 424 429 51 140 141 425 430 51 140 141 426 431 51 140 440 568 439 438 51 140 440 568 427 432 51 140 141 153 428 51 140 141 154 434 51 140 141 155 437 51 140 141 423 433 51 140 441 218 442 51 140 441 219 458 51 140 441 220 459 51 140 441 221 460 51 140 441 222 461 51 140 441 223 462 51 140 441 224 463 51 140 441 225 464 51 140 441 226 465 51 140 441 227 466 51 140 441 316 467 51 140 441 317 468 51 140 441 318 469 51 140 441 319 470 51 140 441 228 471 51 140 441 229 472 51 140 441 230 473 51 140 441 536 540 51 140 441 231 474 51 140 441 232 475 51 140 441 233 476 51 140 441 234 477 51 140 441 235 478 51 140 591 5 569 236 479 51 140 141 237 480 51 140 141 238 101 51 140 141 239 102 51 140 141 240 103 51 140 141 241 104 51 140 141 242 105 51 140 141 243 106 51 140 141 244 107 51 140 141 245 108 51 140 141 246 109 51 140 141 247 481 382 140 141 248 482 382 140 141 249 483 382 140 141 250 484 382 140 141 251 485 382 140 141 252 486 382 140 141 253 487 382 140 141 254 89 382 140 141 255 488 382 140 141 256 90 382 140 141 257 489 382 140 141 258 92 382 140 141 259 490 382 140 141 260 491 382 140 141 261 492 382 140 141 262 493 382 140 141 263 494 382 140 141 264 495 382 140 141 265 496 382 140 141 266 498 497 570 267 499 382 140 141 268 500 382 140 141 269 501 382 140 141 270 502 382 140 141 271 503 382 140 141 272 504 382 140 141 273 505 382 140 141 274 96 382 140 141 275 97 382 140 141 276 506 382 140 141 277 98 382 140 141 278 507 51 140 592 569 279 508 51 140 592 569 280 509 382 140 141 281 510 382 140 141 282 511 382 140 141 283 512 382 140 141 537 541 382 140 141 538 542 382 140 141 539 543 382 140 141 284 513 382 140 141 285 514 382 140 141 286 515 382 140 141 287 516 382 140 141 288 517 382 140 141 289 518 382 140 141 290 519 51 140 141 291 520 51 140 141 292 521 51 140 141 293 522 51 140 141 294 524 51 140 591 571 295 525 51 140 591 571 296 526 51 140 141 297 527 51 140 141 298 528 51 140 141 299 529 51 140 141 300 530 51 140 141 301 531 51 140 141 302 532 51 140 141 303 533 51 140 534 304 110 51 140 535 10 11 12 18 139 138 139 138 52 51 140 141 53 51 140 141 74 51 140 141 54 51 140 141 75 51 140 141 55 51 140 141 556 51 140 141 56 51 140 141 57 51 140 141 58 51 140 141 76 51 140 141 59 51 140 141 60 51 140 141 61 51 140 141 62 51 140 141 63 51 140 141 64 51 140 141 65 51 140 141 77 51 140 141 66 51 140 141 67 51 140 141 78 140 141 68 140 141 79 51 140 141 80 51 140 141 69 51 140 141 81 51 140 141 70 51 140 141 82 51 140 141 71 51 140 141 72 51 140 141 72 51 140 141 73 51 140 141 83 557 140 593 598 84 51 140 593 598 85 51 140 593 598 86 51 140 593 598 87 51 140 593 598 555 51 140 141 88 557 593 598 21 22 139 138 139 138 113 51 140 141 114 51 140 141 115 51 140 141 13 139 138 139 138 110 382 140 141 111 112 14 139 138 139 138 101 382 140 141 102 382 140 141 103 382 140 141 104 382 140 141 105 382 140 141 106 382 140 141 107 382 140 141 108 382 140 141 109 382 140 141 15 5 16 558 51 140 593 598 559 51 140 593 598 560 51 140 593 598 561 564 140 593 598 562 564 140 593 598 563 564 140 593 598 5 17 89 422 90 91 92 93 94 95 374 140 594 598 96 97 98 5 523 595 599 600

6 9 99 139 138 139 138 146 118 51 140 145 147 141 119 51 140 145 147 141 120 51 140 145 147 141 121 51 140 145 147 141 117 51 140 577 147 141 572 5 122 51 140 577 147 141 572 123 51 140 578 147 141 596 124 51 140 578 147 141 596 125 51 140 578 147 141 596 126 51 140 578 147 141 596 127 51 140 578 147 141 596 5 128 51 140 578 147 141 596 129 51 140 443 147 141 596 130 51 140 579 147 141 596 131 51 142 141 147 141 132 51 142 141 147 141 133 51 142 141 147 141 134 51 142 141 147 141 135 51 142 141 147 141 136 51 142 141 147 141 137 51 142 141 147 141 19 139 138 139 138 23 51 140 141 147 141 24 51 140 141 147 141 143 144 140 141 147 141 25 51 140 141 147 141 26 51 140 141 147 141 27 51 140 141 147 141 28 51 140 141 147 141 29 51 140 141 147 141 30 51 140 141 147 141 31 148 140 580 147 141 32 51 140 580 147 141 33 51 140 141 147 141 34 51 140 141 147 141 35 51 140 141 147 141 36 51 140 141 147 141 37 51 140 141 147 141 38 51 140 141 147 141 39 51 140 141 147 141 20 139 138 139 138 40 41 42 43 51 140 581 573 44 45 51 140 581 573 46 47 51 140 582 574 48 49 51 140 582 574 446 544 444 140 453 545 444 140 454 546 444 140 455 547 444 140 456 548 444 140 447 549 444 140 448 550 444 140 449 551 444 140 450 552 444 140 451 553 444 140 452 554 444 140 149 50 444 140 445 5 100 139 138 139 138 323 148 140 583 573 325 148 140 583 573 326 148 140 583 573 327 148 140 583 573 328 148 140 583 573 324 148 140 332 573 329 148 140 330 575 331 148 140 333 575 159 334 51 140 141 575 160 335 51 140 141 575 161 336 51 140 141 575 337 51 140 141 575 338 51 140 141 575 339 51 140 141 575 340 51 140 141 575 341 51 140 141 575 342 51 140 141 575 343 51 140 141 575 344 51 140 141 575 345 51 140 141 575 346 51 140 141 575 347 51 140 141 575 348 51 140 141 575 162 349 51 140 141 575 163 350 51 140 141 575 164 351 51 140 141 575 156 565 51 140 584 573 157 352 51 140 585 573 158 353 51 140 585 573 165 354 51 140 141 575 166 355 51 140 141 575 167 357 51 140 141 575 168 356 51 140 141 575 169 358 51 140 141 575 170 359 51 140 141 575 171 360 51 140 457 576 172 361 51 140 141 575 601 324 51 140 141 575 311 362 51 140 141 575 305 308 51 140 586 573 173 363 51 140 141 575 309 310 51 140 141 575 312 364 51 140 141 575 313 365 51 140 141 575 314 366 51 140 141 575 306 307 51 140 586 573 315 367 51 140 586 573 174 368 51 140 141 175 369 51 140 587 573 176 177 51 140 587 573 178 370 51 140 587 573 179 371 51 140 587 573 180 372 51 140 587 573 181 373 51 140 141 182 375 382 140 588 573 376 382 140 588 573 377 382 140 588 573 378 382 140 588 573 379 382 140 588 573 380 382 140 588 573 381 382 140 588 573 381 51 140 141 183 383 51 140 141 184 384 51 140 141 185 385 51 140 141 186 386 51 140 141 387 331 51 140 589 573 187 388 51 140 588 573 188 389 51 140 588 573 189 390 51 140 588 573 190 391 51 140 141 191 392 374 140 141 192 393 51 140 141 193 394 382 140 141 194 395 51 140 141 195 396 374 140 141 196 397 374 140 141 197 398 374 140 141 198 399 374 140 141 199 400 374 140 141 200 401 374 140 141 201 402 374 140 141 202 403 374 140 141 203 404 374 140 141 204 405 374 140 141 205 406 51 140 141 206 407 51 140 141 207 408 51 140 141 208 409 51 140 141 209 410 51 140 141 210 411 51 140 141 211 412 51 140 141 212 413 51 140 141 213 414 51 140 141 214 415 51 140 141 215 416 51 140 141 216 417 51 140 141 217 418 51 140 419 147 420 597 320 421 51 140 590 566 567 150 113 51 140 141 321 114 382 140 590 147 141 567 322 115 51 140 590 566 567 151 435 51 140 141 152 436 51 140 141 424 429 51 140 141 425 430 51 140 141 426 431 51 140 440 568 439 438 51 140 440 568 427 432 51 140 141 153 428 51 140 141 154 434 51 140 141 155 437 51 140 141 423 433 51 140 441 218 442 51 140 441 219 458 51 140 441 220 459 51 140 441 221 460 51 140 441 222 461 51 140 441 223 462 51 140 441 224 463 51 140 441 225 464 51 140 441 226 465 51 140 441 227 466 51 140 441 316 467 51 140 441 317 468 51 140 441 318 469 51 140 441 319 470 51 140 441 228 471 51 140 441 229 472 51 140 441 230 473 51 140 441 536 540 51 140 441 231 474 51 140 441 232 475 51 140 441 233 476 51 140 441 234 477 51 140 441 235 478 51 140 591 5 569 236 479 51 140 141 237 480 51 140 141 238 101 51 140 141 239 102 51 140 141 240 103 51 140 141 241 104 51 140 141 242 105 51 140 141 243 106 51 140 141 244 107 51 140 141 245 108 51 140 141 246 109 51 140 141 247 481 382 140 141 248 482 382 140 141 249 483 382 140 141 250 484 382 140 141 251 485 382 140 141 252 486 382 140 141 253 487 382 140 141 254 89 382 140 141 255 488 382 140 141 256 90 382 140 141 257 489 382 140 141 258 92 382 140 141 259 490 382 140 141 260 491 382 140 141 261 492 382 140 141 262 493 382 140 141 263 494 382 140 141 264 495 382 140 141 265 496 382 140 141 266 498 497 570 267 499 382 140 141 268 500 382 140 141 269 501 382 140 141 270 502 382 140 141 271 503 382 140 141 272 504 382 140 141 273 505 382 140 141 274 96 382 140 141 275 97 382 140 141 276 506 382 140 141 277 98 382 140 141 278 507 51 140 592 569 279 508 51 140 592 569 280 509 382 140 141 281 510 382 140 141 282 511 382 140 141 283 512 382 140 141 537 541 382 140 141 538 542 382 140 141 539 543 382 140 141 284 513 382 140 141 285 514 382 140 141 286 515 382 140 141 287 516 382 140 141 288 517 382 140 141 289 518 382 140 141 290 519 51 140 141 291 520 51 140 141 292 521 51 140 141 293 522 51 140 141 294 524 51 140 591 571 295 525 51 140 591 571 296 526 51 140 141 297 527 51 140 141 298 528 51 140 141 299 529 51 140 141 300 530 51 140 141 301 531 51 140 141 302 532 51 140 141 303 533 51 140 534 304 110 51 140 535 10 11 12 18 139 138 139 138 52 51 140 141 53 51 140 141 74 51 140 141 54 51 140 141 75 51 140 141 55 51 140 141 556 51 140 141 56 51 140 141 57 51 140 141 58 51 140 141 76 51 140 141 59 51 140 141 60 51 140 141 61 51 140 141 62 51 140 141 63 51 140 141 64 51 140 141 65 51 140 141 77 51 140 141 66 51 140 141 67 51 140 141 78 140 141 68 140 141 79 51 140 141 80 51 140 141 69 51 140 141 81 51 140 141 70 51 140 141 82 51 140 141 71 51 140 141 72 51 140 141 72 51 140 141 73 51 140 141 83 557 140 593 598 84 51 140 593 598 85 51 140 593 598 86 51 140 593 598 87 51 140 593 598 555 51 140 141 88 557 593 598 21 22 139 138 139 138 113 51 140 141 114 51 140 141 115 51 140 141 13 139 138 139 138 110 382 140 141 111 112 14 139 138 139 138 101 382 140 141 102 382 140 141 103 382 140 141 104 382 140 141 105 382 140 141 106 382 140 141 107 382 140 141 108 382 140 141 109 382 140 141 15 5 16 558 51 140 593 598 559 51 140 593 598 560 51 140 593 598 561 564 140 593 598 562 564 140 593 598 563 564 140 593 598 5 17 89 422 90 91 92 93 94 95 374 140 594 598 96 97 98 5 523 595 599 600

6 9 99 139 138 139 138 146 118 51 140 145 147 141 119 51 140 145 147 141 120 51 140 145 147 141 121 51 140 145 147 141 117 51 140 577 147 141 572 5 122 51 140 577 147 141 572 123 51 140 578 147 141 596 124 51 140 578 147 141 596 125 51 140 578 147 141 596 126 51 140 578 147 141 596 127 51 140 578 147 141 596 5 128 51 140 578 147 141 596 129 51 140 443 147 141 596 130 51 140 579 147 141 596 131 51 142 141 147 141 132 51 142 141 147 141 133 51 142 141 147 141 134 51 142 141 147 141 135 51 142 141 147 141 136 51 142 141 147 141 137 51 142 141 147 141 19 139 138 139 138 23 51 140 141 147 141 24 51 140 141 147 141 143 144 140 141 147 141 25 51 140 141 147 141 26 51 140 141 147 141 27 51 140 141 147 141 28 51 140 141 147 141 29 51 140 141 147 141 30 51 140 141 147 141 31 148 140 580 147 141 32 51 140 580 147 141 33 51 140 141 147 141 34 51 140 141 147 141 35 51 140 141 147 141 36 51 140 141 147 141 37 51 140 141 147 141 38 51 140 141 147 141 39 51 140 141 147 141 20 139 138 139 138 40 41 42 43 51 140 581 573 44 45 51 140 581 573 46 47 51 140 582 574 48 49 51 140 582 574 446 544 444 140 453 545 444 140 454 546 444 140 455 547 444 140 456 548 444 140 447 549 444 140 448 550 444 140 449 551 444 140 450 552 444 140 451 553 444 140 452 554 444 140 149 50 444 140 445 5 100 139 138 139 138 323 148 140 583 573 325 148 140 583 573 326 148 140 583 573 327 148 140 583 573 328 148 140 583 573 324 148 140 332 573 329 148 140 330 575 331 148 140 333 575 159 334 51 140 141 575 160 335 51 140 141 575 161 336 51 140 141 575 337 51 140 141 575 338 51 140 141 575 339 51 140 141 575 340 51 140 141 575 341 51 140 141 575 342 51 140 141 575 343 51 140 141 575 344 51 140 141 575 345 51 140 141 575 346 51 140 141 575 347 51 140 141 575 348 51 140 141 575 162 349 51 140 141 575 163 350 51 140 141 575 164 351 51 140 141 575 156 565 51 140 584 573 157 352 51 140 585 573 158 353 51 140 585 573 165 354 51 140 141 575 166 355 51 140 141 575 167 357 51 140 141 575 168 356 51 140 141 575 169 358 51 140 141 575 170 359 51 140 141 575 171 360 51 140 457 576 172 361 51 140 141 575 601 324 51 140 141 575 311 362 51 140 141 575 305 308 51 140 586 573 173 363 51 140 141 575 309 310 51 140 141 575 312 364 51 140 141 575 313 365 51 140 141 575 314 366 51 140 141 575 306 307 51 140 586 573 315 367 51 140 586 573 174 368 51 140 141 175 369 51 140 587 573 176 177 51 140 587 573 178 370 51 140 587 573 179 371 51 140 587 573 180 372 51 140 587 573 181 373 51 140 141 182 375 382 140 588 573 376 382 140 588 573 377 382 140 588 573 378 382 140 588 573 379 382 140 588 573 380 382 140 588 573 381 382 140 588 573 381 51 140 141 183 383 51 140 141 184 384 51 140 141 185 385 51 140 141 186 386 51 140 141 387 331 51 140 589 573 187 388 51 140 588 573 188 389 51 140 588 573 189 390 51 140 588 573 190 391 51 140 141 191 392 374 140 141 192 393 51 140 141 193 394 382 140 141 194 395 51 140 141 195 396 374 140 141 196 397 374 140 141 197 398 374 140 141 198 399 374 140 141 199 400 374 140 141 200 401 374 140 141 201 402 374 140 141 202 403 374 140 141 203 404 374 140 141 204 405 374 140 141 205 406 51 140 141 206 407 51 140 141 207 408 51 140 141 208 409 51 140 141 209 410 51 140 141 210 411 51 140 141 211 412 51 140 141 212 413 51 140 141 213 414 51 140 141 214 415 51 140 141 215 416 51 140 141 216 417 51 140 141 217 418 51 140 419 147 420 597 320 421 51 140 590 566 567 150 113 51 140 141 321 114 382 140 590 147 141 567 322 115 51 140 590 566 567 151 435 51 140 141 152 436 51 140 141 424 429 51 140 141 425 430 51 140 141 426 431 51 140 440 568 439 438 51 140 440 568 427 432 51 140 141 153 428 51 140 141 154 434 51 140 141 155 437 51 140 141 423 433 51 140 441 218 442 51 140 441 219 458 51 140 441 220 459 51 140 441 221 460 51 140 441 222 461 51 140 441 223 462 51 140 441 224 463 51 140 441 225 464 51 140 441 226 465 51 140 441 227 466 51 140 441 316 467 51 140 441 317 468 51 140 441 318 469 51 140 441 319 470 51 140 441 228 471 51 140 441 229 472 51 140 441 230 473 51 140 441 536 540 51 140 441 231 474 51 140 441 232 475 51 140 441 233 476 51 140 441 234 477 51 140 441 235 478 51 140 591 5 569 236 479 51 140 141 237 480 51 140 141 238 101 51 140 141 239 102 51 140 141 240 103 51 140 141 241 104 51 140 141 242 105 51 140 141 243 106 51 140 141 244 107 51 140 141 245 108 51 140 141 246 109 51 140 141 247 481 382 140 141 248 482 382 140 141 249 483 382 140 141 250 484 382 140 141 251 485 382 140 141 252 486 382 140 141 253 487 382 140 141 254 89 382 140 141 255 488 382 140 141 256 90 382 140 141 257 489 382 140 141 258 92 382 140 141 259 490 382 140 141 260 491 382 140 141 261 492 382 140 141 262 493 382 140 141 263 494 382 140 141 264 495 382 140 141 265 496 382 140 141 266 498 497 570 267 499 382 140 141 268 500 382 140 141 269 501 382 140 141 270 502 382 140 141 271 503 382 140 141 272 504 382 140 141 273 505 382 140 141 274 96 382 140 141 275 97 382 140 141 276 506 382 140 141 277 98 382 140 141 278 507 51 140 592 569 279 508 51 140 592 569 280 509 382 140 141 281 510 382 140 141 282 511 382 140 141 283 512 382 140 141 537 541 382 140 141 538 542 382 140 141 539 543 382 140 141 284 513 382 140 141 285 514 382 140 141 286 515 382 140 141 287 516 382 140 141 288 517 382 140 141 289 518 382 140 141 290 519 51 140 141 291 520 51 140 141 292 521 51 140 141 293 522 51 140 141 294 524 51 140 591 571 295 525 51 140 591 571 296 526 51 140 141 297 527 51 140 141 298 528 51 140 141 299 529 51 140 141 300 530 51 140 141 301 531 51 140 141 302 532 51 140 141 303 533 51 140 534 304 110 51 140 535 10 11 12 18 139 138 139 138 52 51 140 141 53 51 140 141 74 51 140 141 54 51 140 141 75 51 140 141 55 51 140 141 556 51 140 141 56 51 140 141 57 51 140 141 58 51 140 141 76 51 140 141 59 51 140 141 60 51 140 141 61 51 140 141 62 51 140 141 63 51 140 141 64 51 140 141 65 51 140 141 77 51 140 141 66 51 140 141 67 51 140 141 78 140 141 68 140 141 79 51 140 141 80 51 140 141 69 51 140 141 81 51 140 141 70 51 140 141 82 51 140 141 71 51 140 141 72 51 140 141 72 51 140 141 73 51 140 141 83 557 140 593 598 84 51 140 593 598 85 51 140 593 598 86 51 140 593 598 87 51 140 593 598 555 51 140 141 88 557 593 598 21 22 139 138 139 138 113 51 140 141 114 51 140 141 115 51 140 141 13 139 138 139 138 110 382 140 141 111 112 14 139 138 139 138 101 382 140 141 102 382 140 141 103 382 140 141 104 382 140 141 105 382 140 141 106 382 140 141 107 382 140 141 108 382 140 141 109 382 140 141 15 5 16 558 51 140 593 598 559 51 140 593 598 560 51 140 593 598 561 564 140 593 598 562 564 140 593 598 563 564 140 593 598 5 17 89 422 90 91 92 93 94 95 374 140 594 598 96 97 98 5 523 595 599 600

6 9 99 139 138 139 138 146 118 51 140 145 147 141 119 51 140 145 147 141 120 51 140 145 147 141 121 51 140 145 147 141 117 51 140 577 147 141 572 5 122 51 140 577 147 141 572 123 51 140 578 147 141 596 124 51 140 578 147 141 596 125 51 140 578 147 141 596 126 51 140 578 147 141 596 127 51 140 578 147 141 596 5 128 51 140 578 147 141 596 129 51 140 443 147 141 596 130 51 140 579 147 141 596 131 51 142 141 147 141 132 51 142 141 147 141 133 51 142 141 147 141 134 51 142 141 147 141 135 51 142 141 147 141 136 51 142 141 147 141 137 51 142 141 147 141 19 139 138 139 138 23 51 140 141 147 141 24 51 140 141 147 141 143 144 140 141 147 141 25 51 140 141 147 141 26 51 140 141 147 141 27 51 140 141 147 141 28 51 140 141 147 141 29 51 140 141 147 141 30 51 140 141 147 141 31 148 140 580 147 141 32 51 140 580 147 141 33 51 140 141 147 141 34 51 140 141 147 141 35 51 140 141 147 141 36 51 140 141 147 141 37 51 140 141 147 141 38 51 140 141 147 141 39 51 140 141 147 141 20 139 138 139 138 40 41 42 43 51 140 581 573 44 45 51 140 581 573 46 47 51 140 582 574 48 49 51 140 582 574 446 544 444 140 453 545 444 140 454 546 444 140 455 547 444 140 456 548 444 140 447 549 444 140 448 550 444 140 449 551 444 140 450 552 444 140 451 553 444 140 452 554 444 140 149 50 444 140 445 5 100 139 138 139 138 323 148 140 583 573 325 148 140 583 573 326 148 140 583 573 327 148 140 583 573 328 148 140 583 573 324 148 140 332 573 329 148 140 330 575 331 148 140 333 575 159 334 51 140 141 575 160 335 51 140 141 575 161 336 51 140 141 575 337 51 140 141 575 338 51 140 141 575 339 51 140 141 575 340 51 140 141 575 341 51 140 141 575 342 51 140 141 575 343 51 140 141 575 344 51 140 141 575 345 51 140 141 575 346 51 140 141 575 347 51 140 141 575 348 51 140 141 575 162 349 51 140 141 575 163 350 51 140 141 575 164 351 51 140 141 575 156 565 51 140 584 573 157 352 51 140 585 573 158 353 51 140 585 573 165 354 51 140 141 575 166 355 51 140 141 575 167 357 51 140 141 575 168 356 51 140 141 575 169 358 51 140 141 575 170 359 51 140 141 575 171 360 51 140 457 576 172 361 51 140 141 575 601 324 51 140 141 575 311 362 51 140 141 575 305 308 51 140 586 573 173 363 51 140 141 575 309 310 51 140 141 575 312 364 51 140 141 575 313 365 51 140 141 575 314 366 51 140 141 575 306 307 51 140 586 573 315 367 51 140 586 573 174 368 51 140 141 175 369 51 140 587 573 176 177 51 140 587 573 178 370 51 140 587 573 179 371 51 140 587 573 180 372 51 140 587 573 181 373 51 140 141 182 375 382 140 588 573 376 382 140 588 573 377 382 140 588 573 378 382 140 588 573 379 382 140 588 573 380 382 140 588 573 381 382 140 588 573 381 51 140 141 183 383 51 140 141 184 384 51 140 141 185 385 51 140 141 186 386 51 140 141 387 331 51 140 589 573 187 388 51 140 588 573 188 389 51 140 588 573 189 390 51 140 588 573 190 391 51 140 141 191 392 374 140 141 192 393 51 140 141 193 394 382 140 141 194 395 51 140 141 195 396 374 140 141 196 397 374 140 141 197 398 374 140 141 198 399 374 140 141 199 400 374 140 141 200 401 374 140 141 201 402 374 140 141 202 403 374 140 141 203 404 374 140 141 204 405 374 140 141 205 406 51 140 141 206 407 51 140 141 207 408 51 140 141 208 409 51 140 141 209 410 51 140 141 210 411 51 140 141 211 412 51 140 141 212 413 51 140 141 213 414 51 140 141 214 415 51 140 141 215 416 51 140 141 216 417 51 140 141 217 418 51 140 419 147 420 597 320 421 51 140 590 566 567 150 113 51 140 141 321 114 382 140 590 147 141 567 322 115 51 140 590 566 567 151 435 51 140 141 152 436 51 140 141 424 429 51 140 141 425 430 51 140 141 426 431 51 140 440 568 439 438 51 140 440 568 427 432 51 140 141 153 428 51 140 141 154 434 51 140 141 155 437 51 140 141 423 433 51 140 441 218 442 51 140 441 219 458 51 140 441 220 459 51 140 441 221 460 51 140 441 222 461 51 140 441 223 462 51 140 441 224 463 51 140 441 225 464 51 140 441 226 465 51 140 441 227 466 51 140 441 316 467 51 140 441 317 468 51 140 441 318 469 51 140 441 319 470 51 140 441 228 471 51 140 441 229 472 51 140 441 230 473 51 140 441 536 540 51 140 441 231 474 51 140 441 232 475 51 140 441 233 476 51 140 441 234 477 51 140 441 235 478 51 140 591 5 569 236 479 51 140 141 237 480 51 140 141 238 101 51 140 141 239 102 51 140 141 240 103 51 140 141 241 104 51 140 141 242 105 51 140 141 243 106 51 140 141 244 107 51 140 141 245 108 51 140 141 246 109 51 140 141 247 481 382 140 141 248 482 382 140 141 249 483 382 140 141 250 484 382 140 141 251 485 382 140 141 252 486 382 140 141 253 487 382 140 141 254 89 382 140 141 255 488 382 140 141 256 90 382 140 141 257 489 382 140 141 258 92 382 140 141 259 490 382 140 141 260 491 382 140 141 261 492 382 140 141 262 493 382 140 141 263 494 382 140 141 264 495 382 140 141 265 496 382 140 141 266 498 497 570 267 499 382 140 141 268 500 382 140 141 269 501 382 140 141 270 502 382 140 141 271 503 382 140 141 272 504 382 140 141 273 505 382 140 141 274 96 382 140 141 275 97 382 140 141 276 506 382 140 141 277 98 382 140 141 278 507 51 140 592 569 279 508 51 140 592 569 280 509 382 140 141 281 510 382 140 141 282 511 382 140 141 283 512 382 140 141 537 541 382 140 141 538 542 382 140 141 539 543 382 140 141 284 513 382 140 141 285 514 382 140 141 286 515 382 140 141 287 516 382 140 141 288 517 382 140 141 289 518 382 140 141 290 519 51 140 141 291 520 51 140 141 292 521 51 140 141 293 522 51 140 141 294 524 51 140 591 571 295 525 51 140 591 571 296 526 51 140 141 297 527 51 140 141 298 528 51 140 141 299 529 51 140 141 300 530 51 140 141 301 531 51 140 141 302 532 51 140 141 303 533 51 140 534 304 110 51 140 535 10 11 12 18 139 138 139 138 52 51 140 141 53 51 140 141 74 51 140 141 54 51 140 141 75 51 140 141 55 51 140 141 556 51 140 141 56 51 140 141 57 51 140 141 58 51 140 141 76 51 140 141 59 51 140 141 60 51 140 141 61 51 140 141 62 51 140 141 63 51 140 141 64 51 140 141 65 51 140 141 77 51 140 141 66 51 140 141 67 51 140 141 78 140 141 68 140 141 79 51 140 141 80 51 140 141 69 51 140 141 81 51 140 141 70 51 140 141 82 51 140 141 71 51 140 141 72 51 140 141 72 51 140 141 73 51 140 141 83 557 140 593 598 84 51 140 593 598 85 51 140 593 598 86 51 140 593 598 87 51 140 593 598 555 51 140 141 88 557 593 598 21 22 139 138 139 138 113 51 140 141 114 51 140 141 115 51 140 141 13 139 138 139 138 110 382 140 141 111 112 14 139 138 139 138 101 382 140 141 102 382 140 141 103 382 140 141 104 382 140 141 105 382 140 141 106 382 140 141 107 382 140 141 108 382 140 141 109 382 140 141 15 5 16 558 51 140 593 598 559 51 140 593 598 560 51 140 593 598 561 564 140 593 598 562 564 140 593 598 563 564 140 593 598 5 17 89 422 90 91 92 93 94 95 374 140 594 598 96 97 98 5 523 595 599 600

6 9 99 139 138 139 138 146 118 51 140 145 147 141 119 51 140 145 147 141 120 51 140 145 147 141 121 51 140 145 147 141 117 51 140 577 147 141 572 5 122 51 140 577 147 141 572 123 51 140 578 147 141 596 124 51 140 578 147 141 596 125 51 140 578 147 141 596 126 51 140 578 147 141 596 127 51 140 578 147 141 596 5 128 51 140 578 147 141 596 129 51 140 443 147 141 596 130 51 140 579 147 141 596 131 51 142 141 147 141 132 51 142 141 147 141 133 51 142 141 147 141 134 51 142 141 147 141 135 51 142 141 147 141 136 51 142 141 147 141 137 51 142 141 147 141 19 139 138 139 138 23 51 140 141 147 141 24 51 140 141 147 141 143 144 140 141 147 141 25 51 140 141 147 141 26 51 140 141 147 141 27 51 140 141 147 141 28 51 140 141 147 141 29 51 140 141 147 141 30 51 140 141 147 141 31 148 140 580 147 141 32 51 140 580 147 141 33 51 140 141 147 141 34 51 140 141 147 141 35 51 140 141 147 141 36 51 140 141 147 141 37 51 140 141 147 141 38 51 140 141 147 141 39 51 140 141 147 141 20 139 138 139 138 40 41 42 43 51 140 581 573 44 45 51 140 581 573 46 47 51 140 582 574 48 49 51 140 582 574 446 544 444 140 453 545 444 140 454 546 444 140 455 547 444 140 456 548 444 140 447 549 444 140 448 550 444 140 449 551 444 140 450 552 444 140 451 553 444 140 452 554 444 140 149 50 444 140 445 5 100 139 138 139 138 323 148 140 583 573 325 148 140 583 573 326 148 140 583 573 327 148 140 583 573 328 148 140 583 573 324 148 140 332 573 329 148 140 330 575 331 148 140 333 575 159 334 51 140 141 575 160 335 51 140 141 575 161 336 51 140 141 575 337 51 140 141 575 338 51 140 141 575 339 51 140 141 575 340 51 140 141 575 341 51 140 141 575 342 51 140 141 575 343 51 140 141 575 344 51 140 141 575 345 51 140 141 575 346 51 140 141 575 347 51 140 141 575 348 51 140 141 575 162 349 51 140 141 575 163 350 51 140 141 575 164 351 51 140 141 575 156 565 51 140 584 573 157 352 51 140 585 573 158 353 51 140 585 573 165 354 51 140 141 575 166 355 51 140 141 575 167 357 51 140 141 575 168 356 51 140 141 575 169 358 51 140 141 575 170 359 51 140 141 575 171 360 51 140 457 576 172 361 51 140 141 575 601 324 51 140 141 575 311 362 51 140 141 575 305 308 51 140 586 573 173 363 51 140 141 575 309 310 51 140 141 575 312 364 51 140 141 575 313 365 51 140 141 575 314 366 51 140 141 575 306 307 51 140 586 573 315 367 51 140 586 573 174 368 51 140 141 175 369 51 140 587 573 176 177 51 140 587 573 178 370 51 140 587 573 179 371 51 140 587 573 180 372 51 140 587 573 181 373 51 140 141 182 375 382 140 588 573 376 382 140 588 573 377 382 140 588 573 378 382 140 588 573 379 382 140 588 573 380 382 140 588 573 381 382 140 588 573 381 51 140 141 183 383 51 140 141 184 384 51 140 141 185 385 51 140 141 186 386 51 140 141 387 331 51 140 589 573 187 388 51 140 588 573 188 389 51 140 588 573 189 390 51 140 588 573 190 391 51 140 141 191 392 374 140 141 192 393 51 140 141 193 394 382 140 141 194 395 51 140 141 195 396 374 140 141 196 397 374 140 141 197 398 374 140 141 198 399 374 140 141 199 400 374 140 141 200 401 374 140 141 201 402 374 140 141 202 403 374 140 141 203 404 374 140 141 204 405 374 140 141 205 406 51 140 141 206 407 51 140 141 207 408 51 140 141 208 409 51 140 141 209 410 51 140 141 210 411 51 140 141 211 412 51 140 141 212 413 51 140 141 213 414 51 140 141 214 415 51 140 141 215 416 51 140 141 216 417 51 140 141 217 418 51 140 419 147 420 597 320 421 51 140 590 566 567 150 113 51 140 141 321 114 382 140 590 147 141 567 322 115 51 140 590 566 567 151 435 51 140 141 152 436 51 140 141 424 429 51 140 141 425 430 51 140 141 426 431 51 140 440 568 439 438 51 140 440 568 427 432 51 140 141 153 428 51 140 141 154 434 51 140 141 155 437 51 140 141 423 433 51 140 441 218 442 51 140 441 219 458 51 140 441 220 459 51 140 441 221 460 51 140 441 222 461 51 140 441 223 462 51 140 441 224 463 51 140 441 225 464 51 140 441 226 465 51 140 441 227 466 51 140 441 316 467 51 140 441 317 468 51 140 441 318 469 51 140 441 319 470 51 140 441 228 471 51 140 441 229 472 51 140 441 230 473 51 140 441 536 540 51 140 441 231 474 51 140 441 232 475 51 140 441 233 476 51 140 441 234 477 51 140 441 235 478 51 140 591 5 569 236 479 51 140 141 237 480 51 140 141 238 101 51 140 141 239 102 51 140 141 240 103 51 140 141 241 104 51 140 141 242 105 51 140 141 243 106 51 140 141 244 107 51 140 141 245 108 51 140 141 246 109 51 140 141 247 481 382 140 141 248 482 382 140 141 249 483 382 140 141 250 484 382 140 141 251 485 382 140 141 252 486 382 140 141 253 487 382 140 141 254 89 382 140 141 255 488 382 140 141 256 90 382 140 141 257 489 382 140 141 258 92 382 140 141 259 490 382 140 141 260 491 382 140 141 261 492 382 140 141 262 493 382 140 141 263 494 382 140 141 264 495 382 140 141 265 496 382 140 141 266 498 497 570 267 499 382 140 141 268 500 382 140 141 269 501 382 140 141 270 502 382 140 141 271 503 382 140 141 272 504 382 140 141 273 505 382 140 141 274 96 382 140 141 275 97 382 140 141 276 506 382 140 141 277 98 382 140 141 278 507 51 140 592 569 279 508 51 140 592 569 280 509 382 140 141 281 510 382 140 141 282 511 382 140 141 283 512 382 140 141 537 541 382 140 141 538 542 382 140 141 539 543 382 140 141 284 513 382 140 141 285 514 382 140 141 286 515 382 140 141 287 516 382 140 141 288 517 382 140 141 289 518 382 140 141 290 519 51 140 141 291 520 51 140 141 292 521 51 140 141 293 522 51 140 141 294 524 51 140 591 571 295 525 51 140 591 571 296 526 51 140 141 297 527 51 140 141 298 528 51 140 141 299 529 51 140 141 300 530 51 140 141 301 531 51 140 141 302 532 51 140 141 303 533 51 140 534 304 110 51 140 535 10 11 12 18 139 138 139 138 52 51 140 141 53 51 140 141 74 51 140 141 54 51 140 141 75 51 140 141 55 51 140 141 556 51 140 141 56 51 140 141 57 51 140 141 58 51 140 141 76 51 140 141 59 51 140 141 60 51 140 141 61 51 140 141 62 51 140 141 63 51 140 141 64 51 140 141 65 51 140 141 77 51 140 141 66 51 140 141 67 51 140 141 78 140 141 68 140 141 79 51 140 141 80 51 140 141 69 51 140 141 81 51 140 141 70 51 140 141 82 51 140 141 71 51 140 141 72 51 140 141 72 51 140 141 73 51 140 141 83 557 140 593 598 84 51 140 593 598 85 51 140 593 598 86 51 140 593 598 87 51 140 593 598 555 51 140 141 88 557 593 598 21 22 139 138 139 138 113 51 140 141 114 51 140 141 115 51 140 141 13 139 138 139 138 110 382 140 141 111 112 14 139 138 139 138 101 382 140 141 102 382 140 141 103 382 140 141 104 382 140 141 105 382 140 141 106 382 140 141 107 382 140 141 108 382 140 141 109 382 140 141 15 5 16 558 51 140 593 598 559 51 140 593 598 560 51 140 593 598 561 564 140 593 598 562 564 140 593 598 563 564 140 593 598 5 17 89 422 90 91 92 93 94 95 374 140 594 598 96 97 98 5 523 595 599 600

6 9 99 139 138 139 138 146 118 51 140 145 147 141 119 51 140 145 147 141 120 51 140 145 147 141 121 51 140 145 147 141 117 51 140 577 147 141 572 5 122 51 140 577 147 141 572 123 51 140 578 147 141 596 124 51 140 578 147 141 596 125 51 140 578 147 141 596 126 51 140 578 147 141 596 127 51 140 578 147 141 596 5 128 51 140 578 147 141 596 129 51 140 443 147 141 596 130 51 140 579 147 141 596 131 51 142 141 147 141 132 51 142 141 147 141 133 51 142 141 147 141 134 51 142 141 147 141 135 51 142 141 147 141 136 51 142 141 147 141 137 51 142 141 147 141 19 139 138 139 138 23 51 140 141 147 141 24 51 140 141 147 141 143 144 140 141 147 141 25 51 140 141 147 141 26 51 140 141 147 141 27 51 140 141 147 141 28 51 140 141 147 141 29 51 140 141 147 141 30 51 140 141 147 141 31 148 140 580 147 141 32 51 140 580 147 141 33 51 140 141 147 141 34 51 140 141 147 141 35 51 140 141 147 141 36 51 140 141 147 141 37 51 140 141 147 141 38 51 140 141 147 141 39 51 140 141 147 141 20 139 138 139 138 40 41 42 43 51 140 581 573 44 45 51 140 581 573 46 47 51 140 582 574 48 49 51 140 582 574 446 544 444 140 453 545 444 140 454 546 444 140 455 547 444 140 456 548 444 140 447 549 444 140 448 550 444 140 449 551 444 140 450 552 444 140 451 553 444 140 452 554 444 140 149 50 444 140 445 5 100 139 138 139 138 323 148 140 583 573 325 148 140 583 573 326 148 140 583 573 327 148 140 583 573 328 148 140 583 573 324 148 140 332 573 329 148 140 330 575 331 148 140 333 575 159 334 51 140 141 575 160 335 51 140 141 575 161 336 51 140 141 575 337 51 140 141 575 338 51 140 141 575 339 51 140 141 575 340 51 140 141 575 341 51 140 141 575 342 51 140 141 575 343 51 140 141 575 344 51 140 141 575 345 51 140 141 575 346 51 140 141 575 347 51 140 141 575 348 51 140 141 575 162 349 51 140 141 575 163 350 51 140 141 575 164 351 51 140 141 575 156 565 51 140 584 573 157 352 51 140 585 573 158 353 51 140 585 573 165 354 51 140 141 575 166 355 51 140 141 575 167 357 51 140 141 575 168 356 51 140 141 575 169 358 51 140 141 575 170 359 51 140 141 575 171 360 51 140 457 576 172 361 51 140 141 575 601 324 51 140 141 575 311 362 51 140 141 575 305 308 51 140 586 573 173 363 51 140 141 575 309 310 51 140 141 575 312 364 51 140 141 575 313 365 51 140 141 575 314 366 51 140 141 575 306 307 51 140 586 573 315 367 51 140 586 573 174 368 51 140 141 175 369 51 140 587 573 176 177 51 140 587 573 178 370 51 140 587 573 179 371 51 140 587 573 180 372 51 140 587 573 181 373 51 140 141 182 375 382 140 588 573 376 382 140 588 573 377 382 140 588 573 378 382 140 588 573 379 382 140 588 573 380 382 140 588 573 381 382 140 588 573 381 51 140 141 183 383 51 140 141 184 384 51 140 141 185 385 51 140 141 186 386 51 140 141 387 331 51 140 589 573 187 388 51 140 588 573 188 389 51 140 588 573 189 390 51 140 588 573 190 391 51 140 141 191 392 374 140 141 192 393 51 140 141 193 394 382 140 141 194 395 51 140 141 195 396 374 140 141 196 397 374 140 141 197 398 374 140 141 198 399 374 140 141 199 400 374 140 141 200 401 374 140 141 201 402 374 140 141 202 403 374 140 141 203 404 374 140 141 204 405 374 140 141 205 406 51 140 141 206 407 51 140 141 207 408 51 140 141 208 409 51 140 141 209 410 51 140 141 210 411 51 140 141 211 412 51 140 141 212 413 51 140 141 213 414 51 140 141 214 415 51 140 141 215 416 51 140 141 216 417 51 140 141 217 418 51 140 419 147 420 597 320 421 51 140 590 566 567 150 113 51 140 141 321 114 382 140 590 147 141 567 322 115 51 140 590 566 567 151 435 51 140 141 152 436 51 140 141 424 429 51 140 141 425 430 51 140 141 426 431 51 140 440 568 439 438 51 140 440 568 427 432 51 140 141 153 428 51 140 141 154 434 51 140 141 155 437 51 140 141 423 433 51 140 441 218 442 51 140 441 219 458 51 140 441 220 459 51 140 441 221 460 51 140 441 222 461 51 140 441 223 462 51 140 441 224 463 51 140 441 225 464 51 140 441 226 465 51 140 441 227 466 51 140 441 316 467 51 140 441 317 468 51 140 441 318 469 51 140 441 319 470 51 140 441 228 471 51 140 441 229 472 51 140 441 230 473 51 140 441 536 540 51 140 441 231 474 51 140 441 232 475 51 140 441 233 476 51 140 441 234 477 51 140 441 235 478 51 140 591 5 569 236 479 51 140 141 237 480 51 140 141 238 101 51 140 141 239 102 51 140 141 240 103 51 140 141 241 104 51 140 141 242 105 51 140 141 243 106 51 140 141 244 107 51 140 141 245 108 51 140 141 246 109 51 140 141 247 481 382 140 141 248 482 382 140 141 249 483 382 140 141 250 484 382 140 141 251 485 382 140 141 252 486 382 140 141 253 487 382 140 141 254 89 382 140 141 255 488 382 140 141 256 90 382 140 141 257 489 382 140 141 258 92 382 140 141 259 490 382 140 141 260 491 382 140 141 261 492 382 140 141 262 493 382 140 141 263 494 382 140 141 264 495 382 140 141 265 496 382 140 141 266 498 497 570 267 499 382 140 141 268 500 382 140 141 269 501 382 140 141 270 502 382 140 141 271 503 382 140 141 272 504 382 140 141 273 505 382 140 141 274 96 382 140 141 275 97 382 140 141 276 506 382 140 141 277 98 382 140 141 278 507 51 140 592 569 279 508 51 140 592 569 280 509 382 140 141 281 510 382 140 141 282 511 382 140 141 283 512 382 140 141 537 541 382 140 141 538 542 382 140 141 539 543 382 140 141 284 513 382 140 141 285 514 382 140 141 286 515 382 140 141 287 516 382 140 141 288 517 382 140 141 289 518 382 140 141 290 519 51 140 141 291 520 51 140 141 292 521 51 140 141 293 522 51 140 141 294 524 51 140 591 571 295 525 51 140 591 571 296 526 51 140 141 297 527 51 140 141 298 528 51 140 141 299 529 51 140 141 300 530 51 140 141 301 531 51 140 141 302 532 51 140 141 303 533 51 140 534 304 110 51 140 535 10 11 12 18 139 138 139 138 52 51 140 141 53 51 140 141 74 51 140 141 54 51 140 141 75 51 140 141 55 51 140 141 556 51 140 141 56 51 140 141 57 51 140 141 58 51 140 141 76 51 140 141 59 51 140 141 60 51 140 141 61 51 140 141 62 51 140 141 63 51 140 141 64 51 140 141 65 51 140 141 77 51 140 141 66 51 140 141 67 51 140 141 78 140 141 68 140 141 79 51 140 141 80 51 140 141 69 51 140 141 81 51 140 141 70 51 140 141 82 51 140 141 71 51 140 141 72 51 140 141 72 51 140 141 73 51 140 141 83 557 140 593 598 84 51 140 593 598 85 51 140 593 598 86 51 140 593 598 87 51 140 593 598 555 51 140 141 88 557 593 598 21 22 139 138 139 138 113 51 140 141 114 51 140 141 115 51 140 141 13 139 138 139 138 110 382 140 141 111 112 14 139 138 139 138 101 382 140 141 102 382 140 141 103 382 140 141 104 382 140 141 105 382 140 141 106 382 140 141 107 382 140 141 108 382 140 141 109 382 140 141 15 5 16 558 51 140 593 598 559 51 140 593 598 560 51 140 593 598 561 564 140 593 598 562 564 140 593 598 563 564 140 593 598 5 17 89 422 90 91 92 93 94 95 374 140 594 598 96 97 98 5 523 595 599 600

6 9 99 139 138 139 138 146 118 51 140 145 147 141 119 51 140 145 147 141 120 51 140 145 147 141 121 51 140 145 147 141 117 51 140 577 147 141 572 5 122 51 140 577 147 141 572 123 51 140 578 147 141 596 124 51 140 578 147 141 596 125 51 140 578 147 141 596 126 51 140 578 147 141 596 127 51 140 578 147 141 596 5 128 51 140 578 147 141 596 129 51 140 443 147 141 596 130 51 140 579 147 141 596 131 51 142 141 147 141 132 51 142 141 147 141 133 51 142 141 147 141 134 51 142 141 147 141 135 51 142 141 147 141 136 51 142 141 147 141 137 51 142 141 147 141 19 139 138 139 138 23 51 140 141 147 141 24 51 140 141 147 141 143 144 140 141 147 141 25 51 140 141 147 141 26 51 140 141 147 141 27 51 140 141 147 141 28 51 140 141 147 141 29 51 140 141 147 141 30 51 140 141 147 141 31 148 140 580 147 141 32 51 140 580 147 141 33 51 140 141 147 141 34 51 140 141 147 141 35 51 140 141 147 141 36 51 140 141 147 141 37 51 140 141 147 141 38 51 140 141 147 141 39 51 140 141 147 141 20 139 138 139 138 40 41 42 43 51 140 581 573 44 45 51 140 581 573 46 47 51 140 582 574 48 49 51 140 582 574 446 544 444 140 453 545 444 140 454 546 444 140 455 547 444 140 456 548 444 140 447 549 444 140 448 550 444 140 449 551 444 140 450 552 444 140 451 553 444 140 452 554 444 140 149 50 444 140 445 5 100 139 138 139 138 323 148 140 583 573 325 148 140 583 573 326 148 140 583 573 327 148 140 583 573 328 148 140 583 573 324 148 140 332 573 329 148 140 330 575 331 148 140 333 575 159 334 51 140 141 575 160 335 51 140 141 575 161 336 51 140 141 575 337 51 140 141 575 338 51 140 141 575 339 51 140 141 575 340 51 140 141 575 341 51 140 141 575 342 51 140 141 575 343 51 140 141 575 344 51 140 141 575 345 51 140 141 575 346 51 140 141 575 347 51 140 141 575 348 51 140 141 575 162 349 51 140 141 575 163 350 51 140 141 575 164 351 51 140 141 575 156 565 51 140 584 573 157 352 51 140 585 573 158 353 51 140 585 573 165 354 51 140 141 575 166 355 51 140 141 575 167 357 51 140 141 575 168 356 51 140 141 575 169 358 51 140 141 575 170 359 51 140 141 575 171 360 51 140 457 576 172 361 51 140 141 575 601 324 51 140 141 575 311 362 51 140 141 575 305 308 51 140 586 573 173 363 51 140 141 575 309 310 51 140 141 575 312 364 51 140 141 575 313 365 51 140 141 575 314 366 51 140 141 575 306 307 51 140 586 573 315 367 51 140 586 573 174 368 51 140 141 175 369 51 140 587 573 176 177 51 140 587 573 178 370 51 140 587 573 179 371 51 140 587 573 180 372 51 140 587 573 181 373 51 140 141 182 375 382 140 588 573 376 382 140 588 573 377 382 140 588 573 378 382 140 588 573 379 382 140 588 573 380 382 140 588 573 381 382 140 588 573 381 51 140 141 183 383 51 140 141 184 384 51 140 141 185 385 51 140 141 186 386 51 140 141 387 331 51 140 589 573 187 388 51 140 588 573 188 389 51 140 588 573 189 390 51 140 588 573 190 391 51 140 141 191 392 374 140 141 192 393 51 140 141 193 394 382 140 141 194 395 51 140 141 195 396 374 140 141 196 397 374 140 141 197 398 374 140 141 198 399 374 140 141 199 400 374 140 141 200 401 374 140 141 201 402 374 140 141 202 403 374 140 141 203 404 374 140 141 204 405 374 140 141 205 406 51 140 141 206 407 51 140 141 207 408 51 140 141 208 409 51 140 141 209 410 51 140 141 210 411 51 140 141 211 412 51 140 141 212 413 51 140 141 213 414 51 140 141 214 415 51 140 141 215 416 51 140 141 216 417 51 140 141 217 418 51 140 419 147 420 597 320 421 51 140 590 566 567 150 113 51 140 141 321 114 382 140 590 147 141 567 322 115 51 140 590 566 567 151 435 51 140 141 152 436 51 140 141 424 429 51 140 141 425 430 51 140 141 426 431 51 140 440 568 439 438 51 140 440 568 427 432 51 140 141 153 428 51 140 141 154 434 51 140 141 155 437 51 140 141 423 433 51 140 441 218 442 51 140 441 219 458 51 140 441 220 459 51 140 441 221 460 51 140 441 222 461 51 140 441 223 462 51 140 441 224 463 51 140 441 225 464 51 140 441 226 465 51 140 441 227 466 51 140 441 316 467 51 140 441 317 468 51 140 441 318 469 51 140 441 319 470 51 140 441 228 471 51 140 441 229 472 51 140 441 230 473 51 140 441 536 540 51 140 441 231 474 51 140 441 232 475 51 140 441 233 476 51 140 441 234 477 51 140 441 235 478 51 140 591 5 569 236 479 51 140 141 237 480 51 140 141 238 101 51 140 141 239 102 51 140 141 240 103 51 140 141 241 104 51 140 141 242 105 51 140 141 243 106 51 140 141 244 107 51 140 141 245 108 51 140 141 246 109 51 140 141 247 481 382 140 141 248 482 382 140 141 249 483 382 140 141 250 484 382 140 141 251 485 382 140 141 252 486 382 140 141 253 487 382 140 141 254 89 382 140 141 255 488 382 140 141 256 90 382 140 141 257 489 382 140 141 258 92 382 140 141 259 490 382 140 141 260 491 382 140 141 261 492 382 140 141 262 493 382 140 141 263 494 382 140 141 264 495 382 140 141 265 496 382 140 141 266 498 497 570 267 499 382 140 141 268 500 382 140 141 269 501 382 140 141 270 502 382 140 141 271 503 382 140 141 272 504 382 140 141 273 505 382 140 141 274 96 382 140 141 275 97 382 140 141 276 506 382 140 141 277 98 382 140 141 278 507 51 140 592 569 279 508 51 140 592 569 280 509 382 140 141 281 510 382 140 141 282 511 382 140 141 283 512 382 140 141 537 541 382 140 141 538 542 382 140 141 539 543 382 140 141 284 513 382 140 141 285 514 382 140 141 286 515 382 140 141 287 516 382 140 141 288 517 382 140 141 289 518 382 140 141 290 519 51 140 141 291 520 51 140 141 292 521 51 140 141 293 522 51 140 141 294 524 51 140 591 571 295 525 51 140 591 571 296 526 51 140 141 297 527 51 140 141 298 528 51 140 141 299 529 51 140 141 300 530 51 140 141 301 531 51 140 141 302 532 51 140 141 303 533 51 140 534 304 110 51 140 535 10 11 12 18 139 138 139 138 52 51 140 141 53 51 140 141 74 51 140 141 54 51 140 141 75 51 140 141 55 51 140 141 556 51 140 141 56 51 140 141 57 51 140 141 58 51 140 141 76 51 140 141 59 51 140 141 60 51 140 141 61 51 140 141 62 51 140 141 63 51 140 141 64 51 140 141 65 51 140 141 77 51 140 141 66 51 140 141 67 51 140 141 78 140 141 68 140 141 79 51 140 141 80 51 140 141 69 51 140 141 81 51 140 141 70 51 140 141 82 51 140 141 71 51 140 141 72 51 140 141 72 51 140 141 73 51 140 141 83 557 140 593 598 84 51 140 593 598 85 51 140 593 598 86 51 140 593 598 87 51 140 593 598 555 51 140 141 88 557 593 598 21 22 139 138 139 138 113 51 140 141 114 51 140 141 115 51 140 141 13 139 138 139 138 110 382 140 141 111 112 14 139 138 139 138 101 382 140 141 102 382 140 141 103 382 140 141 104 382 140 141 105 382 140 141 106 382 140 141 107 382 140 141 108 382 140 141 109 382 140 141 15 5 16 558 51 140 593 598 559 51 140 593 598 560 51 140 593 598 561 564 140 593 598 562 564 140 593 598 563 564 140 593 598 5 17 89 422 90 91 92 93 94 95 374 140 594 598 96 97 98 5 523 595 599 600

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

TMHP REMOVAL OF NECK WRINKLES Chemical peel, nonfacial; epidermal Dermabrasion; regional, other than face Abrasion; single lesion (eg, keratosis, scar) Subcutaneous injection of filling material (eg, collagen); 1 cc or less Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general keratosis) Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc Subcutaneous injection of filling material (eg, collagen); over 10.0 cc Replacement of tissue expander with permanent prosthesis Excision, excessive skin and subcutaneous tissue (includes lipectomy); submental fat pad GOOD Suction assisted lipectomy; head and neck GOOD - Per TMHP Manual maybe covered for injury or trauma Good - Per TMHP Manual maybe covered for injury or trauma Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure) Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Formation of direct or tubed pedicle, with or without transfer; trunk Punch graft for hair transplant; 1 to 15 punch grafts Punch graft for hair transplant; more than 15 punch grafts Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure) Dermabrasion; segmental, face Dermabrasion; superficial, any site (eg, tattoo removal) Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) Chemical peel, facial; epidermal Chemical peel, facial; dermal Chemical peel, nonfacial; dermal Cervicoplasty Rhytidectomy; forehead Rhytidectomy; glabellar frown lines Rhytidectomy; cheek, chin, and neck Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy CPT BOOK Excision, excessive skin and subcutaneous tissue (includes lipectomy); thigh Excision, excessive skin and subcutaneous tissue (includes lipectomy); leg Excision, excessive skin and subcutaneous tissue (includes lipectomy); hip Excision, excessive skin and subcutaneous tissue (includes lipectomy); buttock Excision, excessive skin and subcutaneous tissue (includes lipectomy); arm Excision, excessive skin and subcutaneous tissue (includes lipectomy); forearm or hand Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area CPT Book Graft for facial nerve paralysis; free muscle graft (including obtaining graft) Graft for facial nerve paralysis; free muscle flap by microsurgical technique Graft for facial nerve paralysis; regional muscle transfer Excision, excessive skin and subcutaneous tissue (includes lipectomy), abdomen (eg, abdominoplasty) (includes umbilical transposition and fascial plication) (List separately in addition to code for primary procedure) Suction assisted lipectomy; trunk Suction assisted lipectomy; upper extremity Suction assisted lipectomy; lower extremity Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Chemical cauterization of granulation tissue (ie, proud flesh) Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm Electrolysis epilation, each 30 minutes NONCovered for STAR - is on Noncovered and PA Flag Noncovered for CHIP Mastopexy Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition Open periprosthetic capsulotomy, breast Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction Nipple/areola reconstruction Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion Preparation of moulage for custom breast implant Periprosthetic capsulectomy, breast Removal of intact mammary implant Removal of mammary implant material Revision of reconstructed breast Correction of inverted nipples Need STAR PA flag set Good Tissue grafts, other (eg, paratenon, fat, dermis) Not covered for STAR CPT Book TMHP Per TMHP is covered for 20 years of age & younger w/ certain dx codes NON Covered Genioplasty; augmentation (autograft, allograft, prosthetic material) Genioplasty; sliding osteotomy, single piece Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) Augmentation, mandibular body or angle; prosthetic material Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) Reduction forehead; contouring only Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) Reduction forehead; contouring and setback of anterior frontal sinus wall Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) Osteoplasty, facial bones; reduction Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Malar augmentation, prosthetic material Medial canthopexy (separate procedure) Lateral canthopexy Reconstructive repair of pectus excavatum or carinatum; open Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy Repair macrodactylia, each digit Excision or surgical planing of skin of nose for rhinophyma Rhinectomy; partial Rhinectomy; total Revision of tracheostomy scar Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg Injection(s) of sclerosant for spider veins (telangiectasia), limb or trunk Injection of sclerosant; single incompetent vein (other than telangiectasia) Injection of sclerosant; multiple incompetent veins (other than telangiectasia), same leg Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code for primary procedure) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; venous, other than hemorrhage (eg, congenital or acquired venous malformations, venous and capillary hemangiomas, varices, varicoceles) Vascular embolization or occlusion, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention; for arterial or venous hemorrhage or lymphatic extravasation Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; initial artery Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same artery; each additional artery (List separately in addition to code for primary procedure) Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in addition to code for primary procedure) Code deleted 01/01/2016 Intravascular ultrasound (non-coronary vessel) during diagnostic evaluation and/or therapeutic intervention; initial vessel (List separately in addition to code for primary procedure) Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to code for primary procedure) Vascular endoscopy, surgical, with ligation of perforator veins, subfascial (SEPS) Ligation, division, and stripping, short saphenous vein Ligation, division, and stripping, long (greater) saphenous veins from saphenofemoral junction to knee or below Ligation and division and complete stripping of long or short saphenous veins with radical excision of ulcer and skin graft and/or interruption of communicating veins of lower leg, with excision of deep fascia Ligation of perforator veins, subfascial, radical (Linton type), including skin graft, when performed, open,1 leg Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) Vermilionectomy (lip shave), with mucosal advancement Excision of lip; transverse wedge excision with primary closure Excision of lip; V-excision with primary direct linear closure xcision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander) Resection of lip, more than one-fourth, without reconstruction Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Repair initial incisional or ventral hernia; reducible Repair initial incisional or ventral hernia; incarcerated or strangulated Repair recurrent incisional or ventral hernia; reducible Repair recurrent incisional or ventral hernia; incarcerated or strangulated Implantation of mesh or other prosthesis for open incisional or ventral hernia repair or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for the incisional or ventral hernia repair) Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck Insertion of testicular prosthesis (separate procedure) Plastic repair of introitus Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Codes noticed on noncovered list that should not be Construction of artificial vagina; without graft Construction of artificial vagina; with graft Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) Repair of blepharoptosis; frontalis muscle technique with autologous fascial sling (includes obtaining fascia) Repair of blepharoptosis; (tarso) levator resection or advancement, internal approach Repair of blepharoptosis; (tarso) levator resection or advancement, external approach Repair of blepharoptosis; superior rectus technique with fascial sling (includes obtaining fascia) Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg, Fasanella-Servat type) Reduction of overcorrection of ptosis Ear piercing Good - Non covered TMHP Good Interdental wiring, for condition other than fracture Gingivectomy, excision gingiva, each quadrant Operculectomy, excision pericoronal tissues Excision of hyperplastic alveolar mucosa, each quadrant (specify) Correction of lid retraction Repair of ectropion; excision tarsal wedge Repair of ectropion; extensive (eg, tarsal strip operations) Repair of entropion; excision tarsal wedge Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, upper, 1 stage or first stage Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; second stage Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring total hysterectomy Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof CPT Book

6 9 99 139 138 139 138 146 118 51 140 145 147 141 119 51 140 145 147 141 120 51 140 145 147 141 121 51 140 145 147 141 117 51 140 577 147 141 572 5 122 51 140 577 147 141 572 123 51 140 578 147 141 596 124 51 140 578 147 141 596 125 51 140 578 147 141 596 126 51 140 578 147 141 596 127 51 140 578 147 141 596 5 128 51 140 578 147 141 596 129 51 140 443 147 141 596 130 51 140 579 147 141 596 131 51 142 141 147 141 132 51 142 141 147 141 133 51 142 141 147 141 134 51 142 141 147 141 135 51 142 141 147 141 136 51 142 141 147 141 137 51 142 141 147 141 19 139 138 139 138 23 51 140 141 147 141 24 51 140 141 147 141 143 144 140 141 147 141 25 51 140 141 147 141 26 51 140 141 147 141 27 51 140 141 147 141 28 51 140 141 147 141 29 51 140 141 147 141 30 51 140 141 147 141 31 148 140 580 147 141 32 51 140 580 147 141 33 51 140 141 147 141 34 51 140 141 147 141 35 51 140 141 147 141 36 51 140 141 147 141 37 51 140 141 147 141 38 51 140 141 147 141 39 51 140 141 147 141 20 139 138 139 138 40 41 42 43 51 140 581 573 44 45 51 140 581 573 46 47 51 140 582 574 48 49 51 140 582 574 446 544 444 140 453 545 444 140 454 546 444 140 455 547 444 140 456 548 444 140 447 549 444 140 448 550 444 140 449 551 444 140 450 552 444 140 451 553 444 140 452 554 444 140 149 50 444 140 445 5 100 139 138 139 138 323 148 140 583 573 325 148 140 583 573 326 148 140 583 573 327 148 140 583 573 328 148 140 583 573 324 148 140 332 573 329 148 140 330 575 331 148 140 333 575 159 334 51 140 141 575 160 335 51 140 141 575 161 336 51 140 141 575 337 51 140 141 575 338 51 140 141 575 339 51 140 141 575 340 51 140 141 575 341 51 140 141 575 342 51 140 141 575 343 51 140 141 575 344 51 140 141 575 345 51 140 141 575 346 51 140 141 575 347 51 140 141 575 348 51 140 141 575 162 349 51 140 141 575 163 350 51 140 141 575 164 351 51 140 141 575 156 565 51 140 584 573 157 352 51 140 585 573 158 353 51 140 585 573 165 354 51 140 141 575 166 355 51 140 141 575 167 357 51 140 141 575 168 356 51 140 141 575 169 358 51 140 141 575 170 359 51 140 141 575 171 360 51 140 457 576 172 361 51 140 141 575 601 324 51 140 141 575 311 362 51 140 141 575 305 308 51 140 586 573 173 363 51 140 141 575 309 310 51 140 141 575 312 364 51 140 141 575 313 365 51 140 141 575 314 366 51 140 141 575 306 307 51 140 586 573 315 367 51 140 586 573 174 368 51 140 141 175 369 51 140 587 573 176 177 51 140 587 573 178 370 51 140 587 573 179 371 51 140 587 573 180 372 51 140 587 573 181 373 51 140 141 182 375 382 140 588 573 376 382 140 588 573 377 382 140 588 573 378 382 140 588 573 379 382 140 588 573 380 382 140 588 573 381 382 140 588 573 381 51 140 141 183 383 51 140 141 184 384 51 140 141 185 385 51 140 141 186 386 51 140 141 387 331 51 140 589 573 187 388 51 140 588 573 188 389 51 140 588 573 189 390 51 140 588 573 190 391 51 140 141 191 392 374 140 141 192 393 51 140 141 193 394 382 140 141 194 395 51 140 141 195 396 374 140 141 196 397 374 140 141 197 398 374 140 141 198 399 374 140 141 199 400 374 140 141 200 401 374 140 141 201 402 374 140 141 202 403 374 140 141 203 404 374 140 141 204 405 374 140 141 205 406 51 140 141 206 407 51 140 141 207 408 51 140 141 208 409 51 140 141 209 410 51 140 141 210 411 51 140 141 211 412 51 140 141 212 413 51 140 141 213 414 51 140 141 214 415 51 140 141 215 416 51 140 141 216 417 51 140 141 217 418 51 140 419 147 420 597 320 421 51 140 590 566 567 150 113 51 140 141 321 114 382 140 590 147 141 567 322 115 51 140 590 566 567 151 435 51 140 141 152 436 51 140 141 424 429 51 140 141 425 430 51 140 141 426 431 51 140 440 568 439 438 51 140 440 568 427 432 51 140 141 153 428 51 140 141 154 434 51 140 141 155 437 51 140 141 423 433 51 140 441 218 442 51 140 441 219 458 51 140 441 220 459 51 140 441 221 460 51 140 441 222 461 51 140 441 223 462 51 140 441 224 463 51 140 441 225 464 51 140 441 226 465 51 140 441 227 466 51 140 441 316 467 51 140 441 317 468 51 140 441 318 469 51 140 441 319 470 51 140 441 228 471 51 140 441 229 472 51 140 441 230 473 51 140 441 536 540 51 140 441 231 474 51 140 441 232 475 51 140 441 233 476 51 140 441 234 477 51 140 441 235 478 51 140 591 5 569 236 479 51 140 141 237 480 51 140 141 238 101 51 140 141 239 102 51 140 141 240 103 51 140 141 241 104 51 140 141 242 105 51 140 141 243 106 51 140 141 244 107 51 140 141 245 108 51 140 141 246 109 51 140 141 247 481 382 140 141 248 482 382 140 141 249 483 382 140 141 250 484 382 140 141 251 485 382 140 141 252 486 382 140 141 253 487 382 140 141 254 89 382 140 141 255 488 382 140 141 256 90 382 140 141 257 489 382 140 141 258 92 382 140 141 259 490 382 140 141 260 491 382 140 141 261 492 382 140 141 262 493 382 140 141 263 494 382 140 141 264 495 382 140 141 265 496 382 140 141 266 498 497 570 267 499 382 140 141 268 500 382 140 141 269 501 382 140 141 270 502 382 140 141 271 503 382 140 141 272 504 382 140 141 273 505 382 140 141 274 96 382 140 141 275 97 382 140 141 276 506 382 140 141 277 98 382 140 141 278 507 51 140 592 569 279 508 51 140 592 569 280 509 382 140 141 281 510 382 140 141 282 511 382 140 141 283 512 382 140 141 537 541 382 140 141 538 542 382 140 141 539 543 382 140 141 284 513 382 140 141 285 514 382 140 141 286 515 382 140 141 287 516 382 140 141 288 517 382 140 141 289 518 382 140 141 290 519 51 140 141 291 520 51 140 141 292 521 51 140 141 293 522 51 140 141 294 524 51 140 591 571 295 525 51 140 591 571 296 526 51 140 141 297 527 51 140 141 298 528 51 140 141 299 529 51 140 141 300 530 51 140 141 301 531 51 140 141 302 532 51 140 141 303 533 51 140 534 304 110 51 140 535 10 11 12 18 139 138 139 138 52 51 140 141 53 51 140 141 74 51 140 141 54 51 140 141 75 51 140 141 55 51 140 141 556 51 140 141 56 51 140 141 57 51 140 141 58 51 140 141 76 51 140 141 59 51 140 141 60 51 140 141 61 51 140 141 62 51 140 141 63 51 140 141 64 51 140 141 65 51 140 141 77 51 140 141 66 51 140 141 67 51 140 141 78 140 141 68 140 141 79 51 140 141 80 51 140 141 69 51 140 141 81 51 140 141 70 51 140 141 82 51 140 141 71 51 140 141 72 51 140 141 72 51 140 141 73 51 140 141 83 557 140 593 598 84 51 140 593 598 85 51 140 593 598 86 51 140 593 598 87 51 140 593 598 555 51 140 141 88 557 593 598 21 22 139 138 139 138 113 51 140 141 114 51 140 141 115 51 140 141 13 139 138 139 138 110 382 140 141 111 112 14 139 138 139 138 101 382 140 141 102 382 140 141 103 382 140 141 104 382 140 141 105 382 140 141 106 382 140 141 107 382 140 141 108 382 140 141 109 382 140 141 15 5 16 558 51 140 593 598 559 51 140 593 598 560 51 140 593 598 561 564 140 593 598 562 564 140 593 598 563 564 140 593 598 5 17 89 422 90 91 92 93 94 95 374 140 594 598 96 97 98 5 523 595 599 600

Do not require authorization MRI, MRA – if not ordered by a Neurosurgeon, Neurologist o r Orthopedic MD Clinician Administered Drugs

Do not require authorization MRI, MRA – if not ordered by a Neurosurgeon, Neurologist o r Orthopedic MD Clinician Administered Drugs

Do not require authorization MRI, MRA – if not ordered by a Neurosurgeon, Neurologist o r Orthopedic MD Clinician Administered Drugs

6 9 99 139 138 139 138 146 118 51 140 145 147 141 119 51 140 145 147 141 120 51 140 145 147 141 121 51 140 145 147 141 117 51 140 577 147 141 572 5 122 51 140 577 147 141 572 123 51 140 578 147 141 596 124 51 140 578 147 141 596 125 51 140 578 147 141 596 126 51 140 578 147 141 596 127 51 140 578 147 141 596 5 128 51 140 578 147 141 596 129 51 140 443 147 141 596 130 51 140 579 147 141 596 131 51 142 141 147 141 132 51 142 141 147 141 133 51 142 141 147 141 134 51 142 141 147 141 135 51 142 141 147 141 136 51 142 141 147 141 137 51 142 141 147 141 19 139 138 139 138 23 51 140 141 147 141 24 51 140 141 147 141 143 144 140 141 147 141 25 51 140 141 147 141 26 51 140 141 147 141 27 51 140 141 147 141 28 51 140 141 147 141 29 51 140 141 147 141 30 51 140 141 147 141 31 148 140 580 147 141 32 51 140 580 147 141 33 51 140 141 147 141 34 51 140 141 147 141 35 51 140 141 147 141 36 51 140 141 147 141 37 51 140 141 147 141 38 51 140 141 147 141 39 51 140 141 147 141 20 139 138 139 138 40 41 42 43 51 140 581 573 44 45 51 140 581 573 46 47 51 140 582 574 48 49 51 140 582 574 446 544 444 140 453 545 444 140 454 546 444 140 455 547 444 140 456 548 444 140 447 549 444 140 448 550 444 140 449 551 444 140 450 552 444 140 451 553 444 140 452 554 444 140 149 50 444 140 445 5 100 139 138 139 138 323 148 140 583 573 325 148 140 583 573 326 148 140 583 573 327 148 140 583 573 328 148 140 583 573 324 148 140 332 573 329 148 140 330 575 331 148 140 333 575 159 334 51 140 141 575 160 335 51 140 141 575 161 336 51 140 141 575 337 51 140 141 575 338 51 140 141 575 339 51 140 141 575 340 51 140 141 575 341 51 140 141 575 342 51 140 141 575 343 51 140 141 575 344 51 140 141 575 345 51 140 141 575 346 51 140 141 575 347 51 140 141 575 348 51 140 141 575 162 349 51 140 141 575 163 350 51 140 141 575 164 351 51 140 141 575 156 565 51 140 584 573 157 352 51 140 585 573 158 353 51 140 585 573 165 354 51 140 141 575 166 355 51 140 141 575 167 357 51 140 141 575 168 356 51 140 141 575 169 358 51 140 141 575 170 359 51 140 141 575 171 360 51 140 457 576 172 361 51 140 141 575 601 324 51 140 141 575 311 362 51 140 141 575 305 308 51 140 586 573 173 363 51 140 141 575 309 310 51 140 141 575 312 364 51 140 141 575 313 365 51 140 141 575 314 366 51 140 141 575 306 307 51 140 586 573 315 367 51 140 586 573 174 368 51 140 141 175 369 51 140 587 573 176 177 51 140 587 573 178 370 51 140 587 573 179 371 51 140 587 573 180 372 51 140 587 573 181 373 51 140 141 182 375 382 140 588 573 376 382 140 588 573 377 382 140 588 573 378 382 140 588 573 379 382 140 588 573 380 382 140 588 573 381 382 140 588 573 381 51 140 141 183 383 51 140 141 184 384 51 140 141 185 385 51 140 141 186 386 51 140 141 387 331 51 140 589 573 187 388 51 140 588 573 188 389 51 140 588 573 189 390 51 140 588 573 190 391 51 140 141 191 392 374 140 141 192 393 51 140 141 193 394 382 140 141 194 395 51 140 141 195 396 374 140 141 196 397 374 140 141 197 398 374 140 141 198 399 374 140 141 199 400 374 140 141 200 401 374 140 141 201 402 374 140 141 202 403 374 140 141 203 404 374 140 141 204 405 374 140 141 205 406 51 140 141 206 407 51 140 141 207 408 51 140 141 208 409 51 140 141 209 410 51 140 141 210 411 51 140 141 211 412 51 140 141 212 413 51 140 141 213 414 51 140 141 214 415 51 140 141 215 416 51 140 141 216 417 51 140 141 217 418 51 140 419 147 420 597 320 421 51 140 590 566 567 150 113 51 140 141 321 114 382 140 590 147 141 567 322 115 51 140 590 566 567 151 435 51 140 141 152 436 51 140 141 424 429 51 140 141 425 430 51 140 141 426 431 51 140 440 568 439 438 51 140 440 568 427 432 51 140 141 153 428 51 140 141 154 434 51 140 141 155 437 51 140 141 423 433 51 140 441 218 442 51 140 441 219 458 51 140 441 220 459 51 140 441 221 460 51 140 441 222 461 51 140 441 223 462 51 140 441 224 463 51 140 441 225 464 51 140 441 226 465 51 140 441 227 466 51 140 441 316 467 51 140 441 317 468 51 140 441 318 469 51 140 441 319 470 51 140 441 228 471 51 140 441 229 472 51 140 441 230 473 51 140 441 536 540 51 140 441 231 474 51 140 441 232 475 51 140 441 233 476 51 140 441 234 477 51 140 441 235 478 51 140 591 5 569 236 479 51 140 141 237 480 51 140 141 238 101 51 140 141 239 102 51 140 141 240 103 51 140 141 241 104 51 140 141 242 105 51 140 141 243 106 51 140 141 244 107 51 140 141 245 108 51 140 141 246 109 51 140 141 247 481 382 140 141 248 482 382 140 141 249 483 382 140 141 250 484 382 140 141 251 485 382 140 141 252 486 382 140 141 253 487 382 140 141 254 89 382 140 141 255 488 382 140 141 256 90 382 140 141 257 489 382 140 141 258 92 382 140 141 259 490 382 140 141 260 491 382 140 141 261 492 382 140 141 262 493 382 140 141 263 494 382 140 141 264 495 382 140 141 265 496 382 140 141 266 498 497 570 267 499 382 140 141 268 500 382 140 141 269 501 382 140 141 270 502 382 140 141 271 503 382 140 141 272 504 382 140 141 273 505 382 140 141 274 96 382 140 141 275 97 382 140 141 276 506 382 140 141 277 98 382 140 141 278 507 51 140 592 569 279 508 51 140 592 569 280 509 382 140 141 281 510 382 140 141 282 511 382 140 141 283 512 382 140 141 537 541 382 140 141 538 542 382 140 141 539 543 382 140 141 284 513 382 140 141 285 514 382 140 141 286 515 382 140 141 287 516 382 140 141 288 517 382 140 141 289 518 382 140 141 290 519 51 140 141 291 520 51 140 141 292 521 51 140 141 293 522 51 140 141 294 524 51 140 591 571 295 525 51 140 591 571 296 526 51 140 141 297 527 51 140 141 298 528 51 140 141 299 529 51 140 141 300 530 51 140 141 301 531 51 140 141 302 532 51 140 141 303 533 51 140 534 304 110 51 140 535 10 11 12 18 139 138 139 138 52 51 140 141 53 51 140 141 74 51 140 141 54 51 140 141 75 51 140 141 55 51 140 141 556 51 140 141 56 51 140 141 57 51 140 141 58 51 140 141 76 51 140 141 59 51 140 141 60 51 140 141 61 51 140 141 62 51 140 141 63 51 140 141 64 51 140 141 65 51 140 141 77 51 140 141 66 51 140 141 67 51 140 141 78 140 141 68 140 141 79 51 140 141 80 51 140 141 69 51 140 141 81 51 140 141 70 51 140 141 82 51 140 141 71 51 140 141 72 51 140 141 72 51 140 141 73 51 140 141 83 557 140 593 598 84 51 140 593 598 85 51 140 593 598 86 51 140 593 598 87 51 140 593 598 555 51 140 141 88 557 593 598 21 22 139 138 139 138 113 51 140 141 114 51 140 141 115 51 140 141 13 139 138 139 138 110 382 140 141 111 112 14 139 138 139 138 101 382 140 141 102 382 140 141 103 382 140 141 104 382 140 141 105 382 140 141 106 382 140 141 107 382 140 141 108 382 140 141 109 382 140 141 15 5 16 558 51 140 593 598 559 51 140 593 598 560 51 140 593 598 561 564 140 593 598 562 564 140 593 598 563 564 140 593 598 5 17 89 422 90 91 92 93 94 95 374 140 594 598 96 97 98 5 523 595 599 600

6 9 99 139 138 139 138 146 118 51 140 145 147 141 119 51 140 145 147 141 120 51 140 145 147 141 121 51 140 145 147 141 117 51 140 577 147 141 572 5 122 51 140 577 147 141 572 123 51 140 578 147 141 596 124 51 140 578 147 141 596 125 51 140 578 147 141 596 126 51 140 578 147 141 596 127 51 140 578 147 141 596 5 128 51 140 578 147 141 596 129 51 140 443 147 141 596 130 51 140 579 147 141 596 131 51 142 141 147 141 132 51 142 141 147 141 133 51 142 141 147 141 134 51 142 141 147 141 135 51 142 141 147 141 136 51 142 141 147 141 137 51 142 141 147 141 19 139 138 139 138 23 51 140 141 147 141 24 51 140 141 147 141 143 144 140 141 147 141 25 51 140 141 147 141 26 51 140 141 147 141 27 51 140 141 147 141 28 51 140 141 147 141 29 51 140 141 147 141 30 51 140 141 147 141 31 148 140 580 147 141 32 51 140 580 147 141 33 51 140 141 147 141 34 51 140 141 147 141 35 51 140 141 147 141 36 51 140 141 147 141 37 51 140 141 147 141 38 51 140 141 147 141 39 51 140 141 147 141 20 139 138 139 138 40 41 42 43 51 140 581 573 44 45 51 140 581 573 46 47 51 140 582 574 48 49 51 140 582 574 446 544 444 140 453 545 444 140 454 546 444 140 455 547 444 140 456 548 444 140 447 549 444 140 448 550 444 140 449 551 444 140 450 552 444 140 451 553 444 140 452 554 444 140 149 50 444 140 445 5 100 139 138 139 138 323 148 140 583 573 325 148 140 583 573 326 148 140 583 573 327 148 140 583 573 328 148 140 583 573 324 148 140 332 573 329 148 140 330 575 331 148 140 333 575 159 334 51 140 141 575 160 335 51 140 141 575 161 336 51 140 141 575 337 51 140 141 575 338 51 140 141 575 339 51 140 141 575 340 51 140 141 575 341 51 140 141 575 342 51 140 141 575 343 51 140 141 575 344 51 140 141 575 345 51 140 141 575 346 51 140 141 575 347 51 140 141 575 348 51 140 141 575 162 349 51 140 141 575 163 350 51 140 141 575 164 351 51 140 141 575 156 565 51 140 584 573 157 352 51 140 585 573 158 353 51 140 585 573 165 354 51 140 141 575 166 355 51 140 141 575 167 357 51 140 141 575 168 356 51 140 141 575 169 358 51 140 141 575 170 359 51 140 141 575 171 360 51 140 457 576 172 361 51 140 141 575 601 324 51 140 141 575 311 362 51 140 141 575 305 308 51 140 586 573 173 363 51 140 141 575 309 310 51 140 141 575 312 364 51 140 141 575 313 365 51 140 141 575 314 366 51 140 141 575 306 307 51 140 586 573 315 367 51 140 586 573 174 368 51 140 141 175 369 51 140 587 573 176 177 51 140 587 573 178 370 51 140 587 573 179 371 51 140 587 573 180 372 51 140 587 573 181 373 51 140 141 182 375 382 140 588 573 376 382 140 588 573 377 382 140 588 573 378 382 140 588 573 379 382 140 588 573 380 382 140 588 573 381 382 140 588 573 381 51 140 141 183 383 51 140 141 184 384 51 140 141 185 385 51 140 141 186 386 51 140 141 387 331 51 140 589 573 187 388 51 140 588 573 188 389 51 140 588 573 189 390 51 140 588 573 190 391 51 140 141 191 392 374 140 141 192 393 51 140 141 193 394 382 140 141 194 395 51 140 141 195 396 374 140 141 196 397 374 140 141 197 398 374 140 141 198 399 374 140 141 199 400 374 140 141 200 401 374 140 141 201 402 374 140 141 202 403 374 140 141 203 404 374 140 141 204 405 374 140 141 205 406 51 140 141 206 407 51 140 141 207 408 51 140 141 208 409 51 140 141 209 410 51 140 141 210 411 51 140 141 211 412 51 140 141 212 413 51 140 141 213 414 51 140 141 214 415 51 140 141 215 416 51 140 141 216 417 51 140 141 217 418 51 140 419 147 420 597 320 421 51 140 590 566 567 150 113 51 140 141 321 114 382 140 590 147 141 567 322 115 51 140 590 566 567 151 435 51 140 141 152 436 51 140 141 424 429 51 140 141 425 430 51 140 141 426 431 51 140 440 568 439 438 51 140 440 568 427 432 51 140 141 153 428 51 140 141 154 434 51 140 141 155 437 51 140 141 423 433 51 140 441 218 442 51 140 441 219 458 51 140 441 220 459 51 140 441 221 460 51 140 441 222 461 51 140 441 223 462 51 140 441 224 463 51 140 441 225 464 51 140 441 226 465 51 140 441 227 466 51 140 441 316 467 51 140 441 317 468 51 140 441 318 469 51 140 441 319 470 51 140 441 228 471 51 140 441 229 472 51 140 441 230 473 51 140 441 536 540 51 140 441 231 474 51 140 441 232 475 51 140 441 233 476 51 140 441 234 477 51 140 441 235 478 51 140 591 5 569 236 479 51 140 141 237 480 51 140 141 238 101 51 140 141 239 102 51 140 141 240 103 51 140 141 241 104 51 140 141 242 105 51 140 141 243 106 51 140 141 244 107 51 140 141 245 108 51 140 141 246 109 51 140 141 247 481 382 140 141 248 482 382 140 141 249 483 382 140 141 250 484 382 140 141 251 485 382 140 141 252 486 382 140 141 253 487 382 140 141 254 89 382 140 141 255 488 382 140 141 256 90 382 140 141 257 489 382 140 141 258 92 382 140 141 259 490 382 140 141 260 491 382 140 141 261 492 382 140 141 262 493 382 140 141 263 494 382 140 141 264 495 382 140 141 265 496 382 140 141 266 498 497 570 267 499 382 140 141 268 500 382 140 141 269 501 382 140 141 270 502 382 140 141 271 503 382 140 141 272 504 382 140 141 273 505 382 140 141 274 96 382 140 141 275 97 382 140 141 276 506 382 140 141 277 98 382 140 141 278 507 51 140 592 569 279 508 51 140 592 569 280 509 382 140 141 281 510 382 140 141 282 511 382 140 141 283 512 382 140 141 537 541 382 140 141 538 542 382 140 141 539 543 382 140 141 284 513 382 140 141 285 514 382 140 141 286 515 382 140 141 287 516 382 140 141 288 517 382 140 141 289 518 382 140 141 290 519 51 140 141 291 520 51 140 141 292 521 51 140 141 293 522 51 140 141 294 524 51 140 591 571 295 525 51 140 591 571 296 526 51 140 141 297 527 51 140 141 298 528 51 140 141 299 529 51 140 141 300 530 51 140 141 301 531 51 140 141 302 532 51 140 141 303 533 51 140 534 304 110 51 140 535 10 11 12 18 139 138 139 138 52 51 140 141 53 51 140 141 74 51 140 141 54 51 140 141 75 51 140 141 55 51 140 141 556 51 140 141 56 51 140 141 57 51 140 141 58 51 140 141 76 51 140 141 59 51 140 141 60 51 140 141 61 51 140 141 62 51 140 141 63 51 140 141 64 51 140 141 65 51 140 141 77 51 140 141 66 51 140 141 67 51 140 141 78 140 141 68 140 141 79 51 140 141 80 51 140 141 69 51 140 141 81 51 140 141 70 51 140 141 82 51 140 141 71 51 140 141 72 51 140 141 72 51 140 141 73 51 140 141 83 557 140 593 598 84 51 140 593 598 85 51 140 593 598 86 51 140 593 598 87 51 140 593 598 555 51 140 141 88 557 593 598 21 22 139 138 139 138 113 51 140 141 114 51 140 141 115 51 140 141 13 139 138 139 138 110 382 140 141 111 112 14 139 138 139 138 101 382 140 141 102 382 140 141 103 382 140 141 104 382 140 141 105 382 140 141 106 382 140 141 107 382 140 141 108 382 140 141 109 382 140 141 15 5 16 558 51 140 593 598 559 51 140 593 598 560 51 140 593 598 561 564 140 593 598 562 564 140 593 598 563 564 140 593 598 5 17 89 422 90 91 92 93 94 95 374 140 594 598 96 97 98 5 523 595 599 600

6 9 99 139 138 139 138 146 118 51 140 145 147 141 119 51 140 145 147 141 120 51 140 145 147 141 121 51 140 145 147 141 117 51 140 577 147 141 572 5 122 51 140 577 147 141 572 123 51 140 578 147 141 596 124 51 140 578 147 141 596 125 51 140 578 147 141 596 126 51 140 578 147 141 596 127 51 140 578 147 141 596 5 128 51 140 578 147 141 596 129 51 140 443 147 141 596 130 51 140 579 147 141 596 131 51 142 141 147 141 132 51 142 141 147 141 133 51 142 141 147 141 134 51 142 141 147 141 135 51 142 141 147 141 136 51 142 141 147 141 137 51 142 141 147 141 19 139 138 139 138 23 51 140 141 147 141 24 51 140 141 147 141 143 144 140 141 147 141 25 51 140 141 147 141 26 51 140 141 147 141 27 51 140 141 147 141 28 51 140 141 147 141 29 51 140 141 147 141 30 51 140 141 147 141 31 148 140 580 147 141 32 51 140 580 147 141 33 51 140 141 147 141 34 51 140 141 147 141 35 51 140 141 147 141 36 51 140 141 147 141 37 51 140 141 147 141 38 51 140 141 147 141 39 51 140 141 147 141 20 139 138 139 138 40 41 42 43 51 140 581 573 44 45 51 140 581 573 46 47 51 140 582 574 48 49 51 140 582 574 446 544 444 140 453 545 444 140 454 546 444 140 455 547 444 140 456 548 444 140 447 549 444 140 448 550 444 140 449 551 444 140 450 552 444 140 451 553 444 140 452 554 444 140 149 50 444 140 445 5 100 139 138 139 138 323 148 140 583 573 325 148 140 583 573 326 148 140 583 573 327 148 140 583 573 328 148 140 583 573 324 148 140 332 573 329 148 140 330 575 331 148 140 333 575 159 334 51 140 141 575 160 335 51 140 141 575 161 336 51 140 141 575 337 51 140 141 575 338 51 140 141 575 339 51 140 141 575 340 51 140 141 575 341 51 140 141 575 342 51 140 141 575 343 51 140 141 575 344 51 140 141 575 345 51 140 141 575 346 51 140 141 575 347 51 140 141 575 348 51 140 141 575 162 349 51 140 141 575 163 350 51 140 141 575 164 351 51 140 141 575 156 565 51 140 584 573 157 352 51 140 585 573 158 353 51 140 585 573 165 354 51 140 141 575 166 355 51 140 141 575 167 357 51 140 141 575 168 356 51 140 141 575 169 358 51 140 141 575 170 359 51 140 141 575 171 360 51 140 457 576 172 361 51 140 141 575 601 324 51 140 141 575 311 362 51 140 141 575 305 308 51 140 586 573 173 363 51 140 141 575 309 310 51 140 141 575 312 364 51 140 141 575 313 365 51 140 141 575 314 366 51 140 141 575 306 307 51 140 586 573 315 367 51 140 586 573 174 368 51 140 141 175 369 51 140 587 573 176 177 51 140 587 573 178 370 51 140 587 573 179 371 51 140 587 573 180 372 51 140 587 573 181 373 51 140 141 182 375 382 140 588 573 376 382 140 588 573 377 382 140 588 573 378 382 140 588 573 379 382 140 588 573 380 382 140 588 573 381 382 140 588 573 381 51 140 141 183 383 51 140 141 184 384 51 140 141 185 385 51 140 141 186 386 51 140 141 387 331 51 140 589 573 187 388 51 140 588 573 188 389 51 140 588 573 189 390 51 140 588 573 190 391 51 140 141 191 392 374 140 141 192 393 51 140 141 193 394 382 140 141 194 395 51 140 141 195 396 374 140 141 196 397 374 140 141 197 398 374 140 141 198 399 374 140 141 199 400 374 140 141 200 401 374 140 141 201 402 374 140 141 202 403 374 140 141 203 404 374 140 141 204 405 374 140 141 205 406 51 140 141 206 407 51 140 141 207 408 51 140 141 208 409 51 140 141 209 410 51 140 141 210 411 51 140 141 211 412 51 140 141 212 413 51 140 141 213 414 51 140 141 214 415 51 140 141 215 416 51 140 141 216 417 51 140 141 217 418 51 140 419 147 420 597 320 421 51 140 590 566 567 150 113 51 140 141 321 114 382 140 590 147 141 567 322 115 51 140 590 566 567 151 435 51 140 141 152 436 51 140 141 424 429 51 140 141 425 430 51 140 141 426 431 51 140 440 568 439 438 51 140 440 568 427 432 51 140 141 153 428 51 140 141 154 434 51 140 141 155 437 51 140 141 423 433 51 140 441 218 442 51 140 441 219 458 51 140 441 220 459 51 140 441 221 460 51 140 441 222 461 51 140 441 223 462 51 140 441 224 463 51 140 441 225 464 51 140 441 226 465 51 140 441 227 466 51 140 441 316 467 51 140 441 317 468 51 140 441 318 469 51 140 441 319 470 51 140 441 228 471 51 140 441 229 472 51 140 441 230 473 51 140 441 536 540 51 140 441 231 474 51 140 441 232 475 51 140 441 233 476 51 140 441 234 477 51 140 441 235 478 51 140 591 5 569 236 479 51 140 141 237 480 51 140 141 238 101 51 140 141 239 102 51 140 141 240 103 51 140 141 241 104 51 140 141 242 105 51 140 141 243 106 51 140 141 244 107 51 140 141 245 108 51 140 141 246 109 51 140 141 247 481 382 140 141 248 482 382 140 141 249 483 382 140 141 250 484 382 140 141 251 485 382 140 141 252 486 382 140 141 253 487 382 140 141 254 89 382 140 141 255 488 382 140 141 256 90 382 140 141 257 489 382 140 141 258 92 382 140 141 259 490 382 140 141 260 491 382 140 141 261 492 382 140 141 262 493 382 140 141 263 494 382 140 141 264 495 382 140 141 265 496 382 140 141 266 498 497 570 267 499 382 140 141 268 500 382 140 141 269 501 382 140 141 270 502 382 140 141 271 503 382 140 141 272 504 382 140 141 273 505 382 140 141 274 96 382 140 141 275 97 382 140 141 276 506 382 140 141 277 98 382 140 141 278 507 51 140 592 569 279 508 51 140 592 569 280 509 382 140 141 281 510 382 140 141 282 511 382 140 141 283 512 382 140 141 537 541 382 140 141 538 542 382 140 141 539 543 382 140 141 284 513 382 140 141 285 514 382 140 141 286 515 382 140 141 287 516 382 140 141 288 517 382 140 141 289 518 382 140 141 290 519 51 140 141 291 520 51 140 141 292 521 51 140 141 293 522 51 140 141 294 524 51 140 591 571 295 525 51 140 591 571 296 526 51 140 141 297 527 51 140 141 298 528 51 140 141 299 529 51 140 141 300 530 51 140 141 301 531 51 140 141 302 532 51 140 141 303 533 51 140 534 304 110 51 140 535 10 11 12 18 139 138 139 138 52 51 140 141 53 51 140 141 74 51 140 141 54 51 140 141 75 51 140 141 55 51 140 141 556 51 140 141 56 51 140 141 57 51 140 141 58 51 140 141 76 51 140 141 59 51 140 141 60 51 140 141 61 51 140 141 62 51 140 141 63 51 140 141 64 51 140 141 65 51 140 141 77 51 140 141 66 51 140 141 67 51 140 141 78 140 141 68 140 141 79 51 140 141 80 51 140 141 69 51 140 141 81 51 140 141 70 51 140 141 82 51 140 141 71 51 140 141 72 51 140 141 72 51 140 141 73 51 140 141 83 557 140 593 598 84 51 140 593 598 85 51 140 593 598 86 51 140 593 598 87 51 140 593 598 555 51 140 141 88 557 593 598 21 22 139 138 139 138 113 51 140 141 114 51 140 141 115 51 140 141 13 139 138 139 138 110 382 140 141 111 112 14 139 138 139 138 101 382 140 141 102 382 140 141 103 382 140 141 104 382 140 141 105 382 140 141 106 382 140 141 107 382 140 141 108 382 140 141 109 382 140 141 15 5 16 558 51 140 593 598 559 51 140 593 598 560 51 140 593 598 561 564 140 593 598 562 564 140 593 598 563 564 140 593 598 5 17 89 422 90 91 92 93 94 95 374 140 594 598 96 97 98 5 523 595 599 600

6 9 99 139 138 139 138 146 118 51 140 145 147 141 119 51 140 145 147 141 120 51 140 145 147 141 121 51 140 145 147 141 117 51 140 577 147 141 572 5 122 51 140 577 147 141 572 123 51 140 578 147 141 596 124 51 140 578 147 141 596 125 51 140 578 147 141 596 126 51 140 578 147 141 596 127 51 140 578 147 141 596 5 128 51 140 578 147 141 596 129 51 140 443 147 141 596 130 51 140 579 147 141 596 131 51 142 141 147 141 132 51 142 141 147 141 133 51 142 141 147 141 134 51 142 141 147 141 135 51 142 141 147 141 136 51 142 141 147 141 137 51 142 141 147 141 19 139 138 139 138 23 51 140 141 147 141 24 51 140 141 147 141 143 144 140 141 147 141 25 51 140 141 147 141 26 51 140 141 147 141 27 51 140 141 147 141 28 51 140 141 147 141 29 51 140 141 147 141 30 51 140 141 147 141 31 148 140 580 147 141 32 51 140 580 147 141 33 51 140 141 147 141 34 51 140 141 147 141 35 51 140 141 147 141 36 51 140 141 147 141 37 51 140 141 147 141 38 51 140 141 147 141 39 51 140 141 147 141 20 139 138 139 138 40 41 42 43 51 140 581 573 44 45 51 140 581 573 46 47 51 140 582 574 48 49 51 140 582 574 446 544 444 140 453 545 444 140 454 546 444 140 455 547 444 140 456 548 444 140 447 549 444 140 448 550 444 140 449 551 444 140 450 552 444 140 451 553 444 140 452 554 444 140 149 50 444 140 445 5 100 139 138 139 138 323 148 140 583 573 325 148 140 583 573 326 148 140 583 573 327 148 140 583 573 328 148 140 583 573 324 148 140 332 573 329 148 140 330 575 331 148 140 333 575 159 334 51 140 141 575 160 335 51 140 141 575 161 336 51 140 141 575 337 51 140 141 575 338 51 140 141 575 339 51 140 141 575 340 51 140 141 575 341 51 140 141 575 342 51 140 141 575 343 51 140 141 575 344 51 140 141 575 345 51 140 141 575 346 51 140 141 575 347 51 140 141 575 348 51 140 141 575 162 349 51 140 141 575 163 350 51 140 141 575 164 351 51 140 141 575 156 565 51 140 584 573 157 352 51 140 585 573 158 353 51 140 585 573 165 354 51 140 141 575 166 355 51 140 141 575 167 357 51 140 141 575 168 356 51 140 141 575 169 358 51 140 141 575 170 359 51 140 141 575 171 360 51 140 457 576 172 361 51 140 141 575 601 324 51 140 141 575 311 362 51 140 141 575 305 308 51 140 586 573 173 363 51 140 141 575 309 310 51 140 141 575 312 364 51 140 141 575 313 365 51 140 141 575 314 366 51 140 141 575 306 307 51 140 586 573 315 367 51 140 586 573 174 368 51 140 141 175 369 51 140 587 573 176 177 51 140 587 573 178 370 51 140 587 573 179 371 51 140 587 573 180 372 51 140 587 573 181 373 51 140 141 182 375 382 140 588 573 376 382 140 588 573 377 382 140 588 573 378 382 140 588 573 379 382 140 588 573 380 382 140 588 573 381 382 140 588 573 381 51 140 141 183 383 51 140 141 184 384 51 140 141 185 385 51 140 141 186 386 51 140 141 387 331 51 140 589 573 187 388 51 140 588 573 188 389 51 140 588 573 189 390 51 140 588 573 190 391 51 140 141 191 392 374 140 141 192 393 51 140 141 193 394 382 140 141 194 395 51 140 141 195 396 374 140 141 196 397 374 140 141 197 398 374 140 141 198 399 374 140 141 199 400 374 140 141 200 401 374 140 141 201 402 374 140 141 202 403 374 140 141 203 404 374 140 141 204 405 374 140 141 205 406 51 140 141 206 407 51 140 141 207 408 51 140 141 208 409 51 140 141 209 410 51 140 141 210 411 51 140 141 211 412 51 140 141 212 413 51 140 141 213 414 51 140 141 214 415 51 140 141 215 416 51 140 141 216 417 51 140 141 217 418 51 140 419 147 420 597 320 421 51 140 590 566 567 150 113 51 140 141 321 114 382 140 590 147 141 567 322 115 51 140 590 566 567 151 435 51 140 141 152 436 51 140 141 424 429 51 140 141 425 430 51 140 141 426 431 51 140 440 568 439 438 51 140 440 568 427 432 51 140 141 153 428 51 140 141 154 434 51 140 141 155 437 51 140 141 423 433 51 140 441 218 442 51 140 441 219 458 51 140 441 220 459 51 140 441 221 460 51 140 441 222 461 51 140 441 223 462 51 140 441 224 463 51 140 441 225 464 51 140 441 226 465 51 140 441 227 466 51 140 441 316 467 51 140 441 317 468 51 140 441 318 469 51 140 441 319 470 51 140 441 228 471 51 140 441 229 472 51 140 441 230 473 51 140 441 536 540 51 140 441 231 474 51 140 441 232 475 51 140 441 233 476 51 140 441 234 477 51 140 441 235 478 51 140 591 5 569 236 479 51 140 141 237 480 51 140 141 238 101 51 140 141 239 102 51 140 141 240 103 51 140 141 241 104 51 140 141 242 105 51 140 141 243 106 51 140 141 244 107 51 140 141 245 108 51 140 141 246 109 51 140 141 247 481 382 140 141 248 482 382 140 141 249 483 382 140 141 250 484 382 140 141 251 485 382 140 141 252 486 382 140 141 253 487 382 140 141 254 89 382 140 141 255 488 382 140 141 256 90 382 140 141 257 489 382 140 141 258 92 382 140 141 259 490 382 140 141 260 491 382 140 141 261 492 382 140 141 262 493 382 140 141 263 494 382 140 141 264 495 382 140 141 265 496 382 140 141 266 498 497 570 267 499 382 140 141 268 500 382 140 141 269 501 382 140 141 270 502 382 140 141 271 503 382 140 141 272 504 382 140 141 273 505 382 140 141 274 96 382 140 141 275 97 382 140 141 276 506 382 140 141 277 98 382 140 141 278 507 51 140 592 569 279 508 51 140 592 569 280 509 382 140 141 281 510 382 140 141 282 511 382 140 141 283 512 382 140 141 537 541 382 140 141 538 542 382 140 141 539 543 382 140 141 284 513 382 140 141 285 514 382 140 141 286 515 382 140 141 287 516 382 140 141 288 517 382 140 141 289 518 382 140 141 290 519 51 140 141 291 520 51 140 141 292 521 51 140 141 293 522 51 140 141 294 524 51 140 591 571 295 525 51 140 591 571 296 526 51 140 141 297 527 51 140 141 298 528 51 140 141 299 529 51 140 141 300 530 51 140 141 301 531 51 140 141 302 532 51 140 141 303 533 51 140 534 304 110 51 140 535 10 11 12 18 139 138 139 138 52 51 140 141 53 51 140 141 74 51 140 141 54 51 140 141 75 51 140 141 55 51 140 141 556 51 140 141 56 51 140 141 57 51 140 141 58 51 140 141 76 51 140 141 59 51 140 141 60 51 140 141 61 51 140 141 62 51 140 141 63 51 140 141 64 51 140 141 65 51 140 141 77 51 140 141 66 51 140 141 67 51 140 141 78 140 141 68 140 141 79 51 140 141 80 51 140 141 69 51 140 141 81 51 140 141 70 51 140 141 82 51 140 141 71 51 140 141 72 51 140 141 72 51 140 141 73 51 140 141 83 557 140 593 598 84 51 140 593 598 85 51 140 593 598 86 51 140 593 598 87 51 140 593 598 555 51 140 141 88 557 593 598 21 22 139 138 139 138 113 51 140 141 114 51 140 141 115 51 140 141 13 139 138 139 138 110 382 140 141 111 112 14 139 138 139 138 101 382 140 141 102 382 140 141 103 382 140 141 104 382 140 141 105 382 140 141 106 382 140 141 107 382 140 141 108 382 140 141 109 382 140 141 15 5 16 558 51 140 593 598 559 51 140 593 598 560 51 140 593 598 561 564 140 593 598 562 564 140 593 598 563 564 140 593 598 5 17 89 422 90 91 92 93 94 95 374 140 594 598 96 97 98 5 523 595 599 600

6 9 99 139 138 139 138 146 118 51 140 145 147 141 119 51 140 145 147 141 120 51 140 145 147 141 121 51 140 145 147 141 117 51 140 577 147 141 572 5 122 51 140 577 147 141 572 123 51 140 578 147 141 596 124 51 140 578 147 141 596 125 51 140 578 147 141 596 126 51 140 578 147 141 596 127 51 140 578 147 141 596 5 128 51 140 578 147 141 596 129 51 140 443 147 141 596 130 51 140 579 147 141 596 131 51 142 141 147 141 132 51 142 141 147 141 133 51 142 141 147 141 134 51 142 141 147 141 135 51 142 141 147 141 136 51 142 141 147 141 137 51 142 141 147 141 19 139 138 139 138 23 51 140 141 147 141 24 51 140 141 147 141 143 144 140 141 147 141 25 51 140 141 147 141 26 51 140 141 147 141 27 51 140 141 147 141 28 51 140 141 147 141 29 51 140 141 147 141 30 51 140 141 147 141 31 148 140 580 147 141 32 51 140 580 147 141 33 51 140 141 147 141 34 51 140 141 147 141 35 51 140 141 147 141 36 51 140 141 147 141 37 51 140 141 147 141 38 51 140 141 147 141 39 51 140 141 147 141 20 139 138 139 138 40 41 42 43 51 140 581 573 44 45 51 140 581 573 46 47 51 140 582 574 48 49 51 140 582 574 446 544 444 140 453 545 444 140 454 546 444 140 455 547 444 140 456 548 444 140 447 549 444 140 448 550 444 140 449 551 444 140 450 552 444 140 451 553 444 140 452 554 444 140 149 50 444 140 445 5 100 139 138 139 138 323 148 140 583 573 325 148 140 583 573 326 148 140 583 573 327 148 140 583 573 328 148 140 583 573 324 148 140 332 573 329 148 140 330 575 331 148 140 333 575 159 334 51 140 141 575 160 335 51 140 141 575 161 336 51 140 141 575 337 51 140 141 575 338 51 140 141 575 339 51 140 141 575 340 51 140 141 575 341 51 140 141 575 342 51 140 141 575 343 51 140 141 575 344 51 140 141 575 345 51 140 141 575 346 51 140 141 575 347 51 140 141 575 348 51 140 141 575 162 349 51 140 141 575 163 350 51 140 141 575 164 351 51 140 141 575 156 565 51 140 584 573 157 352 51 140 585 573 158 353 51 140 585 573 165 354 51 140 141 575 166 355 51 140 141 575 167 357 51 140 141 575 168 356 51 140 141 575 169 358 51 140 141 575 170 359 51 140 141 575 171 360 51 140 457 576 172 361 51 140 141 575 601 324 51 140 141 575 311 362 51 140 141 575 305 308 51 140 586 573 173 363 51 140 141 575 309 310 51 140 141 575 312 364 51 140 141 575 313 365 51 140 141 575 314 366 51 140 141 575 306 307 51 140 586 573 315 367 51 140 586 573 174 368 51 140 141 175 369 51 140 587 573 176 177 51 140 587 573 178 370 51 140 587 573 179 371 51 140 587 573 180 372 51 140 587 573 181 373 51 140 141 182 375 382 140 588 573 376 382 140 588 573 377 382 140 588 573 378 382 140 588 573 379 382 140 588 573 380 382 140 588 573 381 382 140 588 573 381 51 140 141 183 383 51 140 141 184 384 51 140 141 185 385 51 140 141 186 386 51 140 141 387 331 51 140 589 573 187 388 51 140 588 573 188 389 51 140 588 573 189 390 51 140 588 573 190 391 51 140 141 191 392 374 140 141 192 393 51 140 141 193 394 382 140 141 194 395 51 140 141 195 396 374 140 141 196 397 374 140 141 197 398 374 140 141 198 399 374 140 141 199 400 374 140 141 200 401 374 140 141 201 402 374 140 141 202 403 374 140 141 203 404 374 140 141 204 405 374 140 141 205 406 51 140 141 206 407 51 140 141 207 408 51 140 141 208 409 51 140 141 209 410 51 140 141 210 411 51 140 141 211 412 51 140 141 212 413 51 140 141 213 414 51 140 141 214 415 51 140 141 215 416 51 140 141 216 417 51 140 141 217 418 51 140 419 147 420 597 320 421 51 140 590 566 567 150 113 51 140 141 321 114 382 140 590 147 141 567 322 115 51 140 590 566 567 151 435 51 140 141 152 436 51 140 141 424 429 51 140 141 425 430 51 140 141 426 431 51 140 440 568 439 438 51 140 440 568 427 432 51 140 141 153 428 51 140 141 154 434 51 140 141 155 437 51 140 141 423 433 51 140 441 218 442 51 140 441 219 458 51 140 441 220 459 51 140 441 221 460 51 140 441 222 461 51 140 441 223 462 51 140 441 224 463 51 140 441 225 464 51 140 441 226 465 51 140 441 227 466 51 140 441 316 467 51 140 441 317 468 51 140 441 318 469 51 140 441 319 470 51 140 441 228 471 51 140 441 229 472 51 140 441 230 473 51 140 441 536 540 51 140 441 231 474 51 140 441 232 475 51 140 441 233 476 51 140 441 234 477 51 140 441 235 478 51 140 591 5 569 236 479 51 140 141 237 480 51 140 141 238 101 51 140 141 239 102 51 140 141 240 103 51 140 141 241 104 51 140 141 242 105 51 140 141 243 106 51 140 141 244 107 51 140 141 245 108 51 140 141 246 109 51 140 141 247 481 382 140 141 248 482 382 140 141 249 483 382 140 141 250 484 382 140 141 251 485 382 140 141 252 486 382 140 141 253 487 382 140 141 254 89 382 140 141 255 488 382 140 141 256 90 382 140 141 257 489 382 140 141 258 92 382 140 141 259 490 382 140 141 260 491 382 140 141 261 492 382 140 141 262 493 382 140 141 263 494 382 140 141 264 495 382 140 141 265 496 382 140 141 266 498 497 570 267 499 382 140 141 268 500 382 140 141 269 501 382 140 141 270 502 382 140 141 271 503 382 140 141 272 504 382 140 141 273 505 382 140 141 274 96 382 140 141 275 97 382 140 141 276 506 382 140 141 277 98 382 140 141 278 507 51 140 592 569 279 508 51 140 592 569 280 509 382 140 141 281 510 382 140 141 282 511 382 140 141 283 512 382 140 141 537 541 382 140 141 538 542 382 140 141 539 543 382 140 141 284 513 382 140 141 285 514 382 140 141 286 515 382 140 141 287 516 382 140 141 288 517 382 140 141 289 518 382 140 141 290 519 51 140 141 291 520 51 140 141 292 521 51 140 141 293 522 51 140 141 294 524 51 140 591 571 295 525 51 140 591 571 296 526 51 140 141 297 527 51 140 141 298 528 51 140 141 299 529 51 140 141 300 530 51 140 141 301 531 51 140 141 302 532 51 140 141 303 533 51 140 534 304 110 51 140 535 10 11 12 18 139 138 139 138 52 51 140 141 53 51 140 141 74 51 140 141 54 51 140 141 75 51 140 141 55 51 140 141 556 51 140 141 56 51 140 141 57 51 140 141 58 51 140 141 76 51 140 141 59 51 140 141 60 51 140 141 61 51 140 141 62 51 140 141 63 51 140 141 64 51 140 141 65 51 140 141 77 51 140 141 66 51 140 141 67 51 140 141 78 140 141 68 140 141 79 51 140 141 80 51 140 141 69 51 140 141 81 51 140 141 70 51 140 141 82 51 140 141 71 51 140 141 72 51 140 141 72 51 140 141 73 51 140 141 83 557 140 593 598 84 51 140 593 598 85 51 140 593 598 86 51 140 593 598 87 51 140 593 598 555 51 140 141 88 557 593 598 21 22 139 138 139 138 113 51 140 141 114 51 140 141 115 51 140 141 13 139 138 139 138 110 382 140 141 111 112 14 139 138 139 138 101 382 140 141 102 382 140 141 103 382 140 141 104 382 140 141 105 382 140 141 106 382 140 141 107 382 140 141 108 382 140 141 109 382 140 141 15 5 16 558 51 140 593 598 559 51 140 593 598 560 51 140 593 598 561 564 140 593 598 562 564 140 593 598 563 564 140 593 598 5 17 89 422 90 91 92 93 94 95 374 140 594 598 96 97 98 5 523 595 599 600

6 9 99 139 138 139 138 146 118 51 140 145 147 141 119 51 140 145 147 141 120 51 140 145 147 141 121 51 140 145 147 141 117 51 140 577 147 141 572 5 122 51 140 577 147 141 572 123 51 140 578 147 141 596 124 51 140 578 147 141 596 125 51 140 578 147 141 596 126 51 140 578 147 141 596 127 51 140 578 147 141 596 5 128 51 140 578 147 141 596 129 51 140 443 147 141 596 130 51 140 579 147 141 596 131 51 142 141 147 141 132 51 142 141 147 141 133 51 142 141 147 141 134 51 142 141 147 141 135 51 142 141 147 141 136 51 142 141 147 141 137 51 142 141 147 141 19 139 138 139 138 23 51 140 141 147 141 24 51 140 141 147 141 143 144 140 141 147 141 25 51 140 141 147 141 26 51 140 141 147 141 27 51 140 141 147 141 28 51 140 141 147 141 29 51 140 141 147 141 30 51 140 141 147 141 31 148 140 580 147 141 32 51 140 580 147 141 33 51 140 141 147 141 34 51 140 141 147 141 35 51 140 141 147 141 36 51 140 141 147 141 37 51 140 141 147 141 38 51 140 141 147 141 39 51 140 141 147 141 20 139 138 139 138 40 41 42 43 51 140 581 573 44 45 51 140 581 573 46 47 51 140 582 574 48 49 51 140 582 574 446 544 444 140 453 545 444 140 454 546 444 140 455 547 444 140 456 548 444 140 447 549 444 140 448 550 444 140 449 551 444 140 450 552 444 140 451 553 444 140 452 554 444 140 149 50 444 140 445 5 100 139 138 139 138 323 148 140 583 573 325 148 140 583 573 326 148 140 583 573 327 148 140 583 573 328 148 140 583 573 324 148 140 332 573 329 148 140 330 575 331 148 140 333 575 159 334 51 140 141 575 160 335 51 140 141 575 161 336 51 140 141 575 337 51 140 141 575 338 51 140 141 575 339 51 140 141 575 340 51 140 141 575 341 51 140 141 575 342 51 140 141 575 343 51 140 141 575 344 51 140 141 575 345 51 140 141 575 346 51 140 141 575 347 51 140 141 575 348 51 140 141 575 162 349 51 140 141 575 163 350 51 140 141 575 164 351 51 140 141 575 156 565 51 140 584 573 157 352 51 140 585 573 158 353 51 140 585 573 165 354 51 140 141 575 166 355 51 140 141 575 167 357 51 140 141 575 168 356 51 140 141 575 169 358 51 140 141 575 170 359 51 140 141 575 171 360 51 140 457 576 172 361 51 140 141 575 601 324 51 140 141 575 311 362 51 140 141 575 305 308 51 140 586 573 173 363 51 140 141 575 309 310 51 140 141 575 312 364 51 140 141 575 313 365 51 140 141 575 314 366 51 140 141 575 306 307 51 140 586 573 315 367 51 140 586 573 174 368 51 140 141 175 369 51 140 587 573 176 177 51 140 587 573 178 370 51 140 587 573 179 371 51 140 587 573 180 372 51 140 587 573 181 373 51 140 141 182 375 382 140 588 573 376 382 140 588 573 377 382 140 588 573 378 382 140 588 573 379 382 140 588 573 380 382 140 588 573 381 382 140 588 573 381 51 140 141 183 383 51 140 141 184 384 51 140 141 185 385 51 140 141 186 386 51 140 141 387 331 51 140 589 573 187 388 51 140 588 573 188 389 51 140 588 573 189 390 51 140 588 573 190 391 51 140 141 191 392 374 140 141 192 393 51 140 141 193 394 382 140 141 194 395 51 140 141 195 396 374 140 141 196 397 374 140 141 197 398 374 140 141 198 399 374 140 141 199 400 374 140 141 200 401 374 140 141 201 402 374 140 141 202 403 374 140 141 203 404 374 140 141 204 405 374 140 141 205 406 51 140 141 206 407 51 140 141 207 408 51 140 141 208 409 51 140 141 209 410 51 140 141 210 411 51 140 141 211 412 51 140 141 212 413 51 140 141 213 414 51 140 141 214 415 51 140 141 215 416 51 140 141 216 417 51 140 141 217 418 51 140 419 147 420 597 320 421 51 140 590 566 567 150 113 51 140 141 321 114 382 140 590 147 141 567 322 115 51 140 590 566 567 151 435 51 140 141 152 436 51 140 141 424 429 51 140 141 425 430 51 140 141 426 431 51 140 440 568 439 438 51 140 440 568 427 432 51 140 141 153 428 51 140 141 154 434 51 140 141 155 437 51 140 141 423 433 51 140 441 218 442 51 140 441 219 458 51 140 441 220 459 51 140 441 221 460 51 140 441 222 461 51 140 441 223 462 51 140 441 224 463 51 140 441 225 464 51 140 441 226 465 51 140 441 227 466 51 140 441 316 467 51 140 441 317 468 51 140 441 318 469 51 140 441 319 470 51 140 441 228 471 51 140 441 229 472 51 140 441 230 473 51 140 441 536 540 51 140 441 231 474 51 140 441 232 475 51 140 441 233 476 51 140 441 234 477 51 140 441 235 478 51 140 591 5 569 236 479 51 140 141 237 480 51 140 141 238 101 51 140 141 239 102 51 140 141 240 103 51 140 141 241 104 51 140 141 242 105 51 140 141 243 106 51 140 141 244 107 51 140 141 245 108 51 140 141 246 109 51 140 141 247 481 382 140 141 248 482 382 140 141 249 483 382 140 141 250 484 382 140 141 251 485 382 140 141 252 486 382 140 141 253 487 382 140 141 254 89 382 140 141 255 488 382 140 141 256 90 382 140 141 257 489 382 140 141 258 92 382 140 141 259 490 382 140 141 260 491 382 140 141 261 492 382 140 141 262 493 382 140 141 263 494 382 140 141 264 495 382 140 141 265 496 382 140 141 266 498 497 570 267 499 382 140 141 268 500 382 140 141 269 501 382 140 141 270 502 382 140 141 271 503 382 140 141 272 504 382 140 141 273 505 382 140 141 274 96 382 140 141 275 97 382 140 141 276 506 382 140 141 277 98 382 140 141 278 507 51 140 592 569 279 508 51 140 592 569 280 509 382 140 141 281 510 382 140 141 282 511 382 140 141 283 512 382 140 141 537 541 382 140 141 538 542 382 140 141 539 543 382 140 141 284 513 382 140 141 285 514 382 140 141 286 515 382 140 141 287 516 382 140 141 288 517 382 140 141 289 518 382 140 141 290 519 51 140 141 291 520 51 140 141 292 521 51 140 141 293 522 51 140 141 294 524 51 140 591 571 295 525 51 140 591 571 296 526 51 140 141 297 527 51 140 141 298 528 51 140 141 299 529 51 140 141 300 530 51 140 141 301 531 51 140 141 302 532 51 140 141 303 533 51 140 534 304 110 51 140 535 10 11 12 18 139 138 139 138 52 51 140 141 53 51 140 141 74 51 140 141 54 51 140 141 75 51 140 141 55 51 140 141 556 51 140 141 56 51 140 141 57 51 140 141 58 51 140 141 76 51 140 141 59 51 140 141 60 51 140 141 61 51 140 141 62 51 140 141 63 51 140 141 64 51 140 141 65 51 140 141 77 51 140 141 66 51 140 141 67 51 140 141 78 140 141 68 140 141 79 51 140 141 80 51 140 141 69 51 140 141 81 51 140 141 70 51 140 141 82 51 140 141 71 51 140 141 72 51 140 141 72 51 140 141 73 51 140 141 83 557 140 593 598 84 51 140 593 598 85 51 140 593 598 86 51 140 593 598 87 51 140 593 598 555 51 140 141 88 557 593 598 21 22 139 138 139 138 113 51 140 141 114 51 140 141 115 51 140 141 13 139 138 139 138 110 382 140 141 111 112 14 139 138 139 138 101 382 140 141 102 382 140 141 103 382 140 141 104 382 140 141 105 382 140 141 106 382 140 141 107 382 140 141 108 382 140 141 109 382 140 141 15 5 16 558 51 140 593 598 559 51 140 593 598 560 51 140 593 598 561 564 140 593 598 562 564 140 593 598 563 564 140 593 598 5 17 89 422 90 91 92 93 94 95 374 140 594 598 96 97 98 5 523 595 599 600

6 9 99 139 138 139 138 146 118 51 140 145 147 141 119 51 140 145 147 141 120 51 140 145 147 141 121 51 140 145 147 141 117 51 140 577 147 141 572 5 122 51 140 577 147 141 572 123 51 140 578 147 141 596 124 51 140 578 147 141 596 125 51 140 578 147 141 596 126 51 140 578 147 141 596 127 51 140 578 147 141 596 5 128 51 140 578 147 141 596 129 51 140 443 147 141 596 130 51 140 579 147 141 596 131 51 142 141 147 141 132 51 142 141 147 141 133 51 142 141 147 141 134 51 142 141 147 141 135 51 142 141 147 141 136 51 142 141 147 141 137 51 142 141 147 141 19 139 138 139 138 23 51 140 141 147 141 24 51 140 141 147 141 143 144 140 141 147 141 25 51 140 141 147 141 26 51 140 141 147 141 27 51 140 141 147 141 28 51 140 141 147 141 29 51 140 141 147 141 30 51 140 141 147 141 31 148 140 580 147 141 32 51 140 580 147 141 33 51 140 141 147 141 34 51 140 141 147 141 35 51 140 141 147 141 36 51 140 141 147 141 37 51 140 141 147 141 38 51 140 141 147 141 39 51 140 141 147 141 20 139 138 139 138 40 41 42 43 51 140 581 573 44 45 51 140 581 573 46 47 51 140 582 574 48 49 51 140 582 574 446 544 444 140 453 545 444 140 454 546 444 140 455 547 444 140 456 548 444 140 447 549 444 140 448 550 444 140 449 551 444 140 450 552 444 140 451 553 444 140 452 554 444 140 149 50 444 140 445 5 100 139 138 139 138 323 148 140 583 573 325 148 140 583 573 326 148 140 583 573 327 148 140 583 573 328 148 140 583 573 324 148 140 332 573 329 148 140 330 575 331 148 140 333 575 159 334 51 140 141 575 160 335 51 140 141 575 161 336 51 140 141 575 337 51 140 141 575 338 51 140 141 575 339 51 140 141 575 340 51 140 141 575 341 51 140 141 575 342 51 140 141 575 343 51 140 141 575 344 51 140 141 575 345 51 140 141 575 346 51 140 141 575 347 51 140 141 575 348 51 140 141 575 162 349 51 140 141 575 163 350 51 140 141 575 164 351 51 140 141 575 156 565 51 140 584 573 157 352 51 140 585 573 158 353 51 140 585 573 165 354 51 140 141 575 166 355 51 140 141 575 167 357 51 140 141 575 168 356 51 140 141 575 169 358 51 140 141 575 170 359 51 140 141 575 171 360 51 140 457 576 172 361 51 140 141 575 601 324 51 140 141 575 311 362 51 140 141 575 305 308 51 140 586 573 173 363 51 140 141 575 309 310 51 140 141 575 312 364 51 140 141 575 313 365 51 140 141 575 314 366 51 140 141 575 306 307 51 140 586 573 315 367 51 140 586 573 174 368 51 140 141 175 369 51 140 587 573 176 177 51 140 587 573 178 370 51 140 587 573 179 371 51 140 587 573 180 372 51 140 587 573 181 373 51 140 141 182 375 382 140 588 573 376 382 140 588 573 377 382 140 588 573 378 382 140 588 573 379 382 140 588 573 380 382 140 588 573 381 382 140 588 573 381 51 140 141 183 383 51 140 141 184 384 51 140 141 185 385 51 140 141 186 386 51 140 141 387 331 51 140 589 573 187 388 51 140 588 573 188 389 51 140 588 573 189 390 51 140 588 573 190 391 51 140 141 191 392 374 140 141 192 393 51 140 141 193 394 382 140 141 194 395 51 140 141 195 396 374 140 141 196 397 374 140 141 197 398 374 140 141 198 399 374 140 141 199 400 374 140 141 200 401 374 140 141 201 402 374 140 141 202 403 374 140 141 203 404 374 140 141 204 405 374 140 141 205 406 51 140 141 206 407 51 140 141 207 408 51 140 141 208 409 51 140 141 209 410 51 140 141 210 411 51 140 141 211 412 51 140 141 212 413 51 140 141 213 414 51 140 141 214 415 51 140 141 215 416 51 140 141 216 417 51 140 141 217 418 51 140 419 147 420 597 320 421 51 140 590 566 567 150 113 51 140 141 321 114 382 140 590 147 141 567 322 115 51 140 590 566 567 151 435 51 140 141 152 436 51 140 141 424 429 51 140 141 425 430 51 140 141 426 431 51 140 440 568 439 438 51 140 440 568 427 432 51 140 141 153 428 51 140 141 154 434 51 140 141 155 437 51 140 141 423 433 51 140 441 218 442 51 140 441 219 458 51 140 441 220 459 51 140 441 221 460 51 140 441 222 461 51 140 441 223 462 51 140 441 224 463 51 140 441 225 464 51 140 441 226 465 51 140 441 227 466 51 140 441 316 467 51 140 441 317 468 51 140 441 318 469 51 140 441 319 470 51 140 441 228 471 51 140 441 229 472 51 140 441 230 473 51 140 441 536 540 51 140 441 231 474 51 140 441 232 475 51 140 441 233 476 51 140 441 234 477 51 140 441 235 478 51 140 591 5 569 236 479 51 140 141 237 480 51 140 141 238 101 51 140 141 239 102 51 140 141 240 103 51 140 141 241 104 51 140 141 242 105 51 140 141 243 106 51 140 141 244 107 51 140 141 245 108 51 140 141 246 109 51 140 141 247 481 382 140 141 248 482 382 140 141 249 483 382 140 141 250 484 382 140 141 251 485 382 140 141 252 486 382 140 141 253 487 382 140 141 254 89 382 140 141 255 488 382 140 141 256 90 382 140 141 257 489 382 140 141 258 92 382 140 141 259 490 382 140 141 260 491 382 140 141 261 492 382 140 141 262 493 382 140 141 263 494 382 140 141 264 495 382 140 141 265 496 382 140 141 266 498 497 570 267 499 382 140 141 268 500 382 140 141 269 501 382 140 141 270 502 382 140 141 271 503 382 140 141 272 504 382 140 141 273 505 382 140 141 274 96 382 140 141 275 97 382 140 141 276 506 382 140 141 277 98 382 140 141 278 507 51 140 592 569 279 508 51 140 592 569 280 509 382 140 141 281 510 382 140 141 282 511 382 140 141 283 512 382 140 141 537 541 382 140 141 538 542 382 140 141 539 543 382 140 141 284 513 382 140 141 285 514 382 140 141 286 515 382 140 141 287 516 382 140 141 288 517 382 140 141 289 518 382 140 141 290 519 51 140 141 291 520 51 140 141 292 521 51 140 141 293 522 51 140 141 294 524 51 140 591 571 295 525 51 140 591 571 296 526 51 140 141 297 527 51 140 141 298 528 51 140 141 299 529 51 140 141 300 530 51 140 141 301 531 51 140 141 302 532 51 140 141 303 533 51 140 534 304 110 51 140 535 10 11 12 18 139 138 139 138 52 51 140 141 53 51 140 141 74 51 140 141 54 51 140 141 75 51 140 141 55 51 140 141 556 51 140 141 56 51 140 141 57 51 140 141 58 51 140 141 76 51 140 141 59 51 140 141 60 51 140 141 61 51 140 141 62 51 140 141 63 51 140 141 64 51 140 141 65 51 140 141 77 51 140 141 66 51 140 141 67 51 140 141 78 140 141 68 140 141 79 51 140 141 80 51 140 141 69 51 140 141 81 51 140 141 70 51 140 141 82 51 140 141 71 51 140 141 72 51 140 141 72 51 140 141 73 51 140 141 83 557 140 593 598 84 51 140 593 598 85 51 140 593 598 86 51 140 593 598 87 51 140 593 598 555 51 140 141 88 557 593 598 21 22 139 138 139 138 113 51 140 141 114 51 140 141 115 51 140 141 13 139 138 139 138 110 382 140 141 111 112 14 139 138 139 138 101 382 140 141 102 382 140 141 103 382 140 141 104 382 140 141 105 382 140 141 106 382 140 141 107 382 140 141 108 382 140 141 109 382 140 141 15 5 16 558 51 140 593 598 559 51 140 593 598 560 51 140 593 598 561 564 140 593 598 562 564 140 593 598 563 564 140 593 598 5 17 89 422 90 91 92 93 94 95 374 140 594 598 96 97 98 5 523 595 599 600

6 9 99 139 138 139 138 146 118 51 140 145 147 141 119 51 140 145 147 141 120 51 140 145 147 141 121 51 140 145 147 141 117 51 140 577 147 141 572 5 122 51 140 577 147 141 572 123 51 140 578 147 141 596 124 51 140 578 147 141 596 125 51 140 578 147 141 596 126 51 140 578 147 141 596 127 51 140 578 147 141 596 5 128 51 140 578 147 141 596 129 51 140 443 147 141 596 130 51 140 579 147 141 596 131 51 142 141 147 141 132 51 142 141 147 141 133 51 142 141 147 141 134 51 142 141 147 141 135 51 142 141 147 141 136 51 142 141 147 141 137 51 142 141 147 141 19 139 138 139 138 23 51 140 141 147 141 24 51 140 141 147 141 143 144 140 141 147 141 25 51 140 141 147 141 26 51 140 141 147 141 27 51 140 141 147 141 28 51 140 141 147 141 29 51 140 141 147 141 30 51 140 141 147 141 31 148 140 580 147 141 32 51 140 580 147 141 33 51 140 141 147 141 34 51 140 141 147 141 35 51 140 141 147 141 36 51 140 141 147 141 37 51 140 141 147 141 38 51 140 141 147 141 39 51 140 141 147 141 20 139 138 139 138 40 41 42 43 51 140 581 573 44 45 51 140 581 573 46 47 51 140 582 574 48 49 51 140 582 574 446 544 444 140 453 545 444 140 454 546 444 140 455 547 444 140 456 548 444 140 447 549 444 140 448 550 444 140 449 551 444 140 450 552 444 140 451 553 444 140 452 554 444 140 149 50 444 140 445 5 100 139 138 139 138 323 148 140 583 573 325 148 140 583 573 326 148 140 583 573 327 148 140 583 573 328 148 140 583 573 324 148 140 332 573 329 148 140 330 575 331 148 140 333 575 159 334 51 140 141 575 160 335 51 140 141 575 161 336 51 140 141 575 337 51 140 141 575 338 51 140 141 575 339 51 140 141 575 340 51 140 141 575 341 51 140 141 575 342 51 140 141 575 343 51 140 141 575 344 51 140 141 575 345 51 140 141 575 346 51 140 141 575 347 51 140 141 575 348 51 140 141 575 162 349 51 140 141 575 163 350 51 140 141 575 164 351 51 140 141 575 156 565 51 140 584 573 157 352 51 140 585 573 158 353 51 140 585 573 165 354 51 140 141 575 166 355 51 140 141 575 167 357 51 140 141 575 168 356 51 140 141 575 169 358 51 140 141 575 170 359 51 140 141 575 171 360 51 140 457 576 172 361 51 140 141 575 601 324 51 140 141 575 311 362 51 140 141 575 305 308 51 140 586 573 173 363 51 140 141 575 309 310 51 140 141 575 312 364 51 140 141 575 313 365 51 140 141 575 314 366 51 140 141 575 306 307 51 140 586 573 315 367 51 140 586 573 174 368 51 140 141 175 369 51 140 587 573 176 177 51 140 587 573 178 370 51 140 587 573 179 371 51 140 587 573 180 372 51 140 587 573 181 373 51 140 141 182 375 382 140 588 573 376 382 140 588 573 377 382 140 588 573 378 382 140 588 573 379 382 140 588 573 380 382 140 588 573 381 382 140 588 573 381 51 140 141 183 383 51 140 141 184 384 51 140 141 185 385 51 140 141 186 386 51 140 141 387 331 51 140 589 573 187 388 51 140 588 573 188 389 51 140 588 573 189 390 51 140 588 573 190 391 51 140 141 191 392 374 140 141 192 393 51 140 141 193 394 382 140 141 194 395 51 140 141 195 396 374 140 141 196 397 374 140 141 197 398 374 140 141 198 399 374 140 141 199 400 374 140 141 200 401 374 140 141 201 402 374 140 141 202 403 374 140 141 203 404 374 140 141 204 405 374 140 141 205 406 51 140 141 206 407 51 140 141 207 408 51 140 141 208 409 51 140 141 209 410 51 140 141 210 411 51 140 141 211 412 51 140 141 212 413 51 140 141 213 414 51 140 141 214 415 51 140 141 215 416 51 140 141 216 417 51 140 141 217 418 51 140 419 147 420 597 320 421 51 140 590 566 567 150 113 51 140 141 321 114 382 140 590 147 141 567 322 115 51 140 590 566 567 151 435 51 140 141 152 436 51 140 141 424 429 51 140 141 425 430 51 140 141 426 431 51 140 440 568 439 438 51 140 440 568 427 432 51 140 141 153 428 51 140 141 154 434 51 140 141 155 437 51 140 141 423 433 51 140 441 218 442 51 140 441 219 458 51 140 441 220 459 51 140 441 221 460 51 140 441 222 461 51 140 441 223 462 51 140 441 224 463 51 140 441 225 464 51 140 441 226 465 51 140 441 227 466 51 140 441 316 467 51 140 441 317 468 51 140 441 318 469 51 140 441 319 470 51 140 441 228 471 51 140 441 229 472 51 140 441 230 473 51 140 441 536 540 51 140 441 231 474 51 140 441 232 475 51 140 441 233 476 51 140 441 234 477 51 140 441 235 478 51 140 591 5 569 236 479 51 140 141 237 480 51 140 141 238 101 51 140 141 239 102 51 140 141 240 103 51 140 141 241 104 51 140 141 242 105 51 140 141 243 106 51 140 141 244 107 51 140 141 245 108 51 140 141 246 109 51 140 141 247 481 382 140 141 248 482 382 140 141 249 483 382 140 141 250 484 382 140 141 251 485 382 140 141 252 486 382 140 141 253 487 382 140 141 254 89 382 140 141 255 488 382 140 141 256 90 382 140 141 257 489 382 140 141 258 92 382 140 141 259 490 382 140 141 260 491 382 140 141 261 492 382 140 141 262 493 382 140 141 263 494 382 140 141 264 495 382 140 141 265 496 382 140 141 266 498 497 570 267 499 382 140 141 268 500 382 140 141 269 501 382 140 141 270 502 382 140 141 271 503 382 140 141 272 504 382 140 141 273 505 382 140 141 274 96 382 140 141 275 97 382 140 141 276 506 382 140 141 277 98 382 140 141 278 507 51 140 592 569 279 508 51 140 592 569 280 509 382 140 141 281 510 382 140 141 282 511 382 140 141 283 512 382 140 141 537 541 382 140 141 538 542 382 140 141 539 543 382 140 141 284 513 382 140 141 285 514 382 140 141 286 515 382 140 141 287 516 382 140 141 288 517 382 140 141 289 518 382 140 141 290 519 51 140 141 291 520 51 140 141 292 521 51 140 141 293 522 51 140 141 294 524 51 140 591 571 295 525 51 140 591 571 296 526 51 140 141 297 527 51 140 141 298 528 51 140 141 299 529 51 140 141 300 530 51 140 141 301 531 51 140 141 302 532 51 140 141 303 533 51 140 534 304 110 51 140 535 10 11 12 18 139 138 139 138 52 51 140 141 53 51 140 141 74 51 140 141 54 51 140 141 75 51 140 141 55 51 140 141 556 51 140 141 56 51 140 141 57 51 140 141 58 51 140 141 76 51 140 141 59 51 140 141 60 51 140 141 61 51 140 141 62 51 140 141 63 51 140 141 64 51 140 141 65 51 140 141 77 51 140 141 66 51 140 141 67 51 140 141 78 140 141 68 140 141 79 51 140 141 80 51 140 141 69 51 140 141 81 51 140 141 70 51 140 141 82 51 140 141 71 51 140 141 72 51 140 141 72 51 140 141 73 51 140 141 83 557 140 593 598 84 51 140 593 598 85 51 140 593 598 86 51 140 593 598 87 51 140 593 598 555 51 140 141 88 557 593 598 21 22 139 138 139 138 113 51 140 141 114 51 140 141 115 51 140 141 13 139 138 139 138 110 382 140 141 111 112 14 139 138 139 138 101 382 140 141 102 382 140 141 103 382 140 141 104 382 140 141 105 382 140 141 106 382 140 141 107 382 140 141 108 382 140 141 109 382 140 141 15 5 16 558 51 140 593 598 559 51 140 593 598 560 51 140 593 598 561 564 140 593 598 562 564 140 593 598 563 564 140 593 598 5 17 89 422 90 91 92 93 94 95 374 140 594 598 96 97 98 5 523 595 599 600

6 9 99 139 138 139 138 146 118 51 140 145 147 141 119 51 140 145 147 141 120 51 140 145 147 141 121 51 140 145 147 141 117 51 140 577 147 141 572 5 122 51 140 577 147 141 572 123 51 140 578 147 141 596 124 51 140 578 147 141 596 125 51 140 578 147 141 596 126 51 140 578 147 141 596 127 51 140 578 147 141 596 5 128 51 140 578 147 141 596 129 51 140 443 147 141 596 130 51 140 579 147 141 596 131 51 142 141 147 141 132 51 142 141 147 141 133 51 142 141 147 141 134 51 142 141 147 141 135 51 142 141 147 141 136 51 142 141 147 141 137 51 142 141 147 141 19 139 138 139 138 23 51 140 141 147 141 24 51 140 141 147 141 143 144 140 141 147 141 25 51 140 141 147 141 26 51 140 141 147 141 27 51 140 141 147 141 28 51 140 141 147 141 29 51 140 141 147 141 30 51 140 141 147 141 31 148 140 580 147 141 32 51 140 580 147 141 33 51 140 141 147 141 34 51 140 141 147 141 35 51 140 141 147 141 36 51 140 141 147 141 37 51 140 141 147 141 38 51 140 141 147 141 39 51 140 141 147 141 20 139 138 139 138 40 41 42 43 51 140 581 573 44 45 51 140 581 573 46 47 51 140 582 574 48 49 51 140 582 574 446 544 444 140 453 545 444 140 454 546 444 140 455 547 444 140 456 548 444 140 447 549 444 140 448 550 444 140 449 551 444 140 450 552 444 140 451 553 444 140 452 554 444 140 149 50 444 140 445 5 100 139 138 139 138 323 148 140 583 573 325 148 140 583 573 326 148 140 583 573 327 148 140 583 573 328 148 140 583 573 324 148 140 332 573 329 148 140 330 575 331 148 140 333 575 159 334 51 140 141 575 160 335 51 140 141 575 161 336 51 140 141 575 337 51 140 141 575 338 51 140 141 575 339 51 140 141 575 340 51 140 141 575 341 51 140 141 575 342 51 140 141 575 343 51 140 141 575 344 51 140 141 575 345 51 140 141 575 346 51 140 141 575 347 51 140 141 575 348 51 140 141 575 162 349 51 140 141 575 163 350 51 140 141 575 164 351 51 140 141 575 156 565 51 140 584 573 157 352 51 140 585 573 158 353 51 140 585 573 165 354 51 140 141 575 166 355 51 140 141 575 167 357 51 140 141 575 168 356 51 140 141 575 169 358 51 140 141 575 170 359 51 140 141 575 171 360 51 140 457 576 172 361 51 140 141 575 601 324 51 140 141 575 311 362 51 140 141 575 305 308 51 140 586 573 173 363 51 140 141 575 309 310 51 140 141 575 312 364 51 140 141 575 313 365 51 140 141 575 314 366 51 140 141 575 306 307 51 140 586 573 315 367 51 140 586 573 174 368 51 140 141 175 369 51 140 587 573 176 177 51 140 587 573 178 370 51 140 587 573 179 371 51 140 587 573 180 372 51 140 587 573 181 373 51 140 141 182 375 382 140 588 573 376 382 140 588 573 377 382 140 588 573 378 382 140 588 573 379 382 140 588 573 380 382 140 588 573 381 382 140 588 573 381 51 140 141 183 383 51 140 141 184 384 51 140 141 185 385 51 140 141 186 386 51 140 141 387 331 51 140 589 573 187 388 51 140 588 573 188 389 51 140 588 573 189 390 51 140 588 573 190 391 51 140 141 191 392 374 140 141 192 393 51 140 141 193 394 382 140 141 194 395 51 140 141 195 396 374 140 141 196 397 374 140 141 197 398 374 140 141 198 399 374 140 141 199 400 374 140 141 200 401 374 140 141 201 402 374 140 141 202 403 374 140 141 203 404 374 140 141 204 405 374 140 141 205 406 51 140 141 206 407 51 140 141 207 408 51 140 141 208 409 51 140 141 209 410 51 140 141 210 411 51 140 141 211 412 51 140 141 212 413 51 140 141 213 414 51 140 141 214 415 51 140 141 215 416 51 140 141 216 417 51 140 141 217 418 51 140 419 147 420 597 320 421 51 140 590 566 567 150 113 51 140 141 321 114 382 140 590 147 141 567 322 115 51 140 590 566 567 151 435 51 140 141 152 436 51 140 141 424 429 51 140 141 425 430 51 140 141 426 431 51 140 440 568 439 438 51 140 440 568 427 432 51 140 141 153 428 51 140 141 154 434 51 140 141 155 437 51 140 141 423 433 51 140 441 218 442 51 140 441 219 458 51 140 441 220 459 51 140 441 221 460 51 140 441 222 461 51 140 441 223 462 51 140 441 224 463 51 140 441 225 464 51 140 441 226 465 51 140 441 227 466 51 140 441 316 467 51 140 441 317 468 51 140 441 318 469 51 140 441 319 470 51 140 441 228 471 51 140 441 229 472 51 140 441 230 473 51 140 441 536 540 51 140 441 231 474 51 140 441 232 475 51 140 441 233 476 51 140 441 234 477 51 140 441 235 478 51 140 591 5 569 236 479 51 140 141 237 480 51 140 141 238 101 51 140 141 239 102 51 140 141 240 103 51 140 141 241 104 51 140 141 242 105 51 140 141 243 106 51 140 141 244 107 51 140 141 245 108 51 140 141 246 109 51 140 141 247 481 382 140 141 248 482 382 140 141 249 483 382 140 141 250 484 382 140 141 251 485 382 140 141 252 486 382 140 141 253 487 382 140 141 254 89 382 140 141 255 488 382 140 141 256 90 382 140 141 257 489 382 140 141 258 92 382 140 141 259 490 382 140 141 260 491 382 140 141 261 492 382 140 141 262 493 382 140 141 263 494 382 140 141 264 495 382 140 141 265 496 382 140 141 266 498 497 570 267 499 382 140 141 268 500 382 140 141 269 501 382 140 141 270 502 382 140 141 271 503 382 140 141 272 504 382 140 141 273 505 382 140 141 274 96 382 140 141 275 97 382 140 141 276 506 382 140 141 277 98 382 140 141 278 507 51 140 592 569 279 508 51 140 592 569 280 509 382 140 141 281 510 382 140 141 282 511 382 140 141 283 512 382 140 141 537 541 382 140 141 538 542 382 140 141 539 543 382 140 141 284 513 382 140 141 285 514 382 140 141 286 515 382 140 141 287 516 382 140 141 288 517 382 140 141 289 518 382 140 141 290 519 51 140 141 291 520 51 140 141 292 521 51 140 141 293 522 51 140 141 294 524 51 140 591 571 295 525 51 140 591 571 296 526 51 140 141 297 527 51 140 141 298 528 51 140 141 299 529 51 140 141 300 530 51 140 141 301 531 51 140 141 302 532 51 140 141 303 533 51 140 534 304 110 51 140 535 10 11 12 18 139 138 139 138 52 51 140 141 53 51 140 141 74 51 140 141 54 51 140 141 75 51 140 141 55 51 140 141 556 51 140 141 56 51 140 141 57 51 140 141 58 51 140 141 76 51 140 141 59 51 140 141 60 51 140 141 61 51 140 141 62 51 140 141 63 51 140 141 64 51 140 141 65 51 140 141 77 51 140 141 66 51 140 141 67 51 140 141 78 140 141 68 140 141 79 51 140 141 80 51 140 141 69 51 140 141 81 51 140 141 70 51 140 141 82 51 140 141 71 51 140 141 72 51 140 141 72 51 140 141 73 51 140 141 83 557 140 593 598 84 51 140 593 598 85 51 140 593 598 86 51 140 593 598 87 51 140 593 598 555 51 140 141 88 557 593 598 21 22 139 138 139 138 113 51 140 141 114 51 140 141 115 51 140 141 13 139 138 139 138 110 382 140 141 111 112 14 139 138 139 138 101 382 140 141 102 382 140 141 103 382 140 141 104 382 140 141 105 382 140 141 106 382 140 141 107 382 140 141 108 382 140 141 109 382 140 141 15 5 16 558 51 140 593 598 559 51 140 593 598 560 51 140 593 598 561 564 140 593 598 562 564 140 593 598 563 564 140 593 598 5 17 89 422 90 91 92 93 94 95 374 140 594 598 96 97 98 5 523 595 599 600

6 9 99 139 138 139 138 146 118 51 140 145 147 141 119 51 140 145 147 141 120 51 140 145 147 141 121 51 140 145 147 141 117 51 140 577 147 141 572 5 122 51 140 577 147 141 572 123 51 140 578 147 141 596 124 51 140 578 147 141 596 125 51 140 578 147 141 596 126 51 140 578 147 141 596 127 51 140 578 147 141 596 5 128 51 140 578 147 141 596 129 51 140 443 147 141 596 130 51 140 579 147 141 596 131 51 142 141 147 141 132 51 142 141 147 141 133 51 142 141 147 141 134 51 142 141 147 141 135 51 142 141 147 141 136 51 142 141 147 141 137 51 142 141 147 141 19 139 138 139 138 23 51 140 141 147 141 24 51 140 141 147 141 143 144 140 141 147 141 25 51 140 141 147 141 26 51 140 141 147 141 27 51 140 141 147 141 28 51 140 141 147 141 29 51 140 141 147 141 30 51 140 141 147 141 31 148 140 580 147 141 32 51 140 580 147 141 33 51 140 141 147 141 34 51 140 141 147 141 35 51 140 141 147 141 36 51 140 141 147 141 37 51 140 141 147 141 38 51 140 141 147 141 39 51 140 141 147 141 20 139 138 139 138 40 41 42 43 51 140 581 573 44 45 51 140 581 573 46 47 51 140 582 574 48 49 51 140 582 574 446 544 444 140 453 545 444 140 454 546 444 140 455 547 444 140 456 548 444 140 447 549 444 140 448 550 444 140 449 551 444 140 450 552 444 140 451 553 444 140 452 554 444 140 149 50 444 140 445 5 100 139 138 139 138 323 148 140 583 573 325 148 140 583 573 326 148 140 583 573 327 148 140 583 573 328 148 140 583 573 324 148 140 332 573 329 148 140 330 575 331 148 140 333 575 159 334 51 140 141 575 160 335 51 140 141 575 161 336 51 140 141 575 337 51 140 141 575 338 51 140 141 575 339 51 140 141 575 340 51 140 141 575 341 51 140 141 575 342 51 140 141 575 343 51 140 141 575 344 51 140 141 575 345 51 140 141 575 346 51 140 141 575 347 51 140 141 575 348 51 140 141 575 162 349 51 140 141 575 163 350 51 140 141 575 164 351 51 140 141 575 156 565 51 140 584 573 157 352 51 140 585 573 158 353 51 140 585 573 165 354 51 140 141 575 166 355 51 140 141 575 167 357 51 140 141 575 168 356 51 140 141 575 169 358 51 140 141 575 170 359 51 140 141 575 171 360 51 140 457 576 172 361 51 140 141 575 601 324 51 140 141 575 311 362 51 140 141 575 305 308 51 140 586 573 173 363 51 140 141 575 309 310 51 140 141 575 312 364 51 140 141 575 313 365 51 140 141 575 314 366 51 140 141 575 306 307 51 140 586 573 315 367 51 140 586 573 174 368 51 140 141 175 369 51 140 587 573 176 177 51 140 587 573 178 370 51 140 587 573 179 371 51 140 587 573 180 372 51 140 587 573 181 373 51 140 141 182 375 382 140 588 573 376 382 140 588 573 377 382 140 588 573 378 382 140 588 573 379 382 140 588 573 380 382 140 588 573 381 382 140 588 573 381 51 140 141 183 383 51 140 141 184 384 51 140 141 185 385 51 140 141 186 386 51 140 141 387 331 51 140 589 573 187 388 51 140 588 573 188 389 51 140 588 573 189 390 51 140 588 573 190 391 51 140 141 191 392 374 140 141 192 393 51 140 141 193 394 382 140 141 194 395 51 140 141 195 396 374 140 141 196 397 374 140 141 197 398 374 140 141 198 399 374 140 141 199 400 374 140 141 200 401 374 140 141 201 402 374 140 141 202 403 374 140 141 203 404 374 140 141 204 405 374 140 141 205 406 51 140 141 206 407 51 140 141 207 408 51 140 141 208 409 51 140 141 209 410 51 140 141 210 411 51 140 141 211 412 51 140 141 212 413 51 140 141 213 414 51 140 141 214 415 51 140 141 215 416 51 140 141 216 417 51 140 141 217 418 51 140 419 147 420 597 320 421 51 140 590 566 567 150 113 51 140 141 321 114 382 140 590 147 141 567 322 115 51 140 590 566 567 151 435 51 140 141 152 436 51 140 141 424 429 51 140 141 425 430 51 140 141 426 431 51 140 440 568 439 438 51 140 440 568 427 432 51 140 141 153 428 51 140 141 154 434 51 140 141 155 437 51 140 141 423 433 51 140 441 218 442 51 140 441 219 458 51 140 441 220 459 51 140 441 221 460 51 140 441 222 461 51 140 441 223 462 51 140 441 224 463 51 140 441 225 464 51 140 441 226 465 51 140 441 227 466 51 140 441 316 467 51 140 441 317 468 51 140 441 318 469 51 140 441 319 470 51 140 441 228 471 51 140 441 229 472 51 140 441 230 473 51 140 441 536 540 51 140 441 231 474 51 140 441 232 475 51 140 441 233 476 51 140 441 234 477 51 140 441 235 478 51 140 591 5 569 236 479 51 140 141 237 480 51 140 141 238 101 51 140 141 239 102 51 140 141 240 103 51 140 141 241 104 51 140 141 242 105 51 140 141 243 106 51 140 141 244 107 51 140 141 245 108 51 140 141 246 109 51 140 141 247 481 382 140 141 248 482 382 140 141 249 483 382 140 141 250 484 382 140 141 251 485 382 140 141 252 486 382 140 141 253 487 382 140 141 254 89 382 140 141 255 488 382 140 141 256 90 382 140 141 257 489 382 140 141 258 92 382 140 141 259 490 382 140 141 260 491 382 140 141 261 492 382 140 141 262 493 382 140 141 263 494 382 140 141 264 495 382 140 141 265 496 382 140 141 266 498 497 570 267 499 382 140 141 268 500 382 140 141 269 501 382 140 141 270 502 382 140 141 271 503 382 140 141 272 504 382 140 141 273 505 382 140 141 274 96 382 140 141 275 97 382 140 141 276 506 382 140 141 277 98 382 140 141 278 507 51 140 592 569 279 508 51 140 592 569 280 509 382 140 141 281 510 382 140 141 282 511 382 140 141 283 512 382 140 141 537 541 382 140 141 538 542 382 140 141 539 543 382 140 141 284 513 382 140 141 285 514 382 140 141 286 515 382 140 141 287 516 382 140 141 288 517 382 140 141 289 518 382 140 141 290 519 51 140 141 291 520 51 140 141 292 521 51 140 141 293 522 51 140 141 294 524 51 140 591 571 295 525 51 140 591 571 296 526 51 140 141 297 527 51 140 141 298 528 51 140 141 299 529 51 140 141 300 530 51 140 141 301 531 51 140 141 302 532 51 140 141 303 533 51 140 534 304 110 51 140 535 10 11 12 18 139 138 139 138 52 51 140 141 53 51 140 141 74 51 140 141 54 51 140 141 75 51 140 141 55 51 140 141 556 51 140 141 56 51 140 141 57 51 140 141 58 51 140 141 76 51 140 141 59 51 140 141 60 51 140 141 61 51 140 141 62 51 140 141 63 51 140 141 64 51 140 141 65 51 140 141 77 51 140 141 66 51 140 141 67 51 140 141 78 140 141 68 140 141 79 51 140 141 80 51 140 141 69 51 140 141 81 51 140 141 70 51 140 141 82 51 140 141 71 51 140 141 72 51 140 141 72 51 140 141 73 51 140 141 83 557 140 593 598 84 51 140 593 598 85 51 140 593 598 86 51 140 593 598 87 51 140 593 598 555 51 140 141 88 557 593 598 21 22 139 138 139 138 113 51 140 141 114 51 140 141 115 51 140 141 13 139 138 139 138 110 382 140 141 111 112 14 139 138 139 138 101 382 140 141 102 382 140 141 103 382 140 141 104 382 140 141 105 382 140 141 106 382 140 141 107 382 140 141 108 382 140 141 109 382 140 141 15 5 16 558 51 140 593 598 559 51 140 593 598 560 51 140 593 598 561 564 140 593 598 562 564 140 593 598 563 564 140 593 598 5 17 89 422 90 91 92 93 94 95 374 140 594 598 96 97 98 5 523 595 599 600

6 9 99 139 138 139 138 146 118 51 140 145 147 141 119 51 140 145 147 141 120 51 140 145 147 141 121 51 140 145 147 141 117 51 140 577 147 141 572 5 122 51 140 577 147 141 572 123 51 140 578 147 141 596 124 51 140 578 147 141 596 125 51 140 578 147 141 596 126 51 140 578 147 141 596 127 51 140 578 147 141 596 5 128 51 140 578 147 141 596 129 51 140 443 147 141 596 130 51 140 579 147 141 596 131 51 142 141 147 141 132 51 142 141 147 141 133 51 142 141 147 141 134 51 142 141 147 141 135 51 142 141 147 141 136 51 142 141 147 141 137 51 142 141 147 141 19 139 138 139 138 23 51 140 141 147 141 24 51 140 141 147 141 143 144 140 141 147 141 25 51 140 141 147 141 26 51 140 141 147 141 27 51 140 141 147 141 28 51 140 141 147 141 29 51 140 141 147 141 30 51 140 141 147 141 31 148 140 580 147 141 32 51 140 580 147 141 33 51 140 141 147 141 34 51 140 141 147 141 35 51 140 141 147 141 36 51 140 141 147 141 37 51 140 141 147 141 38 51 140 141 147 141 39 51 140 141 147 141 20 139 138 139 138 40 41 42 43 51 140 581 573 44 45 51 140 581 573 46 47 51 140 582 574 48 49 51 140 582 574 446 544 444 140 453 545 444 140 454 546 444 140 455 547 444 140 456 548 444 140 447 549 444 140 448 550 444 140 449 551 444 140 450 552 444 140 451 553 444 140 452 554 444 140 149 50 444 140 445 5 100 139 138 139 138 323 148 140 583 573 325 148 140 583 573 326 148 140 583 573 327 148 140 583 573 328 148 140 583 573 324 148 140 332 573 329 148 140 330 575 331 148 140 333 575 159 334 51 140 141 575 160 335 51 140 141 575 161 336 51 140 141 575 337 51 140 141 575 338 51 140 141 575 339 51 140 141 575 340 51 140 141 575 341 51 140 141 575 342 51 140 141 575 343 51 140 141 575 344 51 140 141 575 345 51 140 141 575 346 51 140 141 575 347 51 140 141 575 348 51 140 141 575 162 349 51 140 141 575 163 350 51 140 141 575 164 351 51 140 141 575 156 565 51 140 584 573 157 352 51 140 585 573 158 353 51 140 585 573 165 354 51 140 141 575 166 355 51 140 141 575 167 357 51 140 141 575 168 356 51 140 141 575 169 358 51 140 141 575 170 359 51 140 141 575 171 360 51 140 457 576 172 361 51 140 141 575 601 324 51 140 141 575 311 362 51 140 141 575 305 308 51 140 586 573 173 363 51 140 141 575 309 310 51 140 141 575 312 364 51 140 141 575 313 365 51 140 141 575 314 366 51 140 141 575 306 307 51 140 586 573 315 367 51 140 586 573 174 368 51 140 141 175 369 51 140 587 573 176 177 51 140 587 573 178 370 51 140 587 573 179 371 51 140 587 573 180 372 51 140 587 573 181 373 51 140 141 182 375 382 140 588 573 376 382 140 588 573 377 382 140 588 573 378 382 140 588 573 379 382 140 588 573 380 382 140 588 573 381 382 140 588 573 381 51 140 141 183 383 51 140 141 184 384 51 140 141 185 385 51 140 141 186 386 51 140 141 387 331 51 140 589 573 187 388 51 140 588 573 188 389 51 140 588 573 189 390 51 140 588 573 190 391 51 140 141 191 392 374 140 141 192 393 51 140 141 193 394 382 140 141 194 395 51 140 141 195 396 374 140 141 196 397 374 140 141 197 398 374 140 141 198 399 374 140 141 199 400 374 140 141 200 401 374 140 141 201 402 374 140 141 202 403 374 140 141 203 404 374 140 141 204 405 374 140 141 205 406 51 140 141 206 407 51 140 141 207 408 51 140 141 208 409 51 140 141 209 410 51 140 141 210 411 51 140 141 211 412 51 140 141 212 413 51 140 141 213 414 51 140 141 214 415 51 140 141 215 416 51 140 141 216 417 51 140 141 217 418 51 140 419 147 420 597 320 421 51 140 590 566 567 150 113 51 140 141 321 114 382 140 590 147 141 567 322 115 51 140 590 566 567 151 435 51 140 141 152 436 51 140 141 424 429 51 140 141 425 430 51 140 141 426 431 51 140 440 568 439 438 51 140 440 568 427 432 51 140 141 153 428 51 140 141 154 434 51 140 141 155 437 51 140 141 423 433 51 140 441 218 442 51 140 441 219 458 51 140 441 220 459 51 140 441 221 460 51 140 441 222 461 51 140 441 223 462 51 140 441 224 463 51 140 441 225 464 51 140 441 226 465 51 140 441 227 466 51 140 441 316 467 51 140 441 317 468 51 140 441 318 469 51 140 441 319 470 51 140 441 228 471 51 140 441 229 472 51 140 441 230 473 51 140 441 536 540 51 140 441 231 474 51 140 441 232 475 51 140 441 233 476 51 140 441 234 477 51 140 441 235 478 51 140 591 5 569 236 479 51 140 141 237 480 51 140 141 238 101 51 140 141 239 102 51 140 141 240 103 51 140 141 241 104 51 140 141 242 105 51 140 141 243 106 51 140 141 244 107 51 140 141 245 108 51 140 141 246 109 51 140 141 247 481 382 140 141 248 482 382 140 141 249 483 382 140 141 250 484 382 140 141 251 485 382 140 141 252 486 382 140 141 253 487 382 140 141 254 89 382 140 141 255 488 382 140 141 256 90 382 140 141 257 489 382 140 141 258 92 382 140 141 259 490 382 140 141 260 491 382 140 141 261 492 382 140 141 262 493 382 140 141 263 494 382 140 141 264 495 382 140 141 265 496 382 140 141 266 498 497 570 267 499 382 140 141 268 500 382 140 141 269 501 382 140 141 270 502 382 140 141 271 503 382 140 141 272 504 382 140 141 273 505 382 140 141 274 96 382 140 141 275 97 382 140 141 276 506 382 140 141 277 98 382 140 141 278 507 51 140 592 569 279 508 51 140 592 569 280 509 382 140 141 281 510 382 140 141 282 511 382 140 141 283 512 382 140 141 537 541 382 140 141 538 542 382 140 141 539 543 382 140 141 284 513 382 140 141 285 514 382 140 141 286 515 382 140 141 287 516 382 140 141 288 517 382 140 141 289 518 382 140 141 290 519 51 140 141 291 520 51 140 141 292 521 51 140 141 293 522 51 140 141 294 524 51 140 591 571 295 525 51 140 591 571 296 526 51 140 141 297 527 51 140 141 298 528 51 140 141 299 529 51 140 141 300 530 51 140 141 301 531 51 140 141 302 532 51 140 141 303 533 51 140 534 304 110 51 140 535 10 11 12 18 139 138 139 138 52 51 140 141 53 51 140 141 74 51 140 141 54 51 140 141 75 51 140 141 55 51 140 141 556 51 140 141 56 51 140 141 57 51 140 141 58 51 140 141 76 51 140 141 59 51 140 141 60 51 140 141 61 51 140 141 62 51 140 141 63 51 140 141 64 51 140 141 65 51 140 141 77 51 140 141 66 51 140 141 67 51 140 141 78 140 141 68 140 141 79 51 140 141 80 51 140 141 69 51 140 141 81 51 140 141 70 51 140 141 82 51 140 141 71 51 140 141 72 51 140 141 72 51 140 141 73 51 140 141 83 557 140 593 598 84 51 140 593 598 85 51 140 593 598 86 51 140 593 598 87 51 140 593 598 555 51 140 141 88 557 593 598 21 22 139 138 139 138 113 51 140 141 114 51 140 141 115 51 140 141 13 139 138 139 138 110 382 140 141 111 112 14 139 138 139 138 101 382 140 141 102 382 140 141 103 382 140 141 104 382 140 141 105 382 140 141 106 382 140 141 107 382 140 141 108 382 140 141 109 382 140 141 15 5 16 558 51 140 593 598 559 51 140 593 598 560 51 140 593 598 561 564 140 593 598 562 564 140 593 598 563 564 140 593 598 5 17 89 422 90 91 92 93 94 95 374 140 594 598 96 97 98 5 523 595 599 600

6 9 99 139 138 139 138 146 118 51 140 145 147 141 119 51 140 145 147 141 120 51 140 145 147 141 121 51 140 145 147 141 117 51 140 577 147 141 572 5 122 51 140 577 147 141 572 123 51 140 578 147 141 596 124 51 140 578 147 141 596 125 51 140 578 147 141 596 126 51 140 578 147 141 596 127 51 140 578 147 141 596 5 128 51 140 578 147 141 596 129 51 140 443 147 141 596 130 51 140 579 147 141 596 131 51 142 141 147 141 132 51 142 141 147 141 133 51 142 141 147 141 134 51 142 141 147 141 135 51 142 141 147 141 136 51 142 141 147 141 137 51 142 141 147 141 19 139 138 139 138 23 51 140 141 147 141 24 51 140 141 147 141 143 144 140 141 147 141 25 51 140 141 147 141 26 51 140 141 147 141 27 51 140 141 147 141 28 51 140 141 147 141 29 51 140 141 147 141 30 51 140 141 147 141 31 148 140 580 147 141 32 51 140 580 147 141 33 51 140 141 147 141 34 51 140 141 147 141 35 51 140 141 147 141 36 51 140 141 147 141 37 51 140 141 147 141 38 51 140 141 147 141 39 51 140 141 147 141 20 139 138 139 138 40 41 42 43 51 140 581 573 44 45 51 140 581 573 46 47 51 140 582 574 48 49 51 140 582 574 446 544 444 140 453 545 444 140 454 546 444 140 455 547 444 140 456 548 444 140 447 549 444 140 448 550 444 140 449 551 444 140 450 552 444 140 451 553 444 140 452 554 444 140 149 50 444 140 445 5 100 139 138 139 138 323 148 140 583 573 325 148 140 583 573 326 148 140 583 573 327 148 140 583 573 328 148 140 583 573 324 148 140 332 573 329 148 140 330 575 331 148 140 333 575 159 334 51 140 141 575 160 335 51 140 141 575 161 336 51 140 141 575 337 51 140 141 575 338 51 140 141 575 339 51 140 141 575 340 51 140 141 575 341 51 140 141 575 342 51 140 141 575 343 51 140 141 575 344 51 140 141 575 345 51 140 141 575 346 51 140 141 575 347 51 140 141 575 348 51 140 141 575 162 349 51 140 141 575 163 350 51 140 141 575 164 351 51 140 141 575 156 565 51 140 584 573 157 352 51 140 585 573 158 353 51 140 585 573 165 354 51 140 141 575 166 355 51 140 141 575 167 357 51 140 141 575 168 356 51 140 141 575 169 358 51 140 141 575 170 359 51 140 141 575 171 360 51 140 457 576 172 361 51 140 141 575 601 324 51 140 141 575 311 362 51 140 141 575 305 308 51 140 586 573 173 363 51 140 141 575 309 310 51 140 141 575 312 364 51 140 141 575 313 365 51 140 141 575 314 366 51 140 141 575 306 307 51 140 586 573 315 367 51 140 586 573 174 368 51 140 141 175 369 51 140 587 573 176 177 51 140 587 573 178 370 51 140 587 573 179 371 51 140 587 573 180 372 51 140 587 573 181 373 51 140 141 182 375 382 140 588 573 376 382 140 588 573 377 382 140 588 573 378 382 140 588 573 379 382 140 588 573 380 382 140 588 573 381 382 140 588 573 381 51 140 141 183 383 51 140 141 184 384 51 140 141 185 385 51 140 141 186 386 51 140 141 387 331 51 140 589 573 187 388 51 140 588 573 188 389 51 140 588 573 189 390 51 140 588 573 190 391 51 140 141 191 392 374 140 141 192 393 51 140 141 193 394 382 140 141 194 395 51 140 141 195 396 374 140 141 196 397 374 140 141 197 398 374 140 141 198 399 374 140 141 199 400 374 140 141 200 401 374 140 141 201 402 374 140 141 202 403 374 140 141 203 404 374 140 141 204 405 374 140 141 205 406 51 140 141 206 407 51 140 141 207 408 51 140 141 208 409 51 140 141 209 410 51 140 141 210 411 51 140 141 211 412 51 140 141 212 413 51 140 141 213 414 51 140 141 214 415 51 140 141 215 416 51 140 141 216 417 51 140 141 217 418 51 140 419 147 420 597 320 421 51 140 590 566 567 150 113 51 140 141 321 114 382 140 590 147 141 567 322 115 51 140 590 566 567 151 435 51 140 141 152 436 51 140 141 424 429 51 140 141 425 430 51 140 141 426 431 51 140 440 568 439 438 51 140 440 568 427 432 51 140 141 153 428 51 140 141 154 434 51 140 141 155 437 51 140 141 423 433 51 140 441 218 442 51 140 441 219 458 51 140 441 220 459 51 140 441 221 460 51 140 441 222 461 51 140 441 223 462 51 140 441 224 463 51 140 441 225 464 51 140 441 226 465 51 140 441 227 466 51 140 441 316 467 51 140 441 317 468 51 140 441 318 469 51 140 441 319 470 51 140 441 228 471 51 140 441 229 472 51 140 441 230 473 51 140 441 536 540 51 140 441 231 474 51 140 441 232 475 51 140 441 233 476 51 140 441 234 477 51 140 441 235 478 51 140 591 5 569 236 479 51 140 141 237 480 51 140 141 238 101 51 140 141 239 102 51 140 141 240 103 51 140 141 241 104 51 140 141 242 105 51 140 141 243 106 51 140 141 244 107 51 140 141 245 108 51 140 141 246 109 51 140 141 247 481 382 140 141 248 482 382 140 141 249 483 382 140 141 250 484 382 140 141 251 485 382 140 141 252 486 382 140 141 253 487 382 140 141 254 89 382 140 141 255 488 382 140 141 256 90 382 140 141 257 489 382 140 141 258 92 382 140 141 259 490 382 140 141 260 491 382 140 141 261 492 382 140 141 262 493 382 140 141 263 494 382 140 141 264 495 382 140 141 265 496 382 140 141 266 498 497 570 267 499 382 140 141 268 500 382 140 141 269 501 382 140 141 270 502 382 140 141 271 503 382 140 141 272 504 382 140 141 273 505 382 140 141 274 96 382 140 141 275 97 382 140 141 276 506 382 140 141 277 98 382 140 141 278 507 51 140 592 569 279 508 51 140 592 569 280 509 382 140 141 281 510 382 140 141 282 511 382 140 141 283 512 382 140 141 537 541 382 140 141 538 542 382 140 141 539 543 382 140 141 284 513 382 140 141 285 514 382 140 141 286 515 382 140 141 287 516 382 140 141 288 517 382 140 141 289 518 382 140 141 290 519 51 140 141 291 520 51 140 141 292 521 51 140 141 293 522 51 140 141 294 524 51 140 591 571 295 525 51 140 591 571 296 526 51 140 141 297 527 51 140 141 298 528 51 140 141 299 529 51 140 141 300 530 51 140 141 301 531 51 140 141 302 532 51 140 141 303 533 51 140 534 304 110 51 140 535 10 11 12 18 139 138 139 138 52 51 140 141 53 51 140 141 74 51 140 141 54 51 140 141 75 51 140 141 55 51 140 141 556 51 140 141 56 51 140 141 57 51 140 141 58 51 140 141 76 51 140 141 59 51 140 141 60 51 140 141 61 51 140 141 62 51 140 141 63 51 140 141 64 51 140 141 65 51 140 141 77 51 140 141 66 51 140 141 67 51 140 141 78 140 141 68 140 141 79 51 140 141 80 51 140 141 69 51 140 141 81 51 140 141 70 51 140 141 82 51 140 141 71 51 140 141 72 51 140 141 72 51 140 141 73 51 140 141 83 557 140 593 598 84 51 140 593 598 85 51 140 593 598 86 51 140 593 598 87 51 140 593 598 555 51 140 141 88 557 593 598 21 22 139 138 139 138 113 51 140 141 114 51 140 141 115 51 140 141 13 139 138 139 138 110 382 140 141 111 112 14 139 138 139 138 101 382 140 141 102 382 140 141 103 382 140 141 104 382 140 141 105 382 140 141 106 382 140 141 107 382 140 141 108 382 140 141 109 382 140 141 15 5 16 558 51 140 593 598 559 51 140 593 598 560 51 140 593 598 561 564 140 593 598 562 564 140 593 598 563 564 140 593 598 5 17 89 422 90 91 92 93 94 95 374 140 594 598 96 97 98 5 523 595 599 600

6 9 99 139 138 139 138 146 118 51 140 145 147 141 119 51 140 145 147 141 120 51 140 145 147 141 121 51 140 145 147 141 117 51 140 577 147 141 572 5 122 51 140 577 147 141 572 123 51 140 578 147 141 596 124 51 140 578 147 141 596 125 51 140 578 147 141 596 126 51 140 578 147 141 596 127 51 140 578 147 141 596 5 128 51 140 578 147 141 596 129 51 140 443 147 141 596 130 51 140 579 147 141 596 131 51 142 141 147 141 132 51 142 141 147 141 133 51 142 141 147 141 134 51 142 141 147 141 135 51 142 141 147 141 136 51 142 141 147 141 137 51 142 141 147 141 19 139 138 139 138 23 51 140 141 147 141 24 51 140 141 147 141 143 144 140 141 147 141 25 51 140 141 147 141 26 51 140 141 147 141 27 51 140 141 147 141 28 51 140 141 147 141 29 51 140 141 147 141 30 51 140 141 147 141 31 148 140 580 147 141 32 51 140 580 147 141 33 51 140 141 147 141 34 51 140 141 147 141 35 51 140 141 147 141 36 51 140 141 147 141 37 51 140 141 147 141 38 51 140 141 147 141 39 51 140 141 147 141 20 139 138 139 138 40 41 42 43 51 140 581 573 44 45 51 140 581 573 46 47 51 140 582 574 48 49 51 140 582 574 446 544 444 140 453 545 444 140 454 546 444 140 455 547 444 140 456 548 444 140 447 549 444 140 448 550 444 140 449 551 444 140 450 552 444 140 451 553 444 140 452 554 444 140 149 50 444 140 445 5 100 139 138 139 138 323 148 140 583 573 325 148 140 583 573 326 148 140 583 573 327 148 140 583 573 328 148 140 583 573 324 148 140 332 573 329 148 140 330 575 331 148 140 333 575 159 334 51 140 141 575 160 335 51 140 141 575 161 336 51 140 141 575 337 51 140 141 575 338 51 140 141 575 339 51 140 141 575 340 51 140 141 575 341 51 140 141 575 342 51 140 141 575 343 51 140 141 575 344 51 140 141 575 345 51 140 141 575 346 51 140 141 575 347 51 140 141 575 348 51 140 141 575 162 349 51 140 141 575 163 350 51 140 141 575 164 351 51 140 141 575 156 565 51 140 584 573 157 352 51 140 585 573 158 353 51 140 585 573 165 354 51 140 141 575 166 355 51 140 141 575 167 357 51 140 141 575 168 356 51 140 141 575 169 358 51 140 141 575 170 359 51 140 141 575 171 360 51 140 457 576 172 361 51 140 141 575 601 324 51 140 141 575 311 362 51 140 141 575 305 308 51 140 586 573 173 363 51 140 141 575 309 310 51 140 141 575 312 364 51 140 141 575 313 365 51 140 141 575 314 366 51 140 141 575 306 307 51 140 586 573 315 367 51 140 586 573 174 368 51 140 141 175 369 51 140 587 573 176 177 51 140 587 573 178 370 51 140 587 573 179 371 51 140 587 573 180 372 51 140 587 573 181 373 51 140 141 182 375 382 140 588 573 376 382 140 588 573 377 382 140 588 573 378 382 140 588 573 379 382 140 588 573 380 382 140 588 573 381 382 140 588 573 381 51 140 141 183 383 51 140 141 184 384 51 140 141 185 385 51 140 141 186 386 51 140 141 387 331 51 140 589 573 187 388 51 140 588 573 188 389 51 140 588 573 189 390 51 140 588 573 190 391 51 140 141 191 392 374 140 141 192 393 51 140 141 193 394 382 140 141 194 395 51 140 141 195 396 374 140 141 196 397 374 140 141 197 398 374 140 141 198 399 374 140 141 199 400 374 140 141 200 401 374 140 141 201 402 374 140 141 202 403 374 140 141 203 404 374 140 141 204 405 374 140 141 205 406 51 140 141 206 407 51 140 141 207 408 51 140 141 208 409 51 140 141 209 410 51 140 141 210 411 51 140 141 211 412 51 140 141 212 413 51 140 141 213 414 51 140 141 214 415 51 140 141 215 416 51 140 141 216 417 51 140 141 217 418 51 140 419 147 420 597 320 421 51 140 590 566 567 150 113 51 140 141 321 114 382 140 590 147 141 567 322 115 51 140 590 566 567 151 435 51 140 141 152 436 51 140 141 424 429 51 140 141 425 430 51 140 141 426 431 51 140 440 568 439 438 51 140 440 568 427 432 51 140 141 153 428 51 140 141 154 434 51 140 141 155 437 51 140 141 423 433 51 140 441 218 442 51 140 441 219 458 51 140 441 220 459 51 140 441 221 460 51 140 441 222 461 51 140 441 223 462 51 140 441 224 463 51 140 441 225 464 51 140 441 226 465 51 140 441 227 466 51 140 441 316 467 51 140 441 317 468 51 140 441 318 469 51 140 441 319 470 51 140 441 228 471 51 140 441 229 472 51 140 441 230 473 51 140 441 536 540 51 140 441 231 474 51 140 441 232 475 51 140 441 233 476 51 140 441 234 477 51 140 441 235 478 51 140 591 5 569 236 479 51 140 141 237 480 51 140 141 238 101 51 140 141 239 102 51 140 141 240 103 51 140 141 241 104 51 140 141 242 105 51 140 141 243 106 51 140 141 244 107 51 140 141 245 108 51 140 141 246 109 51 140 141 247 481 382 140 141 248 482 382 140 141 249 483 382 140 141 250 484 382 140 141 251 485 382 140 141 252 486 382 140 141 253 487 382 140 141 254 89 382 140 141 255 488 382 140 141 256 90 382 140 141 257 489 382 140 141 258 92 382 140 141 259 490 382 140 141 260 491 382 140 141 261 492 382 140 141 262 493 382 140 141 263 494 382 140 141 264 495 382 140 141 265 496 382 140 141 266 498 497 570 267 499 382 140 141 268 500 382 140 141 269 501 382 140 141 270 502 382 140 141 271 503 382 140 141 272 504 382 140 141 273 505 382 140 141 274 96 382 140 141 275 97 382 140 141 276 506 382 140 141 277 98 382 140 141 278 507 51 140 592 569 279 508 51 140 592 569 280 509 382 140 141 281 510 382 140 141 282 511 382 140 141 283 512 382 140 141 537 541 382 140 141 538 542 382 140 141 539 543 382 140 141 284 513 382 140 141 285 514 382 140 141 286 515 382 140 141 287 516 382 140 141 288 517 382 140 141 289 518 382 140 141 290 519 51 140 141 291 520 51 140 141 292 521 51 140 141 293 522 51 140 141 294 524 51 140 591 571 295 525 51 140 591 571 296 526 51 140 141 297 527 51 140 141 298 528 51 140 141 299 529 51 140 141 300 530 51 140 141 301 531 51 140 141 302 532 51 140 141 303 533 51 140 534 304 110 51 140 535 10 11 12 18 139 138 139 138 52 51 140 141 53 51 140 141 74 51 140 141 54 51 140 141 75 51 140 141 55 51 140 141 556 51 140 141 56 51 140 141 57 51 140 141 58 51 140 141 76 51 140 141 59 51 140 141 60 51 140 141 61 51 140 141 62 51 140 141 63 51 140 141 64 51 140 141 65 51 140 141 77 51 140 141 66 51 140 141 67 51 140 141 78 140 141 68 140 141 79 51 140 141 80 51 140 141 69 51 140 141 81 51 140 141 70 51 140 141 82 51 140 141 71 51 140 141 72 51 140 141 72 51 140 141 73 51 140 141 83 557 140 593 598 84 51 140 593 598 85 51 140 593 598 86 51 140 593 598 87 51 140 593 598 555 51 140 141 88 557 593 598 21 22 139 138 139 138 113 51 140 141 114 51 140 141 115 51 140 141 13 139 138 139 138 110 382 140 141 111 112 14 139 138 139 138 101 382 140 141 102 382 140 141 103 382 140 141 104 382 140 141 105 382 140 141 106 382 140 141 107 382 140 141 108 382 140 141 109 382 140 141 15 5 16 558 51 140 593 598 559 51 140 593 598 560 51 140 593 598 561 564 140 593 598 562 564 140 593 598 563 564 140 593 598 5 17 89 422 90 91 92 93 94 95 374 140 594 598 96 97 98 5 523 595 599 600

6 9 99 139 138 139 138 146 118 51 140 145 147 141 119 51 140 145 147 141 120 51 140 145 147 141 121 51 140 145 147 141 117 51 140 577 147 141 572 5 122 51 140 577 147 141 572 123 51 140 578 147 141 596 124 51 140 578 147 141 596 125 51 140 578 147 141 596 126 51 140 578 147 141 596 127 51 140 578 147 141 596 5 128 51 140 578 147 141 596 129 51 140 443 147 141 596 130 51 140 579 147 141 596 131 51 142 141 147 141 132 51 142 141 147 141 133 51 142 141 147 141 134 51 142 141 147 141 135 51 142 141 147 141 136 51 142 141 147 141 137 51 142 141 147 141 19 139 138 139 138 23 51 140 141 147 141 24 51 140 141 147 141 143 144 140 141 147 141 25 51 140 141 147 141 26 51 140 141 147 141 27 51 140 141 147 141 28 51 140 141 147 141 29 51 140 141 147 141 30 51 140 141 147 141 31 148 140 580 147 141 32 51 140 580 147 141 33 51 140 141 147 141 34 51 140 141 147 141 35 51 140 141 147 141 36 51 140 141 147 141 37 51 140 141 147 141 38 51 140 141 147 141 39 51 140 141 147 141 20 139 138 139 138 40 41 42 43 51 140 581 573 44 45 51 140 581 573 46 47 51 140 582 574 48 49 51 140 582 574 446 544 444 140 453 545 444 140 454 546 444 140 455 547 444 140 456 548 444 140 447 549 444 140 448 550 444 140 449 551 444 140 450 552 444 140 451 553 444 140 452 554 444 140 149 50 444 140 445 5 100 139 138 139 138 323 148 140 583 573 325 148 140 583 573 326 148 140 583 573 327 148 140 583 573 328 148 140 583 573 324 148 140 332 573 329 148 140 330 575 331 148 140 333 575 159 334 51 140 141 575 160 335 51 140 141 575 161 336 51 140 141 575 337 51 140 141 575 338 51 140 141 575 339 51 140 141 575 340 51 140 141 575 341 51 140 141 575 342 51 140 141 575 343 51 140 141 575 344 51 140 141 575 345 51 140 141 575 346 51 140 141 575 347 51 140 141 575 348 51 140 141 575 162 349 51 140 141 575 163 350 51 140 141 575 164 351 51 140 141 575 156 565 51 140 584 573 157 352 51 140 585 573 158 353 51 140 585 573 165 354 51 140 141 575 166 355 51 140 141 575 167 357 51 140 141 575 168 356 51 140 141 575 169 358 51 140 141 575 170 359 51 140 141 575 171 360 51 140 457 576 172 361 51 140 141 575 601 324 51 140 141 575 311 362 51 140 141 575 305 308 51 140 586 573 173 363 51 140 141 575 309 310 51 140 141 575 312 364 51 140 141 575 313 365 51 140 141 575 314 366 51 140 141 575 306 307 51 140 586 573 315 367 51 140 586 573 174 368 51 140 141 175 369 51 140 587 573 176 177 51 140 587 573 178 370 51 140 587 573 179 371 51 140 587 573 180 372 51 140 587 573 181 373 51 140 141 182 375 382 140 588 573 376 382 140 588 573 377 382 140 588 573 378 382 140 588 573 379 382 140 588 573 380 382 140 588 573 381 382 140 588 573 381 51 140 141 183 383 51 140 141 184 384 51 140 141 185 385 51 140 141 186 386 51 140 141 387 331 51 140 589 573 187 388 51 140 588 573 188 389 51 140 588 573 189 390 51 140 588 573 190 391 51 140 141 191 392 374 140 141 192 393 51 140 141 193 394 382 140 141 194 395 51 140 141 195 396 374 140 141 196 397 374 140 141 197 398 374 140 141 198 399 374 140 141 199 400 374 140 141 200 401 374 140 141 201 402 374 140 141 202 403 374 140 141 203 404 374 140 141 204 405 374 140 141 205 406 51 140 141 206 407 51 140 141 207 408 51 140 141 208 409 51 140 141 209 410 51 140 141 210 411 51 140 141 211 412 51 140 141 212 413 51 140 141 213 414 51 140 141 214 415 51 140 141 215 416 51 140 141 216 417 51 140 141 217 418 51 140 419 147 420 597 320 421 51 140 590 566 567 150 113 51 140 141 321 114 382 140 590 147 141 567 322 115 51 140 590 566 567 151 435 51 140 141 152 436 51 140 141 424 429 51 140 141 425 430 51 140 141 426 431 51 140 440 568 439 438 51 140 440 568 427 432 51 140 141 153 428 51 140 141 154 434 51 140 141 155 437 51 140 141 423 433 51 140 441 218 442 51 140 441 219 458 51 140 441 220 459 51 140 441 221 460 51 140 441 222 461 51 140 441 223 462 51 140 441 224 463 51 140 441 225 464 51 140 441 226 465 51 140 441 227 466 51 140 441 316 467 51 140 441 317 468 51 140 441 318 469 51 140 441 319 470 51 140 441 228 471 51 140 441 229 472 51 140 441 230 473 51 140 441 536 540 51 140 441 231 474 51 140 441 232 475 51 140 441 233 476 51 140 441 234 477 51 140 441 235 478 51 140 591 5 569 236 479 51 140 141 237 480 51 140 141 238 101 51 140 141 239 102 51 140 141 240 103 51 140 141 241 104 51 140 141 242 105 51 140 141 243 106 51 140 141 244 107 51 140 141 245 108 51 140 141 246 109 51 140 141 247 481 382 140 141 248 482 382 140 141 249 483 382 140 141 250 484 382 140 141 251 485 382 140 141 252 486 382 140 141 253 487 382 140 141 254 89 382 140 141 255 488 382 140 141 256 90 382 140 141 257 489 382 140 141 258 92 382 140 141 259 490 382 140 141 260 491 382 140 141 261 492 382 140 141 262 493 382 140 141 263 494 382 140 141 264 495 382 140 141 265 496 382 140 141 266 498 497 570 267 499 382 140 141 268 500 382 140 141 269 501 382 140 141 270 502 382 140 141 271 503 382 140 141 272 504 382 140 141 273 505 382 140 141 274 96 382 140 141 275 97 382 140 141 276 506 382 140 141 277 98 382 140 141 278 507 51 140 592 569 279 508 51 140 592 569 280 509 382 140 141 281 510 382 140 141 282 511 382 140 141 283 512 382 140 141 537 541 382 140 141 538 542 382 140 141 539 543 382 140 141 284 513 382 140 141 285 514 382 140 141 286 515 382 140 141 287 516 382 140 141 288 517 382 140 141 289 518 382 140 141 290 519 51 140 141 291 520 51 140 141 292 521 51 140 141 293 522 51 140 141 294 524 51 140 591 571 295 525 51 140 591 571 296 526 51 140 141 297 527 51 140 141 298 528 51 140 141 299 529 51 140 141 300 530 51 140 141 301 531 51 140 141 302 532 51 140 141 303 533 51 140 534 304 110 51 140 535 10 11 12 18 139 138 139 138 52 51 140 141 53 51 140 141 74 51 140 141 54 51 140 141 75 51 140 141 55 51 140 141 556 51 140 141 56 51 140 141 57 51 140 141 58 51 140 141 76 51 140 141 59 51 140 141 60 51 140 141 61 51 140 141 62 51 140 141 63 51 140 141 64 51 140 141 65 51 140 141 77 51 140 141 66 51 140 141 67 51 140 141 78 140 141 68 140 141 79 51 140 141 80 51 140 141 69 51 140 141 81 51 140 141 70 51 140 141 82 51 140 141 71 51 140 141 72 51 140 141 72 51 140 141 73 51 140 141 83 557 140 593 598 84 51 140 593 598 85 51 140 593 598 86 51 140 593 598 87 51 140 593 598 555 51 140 141 88 557 593 598 21 22 139 138 139 138 113 51 140 141 114 51 140 141 115 51 140 141 13 139 138 139 138 110 382 140 141 111 112 14 139 138 139 138 101 382 140 141 102 382 140 141 103 382 140 141 104 382 140 141 105 382 140 141 106 382 140 141 107 382 140 141 108 382 140 141 109 382 140 141 15 5 16 558 51 140 593 598 559 51 140 593 598 560 51 140 593 598 561 564 140 593 598 562 564 140 593 598 563 564 140 593 598 5 17 89 422 90 91 92 93 94 95 374 140 594 598 96 97 98 5 523 595 599 600

6 9 99 139 138 139 138 146 118 51 140 145 147 141 119 51 140 145 147 141 120 51 140 145 147 141 121 51 140 145 147 141 117 51 140 577 147 141 572 5 122 51 140 577 147 141 572 123 51 140 578 147 141 596 124 51 140 578 147 141 596 125 51 140 578 147 141 596 126 51 140 578 147 141 596 127 51 140 578 147 141 596 5 128 51 140 578 147 141 596 129 51 140 443 147 141 596 130 51 140 579 147 141 596 131 51 142 141 147 141 132 51 142 141 147 141 133 51 142 141 147 141 134 51 142 141 147 141 135 51 142 141 147 141 136 51 142 141 147 141 137 51 142 141 147 141 19 139 138 139 138 23 51 140 141 147 141 24 51 140 141 147 141 143 144 140 141 147 141 25 51 140 141 147 141 26 51 140 141 147 141 27 51 140 141 147 141 28 51 140 141 147 141 29 51 140 141 147 141 30 51 140 141 147 141 31 148 140 580 147 141 32 51 140 580 147 141 33 51 140 141 147 141 34 51 140 141 147 141 35 51 140 141 147 141 36 51 140 141 147 141 37 51 140 141 147 141 38 51 140 141 147 141 39 51 140 141 147 141 20 139 138 139 138 40 41 42 43 51 140 581 573 44 45 51 140 581 573 46 47 51 140 582 574 48 49 51 140 582 574 446 544 444 140 453 545 444 140 454 546 444 140 455 547 444 140 456 548 444 140 447 549 444 140 448 550 444 140 449 551 444 140 450 552 444 140 451 553 444 140 452 554 444 140 149 50 444 140 445 5 100 139 138 139 138 323 148 140 583 573 325 148 140 583 573 326 148 140 583 573 327 148 140 583 573 328 148 140 583 573 324 148 140 332 573 329 148 140 330 575 331 148 140 333 575 159 334 51 140 141 575 160 335 51 140 141 575 161 336 51 140 141 575 337 51 140 141 575 338 51 140 141 575 339 51 140 141 575 340 51 140 141 575 341 51 140 141 575 342 51 140 141 575 343 51 140 141 575 344 51 140 141 575 345 51 140 141 575 346 51 140 141 575 347 51 140 141 575 348 51 140 141 575 162 349 51 140 141 575 163 350 51 140 141 575 164 351 51 140 141 575 156 565 51 140 584 573 157 352 51 140 585 573 158 353 51 140 585 573 165 354 51 140 141 575 166 355 51 140 141 575 167 357 51 140 141 575 168 356 51 140 141 575 169 358 51 140 141 575 170 359 51 140 141 575 171 360 51 140 457 576 172 361 51 140 141 575 601 324 51 140 141 575 311 362 51 140 141 575 305 308 51 140 586 573 173 363 51 140 141 575 309 310 51 140 141 575 312 364 51 140 141 575 313 365 51 140 141 575 314 366 51 140 141 575 306 307 51 140 586 573 315 367 51 140 586 573 174 368 51 140 141 175 369 51 140 587 573 176 177 51 140 587 573 178 370 51 140 587 573 179 371 51 140 587 573 180 372 51 140 587 573 181 373 51 140 141 182 375 382 140 588 573 376 382 140 588 573 377 382 140 588 573 378 382 140 588 573 379 382 140 588 573 380 382 140 588 573 381 382 140 588 573 381 51 140 141 183 383 51 140 141 184 384 51 140 141 185 385 51 140 141 186 386 51 140 141 387 331 51 140 589 573 187 388 51 140 588 573 188 389 51 140 588 573 189 390 51 140 588 573 190 391 51 140 141 191 392 374 140 141 192 393 51 140 141 193 394 382 140 141 194 395 51 140 141 195 396 374 140 141 196 397 374 140 141 197 398 374 140 141 198 399 374 140 141 199 400 374 140 141 200 401 374 140 141 201 402 374 140 141 202 403 374 140 141 203 404 374 140 141 204 405 374 140 141 205 406 51 140 141 206 407 51 140 141 207 408 51 140 141 208 409 51 140 141 209 410 51 140 141 210 411 51 140 141 211 412 51 140 141 212 413 51 140 141 213 414 51 140 141 214 415 51 140 141 215 416 51 140 141 216 417 51 140 141 217 418 51 140 419 147 420 597 320 421 51 140 590 566 567 150 113 51 140 141 321 114 382 140 590 147 141 567 322 115 51 140 590 566 567 151 435 51 140 141 152 436 51 140 141 424 429 51 140 141 425 430 51 140 141 426 431 51 140 440 568 439 438 51 140 440 568 427 432 51 140 141 153 428 51 140 141 154 434 51 140 141 155 437 51 140 141 423 433 51 140 441 218 442 51 140 441 219 458 51 140 441 220 459 51 140 441 221 460 51 140 441 222 461 51 140 441 223 462 51 140 441 224 463 51 140 441 225 464 51 140 441 226 465 51 140 441 227 466 51 140 441 316 467 51 140 441 317 468 51 140 441 318 469 51 140 441 319 470 51 140 441 228 471 51 140 441 229 472 51 140 441 230 473 51 140 441 536 540 51 140 441 231 474 51 140 441 232 475 51 140 441 233 476 51 140 441 234 477 51 140 441 235 478 51 140 591 5 569 236 479 51 140 141 237 480 51 140 141 238 101 51 140 141 239 102 51 140 141 240 103 51 140 141 241 104 51 140 141 242 105 51 140 141 243 106 51 140 141 244 107 51 140 141 245 108 51 140 141 246 109 51 140 141 247 481 382 140 141 248 482 382 140 141 249 483 382 140 141 250 484 382 140 141 251 485 382 140 141 252 486 382 140 141 253 487 382 140 141 254 89 382 140 141 255 488 382 140 141 256 90 382 140 141 257 489 382 140 141 258 92 382 140 141 259 490 382 140 141 260 491 382 140 141 261 492 382 140 141 262 493 382 140 141 263 494 382 140 141 264 495 382 140 141 265 496 382 140 141 266 498 497 570 267 499 382 140 141 268 500 382 140 141 269 501 382 140 141 270 502 382 140 141 271 503 382 140 141 272 504 382 140 141 273 505 382 140 141 274 96 382 140 141 275 97 382 140 141 276 506 382 140 141 277 98 382 140 141 278 507 51 140 592 569 279 508 51 140 592 569 280 509 382 140 141 281 510 382 140 141 282 511 382 140 141 283 512 382 140 141 537 541 382 140 141 538 542 382 140 141 539 543 382 140 141 284 513 382 140 141 285 514 382 140 141 286 515 382 140 141 287 516 382 140 141 288 517 382 140 141 289 518 382 140 141 290 519 51 140 141 291 520 51 140 141 292 521 51 140 141 293 522 51 140 141 294 524 51 140 591 571 295 525 51 140 591 571 296 526 51 140 141 297 527 51 140 141 298 528 51 140 141 299 529 51 140 141 300 530 51 140 141 301 531 51 140 141 302 532 51 140 141 303 533 51 140 534 304 110 51 140 535 10 11 12 18 139 138 139 138 52 51 140 141 53 51 140 141 74 51 140 141 54 51 140 141 75 51 140 141 55 51 140 141 556 51 140 141 56 51 140 141 57 51 140 141 58 51 140 141 76 51 140 141 59 51 140 141 60 51 140 141 61 51 140 141 62 51 140 141 63 51 140 141 64 51 140 141 65 51 140 141 77 51 140 141 66 51 140 141 67 51 140 141 78 140 141 68 140 141 79 51 140 141 80 51 140 141 69 51 140 141 81 51 140 141 70 51 140 141 82 51 140 141 71 51 140 141 72 51 140 141 72 51 140 141 73 51 140 141 83 557 140 593 598 84 51 140 593 598 85 51 140 593 598 86 51 140 593 598 87 51 140 593 598 555 51 140 141 88 557 593 598 21 22 139 138 139 138 113 51 140 141 114 51 140 141 115 51 140 141 13 139 138 139 138 110 382 140 141 111 112 14 139 138 139 138 101 382 140 141 102 382 140 141 103 382 140 141 104 382 140 141 105 382 140 141 106 382 140 141 107 382 140 141 108 382 140 141 109 382 140 141 15 5 16 558 51 140 593 598 559 51 140 593 598 560 51 140 593 598 561 564 140 593 598 562 564 140 593 598 563 564 140 593 598 5 17 89 422 90 91 92 93 94 95 374 140 594 598 96 97 98 5 523 595 599 600

6 9 99 139 138 139 138 146 118 51 140 145 147 141 119 51 140 145 147 141 120 51 140 145 147 141 121 51 140 145 147 141 117 51 140 577 147 141 572 5 122 51 140 577 147 141 572 123 51 140 578 147 141 596 124 51 140 578 147 141 596 125 51 140 578 147 141 596 126 51 140 578 147 141 596 127 51 140 578 147 141 596 5 128 51 140 578 147 141 596 129 51 140 443 147 141 596 130 51 140 579 147 141 596 131 51 142 141 147 141 132 51 142 141 147 141 133 51 142 141 147 141 134 51 142 141 147 141 135 51 142 141 147 141 136 51 142 141 147 141 137 51 142 141 147 141 19 139 138 139 138 23 51 140 141 147 141 24 51 140 141 147 141 143 144 140 141 147 141 25 51 140 141 147 141 26 51 140 141 147 141 27 51 140 141 147 141 28 51 140 141 147 141 29 51 140 141 147 141 30 51 140 141 147 141 31 148 140 580 147 141 32 51 140 580 147 141 33 51 140 141 147 141 34 51 140 141 147 141 35 51 140 141 147 141 36 51 140 141 147 141 37 51 140 141 147 141 38 51 140 141 147 141 39 51 140 141 147 141 20 139 138 139 138 40 41 42 43 51 140 581 573 44 45 51 140 581 573 46 47 51 140 582 574 48 49 51 140 582 574 446 544 444 140 453 545 444 140 454 546 444 140 455 547 444 140 456 548 444 140 447 549 444 140 448 550 444 140 449 551 444 140 450 552 444 140 451 553 444 140 452 554 444 140 149 50 444 140 445 5 100 139 138 139 138 323 148 140 583 573 325 148 140 583 573 326 148 140 583 573 327 148 140 583 573 328 148 140 583 573 324 148 140 332 573 329 148 140 330 575 331 148 140 333 575 159 334 51 140 141 575 160 335 51 140 141 575 161 336 51 140 141 575 337 51 140 141 575 338 51 140 141 575 339 51 140 141 575 340 51 140 141 575 341 51 140 141 575 342 51 140 141 575 343 51 140 141 575 344 51 140 141 575 345 51 140 141 575 346 51 140 141 575 347 51 140 141 575 348 51 140 141 575 162 349 51 140 141 575 163 350 51 140 141 575 164 351 51 140 141 575 156 565 51 140 584 573 157 352 51 140 585 573 158 353 51 140 585 573 165 354 51 140 141 575 166 355 51 140 141 575 167 357 51 140 141 575 168 356 51 140 141 575 169 358 51 140 141 575 170 359 51 140 141 575 171 360 51 140 457 576 172 361 51 140 141 575 601 324 51 140 141 575 311 362 51 140 141 575 305 308 51 140 586 573 173 363 51 140 141 575 309 310 51 140 141 575 312 364 51 140 141 575 313 365 51 140 141 575 314 366 51 140 141 575 306 307 51 140 586 573 315 367 51 140 586 573 174 368 51 140 141 175 369 51 140 587 573 176 177 51 140 587 573 178 370 51 140 587 573 179 371 51 140 587 573 180 372 51 140 587 573 181 373 51 140 141 182 375 382 140 588 573 376 382 140 588 573 377 382 140 588 573 378 382 140 588 573 379 382 140 588 573 380 382 140 588 573 381 382 140 588 573 381 51 140 141 183 383 51 140 141 184 384 51 140 141 185 385 51 140 141 186 386 51 140 141 387 331 51 140 589 573 187 388 51 140 588 573 188 389 51 140 588 573 189 390 51 140 588 573 190 391 51 140 141 191 392 374 140 141 192 393 51 140 141 193 394 382 140 141 194 395 51 140 141 195 396 374 140 141 196 397 374 140 141 197 398 374 140 141 198 399 374 140 141 199 400 374 140 141 200 401 374 140 141 201 402 374 140 141 202 403 374 140 141 203 404 374 140 141 204 405 374 140 141 205 406 51 140 141 206 407 51 140 141 207 408 51 140 141 208 409 51 140 141 209 410 51 140 141 210 411 51 140 141 211 412 51 140 141 212 413 51 140 141 213 414 51 140 141 214 415 51 140 141 215 416 51 140 141 216 417 51 140 141 217 418 51 140 419 147 420 597 320 421 51 140 590 566 567 150 113 51 140 141 321 114 382 140 590 147 141 567 322 115 51 140 590 566 567 151 435 51 140 141 152 436 51 140 141 424 429 51 140 141 425 430 51 140 141 426 431 51 140 440 568 439 438 51 140 440 568 427 432 51 140 141 153 428 51 140 141 154 434 51 140 141 155 437 51 140 141 423 433 51 140 441 218 442 51 140 441 219 458 51 140 441 220 459 51 140 441 221 460 51 140 441 222 461 51 140 441 223 462 51 140 441 224 463 51 140 441 225 464 51 140 441 226 465 51 140 441 227 466 51 140 441 316 467 51 140 441 317 468 51 140 441 318 469 51 140 441 319 470 51 140 441 228 471 51 140 441 229 472 51 140 441 230 473 51 140 441 536 540 51 140 441 231 474 51 140 441 232 475 51 140 441 233 476 51 140 441 234 477 51 140 441 235 478 51 140 591 5 569 236 479 51 140 141 237 480 51 140 141 238 101 51 140 141 239 102 51 140 141 240 103 51 140 141 241 104 51 140 141 242 105 51 140 141 243 106 51 140 141 244 107 51 140 141 245 108 51 140 141 246 109 51 140 141 247 481 382 140 141 248 482 382 140 141 249 483 382 140 141 250 484 382 140 141 251 485 382 140 141 252 486 382 140 141 253 487 382 140 141 254 89 382 140 141 255 488 382 140 141 256 90 382 140 141 257 489 382 140 141 258 92 382 140 141 259 490 382 140 141 260 491 382 140 141 261 492 382 140 141 262 493 382 140 141 263 494 382 140 141 264 495 382 140 141 265 496 382 140 141 266 498 497 570 267 499 382 140 141 268 500 382 140 141 269 501 382 140 141 270 502 382 140 141 271 503 382 140 141 272 504 382 140 141 273 505 382 140 141 274 96 382 140 141 275 97 382 140 141 276 506 382 140 141 277 98 382 140 141 278 507 51 140 592 569 279 508 51 140 592 569 280 509 382 140 141 281 510 382 140 141 282 511 382 140 141 283 512 382 140 141 537 541 382 140 141 538 542 382 140 141 539 543 382 140 141 284 513 382 140 141 285 514 382 140 141 286 515 382 140 141 287 516 382 140 141 288 517 382 140 141 289 518 382 140 141 290 519 51 140 141 291 520 51 140 141 292 521 51 140 141 293 522 51 140 141 294 524 51 140 591 571 295 525 51 140 591 571 296 526 51 140 141 297 527 51 140 141 298 528 51 140 141 299 529 51 140 141 300 530 51 140 141 301 531 51 140 141 302 532 51 140 141 303 533 51 140 534 304 110 51 140 535 10 11 12 18 139 138 139 138 52 51 140 141 53 51 140 141 74 51 140 141 54 51 140 141 75 51 140 141 55 51 140 141 556 51 140 141 56 51 140 141 57 51 140 141 58 51 140 141 76 51 140 141 59 51 140 141 60 51 140 141 61 51 140 141 62 51 140 141 63 51 140 141 64 51 140 141 65 51 140 141 77 51 140 141 66 51 140 141 67 51 140 141 78 140 141 68 140 141 79 51 140 141 80 51 140 141 69 51 140 141 81 51 140 141 70 51 140 141 82 51 140 141 71 51 140 141 72 51 140 141 72 51 140 141 73 51 140 141 83 557 140 593 598 84 51 140 593 598 85 51 140 593 598 86 51 140 593 598 87 51 140 593 598 555 51 140 141 88 557 593 598 21 22 139 138 139 138 113 51 140 141 114 51 140 141 115 51 140 141 13 139 138 139 138 110 382 140 141 111 112 14 139 138 139 138 101 382 140 141 102 382 140 141 103 382 140 141 104 382 140 141 105 382 140 141 106 382 140 141 107 382 140 141 108 382 140 141 109 382 140 141 15 5 16 558 51 140 593 598 559 51 140 593 598 560 51 140 593 598 561 564 140 593 598 562 564 140 593 598 563 564 140 593 598 5 17 89 422 90 91 92 93 94 95 374 140 594 598 96 97 98 5 523 595 599 600

6 9 99 139 138 139 138 146 118 51 140 145 147 141 119 51 140 145 147 141 120 51 140 145 147 141 121 51 140 145 147 141 117 51 140 577 147 141 572 5 122 51 140 577 147 141 572 123 51 140 578 147 141 596 124 51 140 578 147 141 596 125 51 140 578 147 141 596 126 51 140 578 147 141 596 127 51 140 578 147 141 596 5 128 51 140 578 147 141 596 129 51 140 443 147 141 596 130 51 140 579 147 141 596 131 51 142 141 147 141 132 51 142 141 147 141 133 51 142 141 147 141 134 51 142 141 147 141 135 51 142 141 147 141 136 51 142 141 147 141 137 51 142 141 147 141 19 139 138 139 138 23 51 140 141 147 141 24 51 140 141 147 141 143 144 140 141 147 141 25 51 140 141 147 141 26 51 140 141 147 141 27 51 140 141 147 141 28 51 140 141 147 141 29 51 140 141 147 141 30 51 140 141 147 141 31 148 140 580 147 141 32 51 140 580 147 141 33 51 140 141 147 141 34 51 140 141 147 141 35 51 140 141 147 141 36 51 140 141 147 141 37 51 140 141 147 141 38 51 140 141 147 141 39 51 140 141 147 141 20 139 138 139 138 40 41 42 43 51 140 581 573 44 45 51 140 581 573 46 47 51 140 582 574 48 49 51 140 582 574 446 544 444 140 453 545 444 140 454 546 444 140 455 547 444 140 456 548 444 140 447 549 444 140 448 550 444 140 449 551 444 140 450 552 444 140 451 553 444 140 452 554 444 140 149 50 444 140 445 5 100 139 138 139 138 323 148 140 583 573 325 148 140 583 573 326 148 140 583 573 327 148 140 583 573 328 148 140 583 573 324 148 140 332 573 329 148 140 330 575 331 148 140 333 575 159 334 51 140 141 575 160 335 51 140 141 575 161 336 51 140 141 575 337 51 140 141 575 338 51 140 141 575 339 51 140 141 575 340 51 140 141 575 341 51 140 141 575 342 51 140 141 575 343 51 140 141 575 344 51 140 141 575 345 51 140 141 575 346 51 140 141 575 347 51 140 141 575 348 51 140 141 575 162 349 51 140 141 575 163 350 51 140 141 575 164 351 51 140 141 575 156 565 51 140 584 573 157 352 51 140 585 573 158 353 51 140 585 573 165 354 51 140 141 575 166 355 51 140 141 575 167 357 51 140 141 575 168 356 51 140 141 575 169 358 51 140 141 575 170 359 51 140 141 575 171 360 51 140 457 576 172 361 51 140 141 575 601 324 51 140 141 575 311 362 51 140 141 575 305 308 51 140 586 573 173 363 51 140 141 575 309 310 51 140 141 575 312 364 51 140 141 575 313 365 51 140 141 575 314 366 51 140 141 575 306 307 51 140 586 573 315 367 51 140 586 573 174 368 51 140 141 175 369 51 140 587 573 176 177 51 140 587 573 178 370 51 140 587 573 179 371 51 140 587 573 180 372 51 140 587 573 181 373 51 140 141 182 375 382 140 588 573 376 382 140 588 573 377 382 140 588 573 378 382 140 588 573 379 382 140 588 573 380 382 140 588 573 381 382 140 588 573 381 51 140 141 183 383 51 140 141 184 384 51 140 141 185 385 51 140 141 186 386 51 140 141 387 331 51 140 589 573 187 388 51 140 588 573 188 389 51 140 588 573 189 390 51 140 588 573 190 391 51 140 141 191 392 374 140 141 192 393 51 140 141 193 394 382 140 141 194 395 51 140 141 195 396 374 140 141 196 397 374 140 141 197 398 374 140 141 198 399 374 140 141 199 400 374 140 141 200 401 374 140 141 201 402 374 140 141 202 403 374 140 141 203 404 374 140 141 204 405 374 140 141 205 406 51 140 141 206 407 51 140 141 207 408 51 140 141 208 409 51 140 141 209 410 51 140 141 210 411 51 140 141 211 412 51 140 141 212 413 51 140 141 213 414 51 140 141 214 415 51 140 141 215 416 51 140 141 216 417 51 140 141 217 418 51 140 419 147 420 597 320 421 51 140 590 566 567 150 113 51 140 141 321 114 382 140 590 147 141 567 322 115 51 140 590 566 567 151 435 51 140 141 152 436 51 140 141 424 429 51 140 141 425 430 51 140 141 426 431 51 140 440 568 439 438 51 140 440 568 427 432 51 140 141 153 428 51 140 141 154 434 51 140 141 155 437 51 140 141 423 433 51 140 441 218 442 51 140 441 219 458 51 140 441 220 459 51 140 441 221 460 51 140 441 222 461 51 140 441 223 462 51 140 441 224 463 51 140 441 225 464 51 140 441 226 465 51 140 441 227 466 51 140 441 316 467 51 140 441 317 468 51 140 441 318 469 51 140 441 319 470 51 140 441 228 471 51 140 441 229 472 51 140 441 230 473 51 140 441 536 540 51 140 441 231 474 51 140 441 232 475 51 140 441 233 476 51 140 441 234 477 51 140 441 235 478 51 140 591 5 569 236 479 51 140 141 237 480 51 140 141 238 101 51 140 141 239 102 51 140 141 240 103 51 140 141 241 104 51 140 141 242 105 51 140 141 243 106 51 140 141 244 107 51 140 141 245 108 51 140 141 246 109 51 140 141 247 481 382 140 141 248 482 382 140 141 249 483 382 140 141 250 484 382 140 141 251 485 382 140 141 252 486 382 140 141 253 487 382 140 141 254 89 382 140 141 255 488 382 140 141 256 90 382 140 141 257 489 382 140 141 258 92 382 140 141 259 490 382 140 141 260 491 382 140 141 261 492 382 140 141 262 493 382 140 141 263 494 382 140 141 264 495 382 140 141 265 496 382 140 141 266 498 497 570 267 499 382 140 141 268 500 382 140 141 269 501 382 140 141 270 502 382 140 141 271 503 382 140 141 272 504 382 140 141 273 505 382 140 141 274 96 382 140 141 275 97 382 140 141 276 506 382 140 141 277 98 382 140 141 278 507 51 140 592 569 279 508 51 140 592 569 280 509 382 140 141 281 510 382 140 141 282 511 382 140 141 283 512 382 140 141 537 541 382 140 141 538 542 382 140 141 539 543 382 140 141 284 513 382 140 141 285 514 382 140 141 286 515 382 140 141 287 516 382 140 141 288 517 382 140 141 289 518 382 140 141 290 519 51 140 141 291 520 51 140 141 292 521 51 140 141 293 522 51 140 141 294 524 51 140 591 571 295 525 51 140 591 571 296 526 51 140 141 297 527 51 140 141 298 528 51 140 141 299 529 51 140 141 300 530 51 140 141 301 531 51 140 141 302 532 51 140 141 303 533 51 140 534 304 110 51 140 535 10 11 12 18 139 138 139 138 52 51 140 141 53 51 140 141 74 51 140 141 54 51 140 141 75 51 140 141 55 51 140 141 556 51 140 141 56 51 140 141 57 51 140 141 58 51 140 141 76 51 140 141 59 51 140 141 60 51 140 141 61 51 140 141 62 51 140 141 63 51 140 141 64 51 140 141 65 51 140 141 77 51 140 141 66 51 140 141 67 51 140 141 78 140 141 68 140 141 79 51 140 141 80 51 140 141 69 51 140 141 81 51 140 141 70 51 140 141 82 51 140 141 71 51 140 141 72 51 140 141 72 51 140 141 73 51 140 141 83 557 140 593 598 84 51 140 593 598 85 51 140 593 598 86 51 140 593 598 87 51 140 593 598 555 51 140 141 88 557 593 598 21 22 139 138 139 138 113 51 140 141 114 51 140 141 115 51 140 141 13 139 138 139 138 110 382 140 141 111 112 14 139 138 139 138 101 382 140 141 102 382 140 141 103 382 140 141 104 382 140 141 105 382 140 141 106 382 140 141 107 382 140 141 108 382 140 141 109 382 140 141 15 5 16 558 51 140 593 598 559 51 140 593 598 560 51 140 593 598 561 564 140 593 598 562 564 140 593 598 563 564 140 593 598 5 17 89 422 90 91 92 93 94 95 374 140 594 598 96 97 98 5 523 595 599 600

6 9 99 139 138 139 138 146 118 51 140 145 147 141 119 51 140 145 147 141 120 51 140 145 147 141 121 51 140 145 147 141 117 51 140 577 147 141 572 5 122 51 140 577 147 141 572 123 51 140 578 147 141 596 124 51 140 578 147 141 596 125 51 140 578 147 141 596 126 51 140 578 147 141 596 127 51 140 578 147 141 596 5 128 51 140 578 147 141 596 129 51 140 443 147 141 596 130 51 140 579 147 141 596 131 51 142 141 147 141 132 51 142 141 147 141 133 51 142 141 147 141 134 51 142 141 147 141 135 51 142 141 147 141 136 51 142 141 147 141 137 51 142 141 147 141 19 139 138 139 138 23 51 140 141 147 141 24 51 140 141 147 141 143 144 140 141 147 141 25 51 140 141 147 141 26 51 140 141 147 141 27 51 140 141 147 141 28 51 140 141 147 141 29 51 140 141 147 141 30 51 140 141 147 141 31 148 140 580 147 141 32 51 140 580 147 141 33 51 140 141 147 141 34 51 140 141 147 141 35 51 140 141 147 141 36 51 140 141 147 141 37 51 140 141 147 141 38 51 140 141 147 141 39 51 140 141 147 141 20 139 138 139 138 40 41 42 43 51 140 581 573 44 45 51 140 581 573 46 47 51 140 582 574 48 49 51 140 582 574 446 544 444 140 453 545 444 140 454 546 444 140 455 547 444 140 456 548 444 140 447 549 444 140 448 550 444 140 449 551 444 140 450 552 444 140 451 553 444 140 452 554 444 140 149 50 444 140 445 5 100 139 138 139 138 323 148 140 583 573 325 148 140 583 573 326 148 140 583 573 327 148 140 583 573 328 148 140 583 573 324 148 140 332 573 329 148 140 330 575 331 148 140 333 575 159 334 51 140 141 575 160 335 51 140 141 575 161 336 51 140 141 575 337 51 140 141 575 338 51 140 141 575 339 51 140 141 575 340 51 140 141 575 341 51 140 141 575 342 51 140 141 575 343 51 140 141 575 344 51 140 141 575 345 51 140 141 575 346 51 140 141 575 347 51 140 141 575 348 51 140 141 575 162 349 51 140 141 575 163 350 51 140 141 575 164 351 51 140 141 575 156 565 51 140 584 573 157 352 51 140 585 573 158 353 51 140 585 573 165 354 51 140 141 575 166 355 51 140 141 575 167 357 51 140 141 575 168 356 51 140 141 575 169 358 51 140 141 575 170 359 51 140 141 575 171 360 51 140 457 576 172 361 51 140 141 575 601 324 51 140 141 575 311 362 51 140 141 575 305 308 51 140 586 573 173 363 51 140 141 575 309 310 51 140 141 575 312 364 51 140 141 575 313 365 51 140 141 575 314 366 51 140 141 575 306 307 51 140 586 573 315 367 51 140 586 573 174 368 51 140 141 175 369 51 140 587 573 176 177 51 140 587 573 178 370 51 140 587 573 179 371 51 140 587 573 180 372 51 140 587 573 181 373 51 140 141 182 375 382 140 588 573 376 382 140 588 573 377 382 140 588 573 378 382 140 588 573 379 382 140 588 573 380 382 140 588 573 381 382 140 588 573 381 51 140 141 183 383 51 140 141 184 384 51 140 141 185 385 51 140 141 186 386 51 140 141 387 331 51 140 589 573 187 388 51 140 588 573 188 389 51 140 588 573 189 390 51 140 588 573 190 391 51 140 141 191 392 374 140 141 192 393 51 140 141 193 394 382 140 141 194 395 51 140 141 195 396 374 140 141 196 397 374 140 141 197 398 374 140 141 198 399 374 140 141 199 400 374 140 141 200 401 374 140 141 201 402 374 140 141 202 403 374 140 141 203 404 374 140 141 204 405 374 140 141 205 406 51 140 141 206 407 51 140 141 207 408 51 140 141 208 409 51 140 141 209 410 51 140 141 210 411 51 140 141 211 412 51 140 141 212 413 51 140 141 213 414 51 140 141 214 415 51 140 141 215 416 51 140 141 216 417 51 140 141 217 418 51 140 419 147 420 597 320 421 51 140 590 566 567 150 113 51 140 141 321 114 382 140 590 147 141 567 322 115 51 140 590 566 567 151 435 51 140 141 152 436 51 140 141 424 429 51 140 141 425 430 51 140 141 426 431 51 140 440 568 439 438 51 140 440 568 427 432 51 140 141 153 428 51 140 141 154 434 51 140 141 155 437 51 140 141 423 433 51 140 441 218 442 51 140 441 219 458 51 140 441 220 459 51 140 441 221 460 51 140 441 222 461 51 140 441 223 462 51 140 441 224 463 51 140 441 225 464 51 140 441 226 465 51 140 441 227 466 51 140 441 316 467 51 140 441 317 468 51 140 441 318 469 51 140 441 319 470 51 140 441 228 471 51 140 441 229 472 51 140 441 230 473 51 140 441 536 540 51 140 441 231 474 51 140 441 232 475 51 140 441 233 476 51 140 441 234 477 51 140 441 235 478 51 140 591 5 569 236 479 51 140 141 237 480 51 140 141 238 101 51 140 141 239 102 51 140 141 240 103 51 140 141 241 104 51 140 141 242 105 51 140 141 243 106 51 140 141 244 107 51 140 141 245 108 51 140 141 246 109 51 140 141 247 481 382 140 141 248 482 382 140 141 249 483 382 140 141 250 484 382 140 141 251 485 382 140 141 252 486 382 140 141 253 487 382 140 141 254 89 382 140 141 255 488 382 140 141 256 90 382 140 141 257 489 382 140 141 258 92 382 140 141 259 490 382 140 141 260 491 382 140 141 261 492 382 140 141 262 493 382 140 141 263 494 382 140 141 264 495 382 140 141 265 496 382 140 141 266 498 497 570 267 499 382 140 141 268 500 382 140 141 269 501 382 140 141 270 502 382 140 141 271 503 382 140 141 272 504 382 140 141 273 505 382 140 141 274 96 382 140 141 275 97 382 140 141 276 506 382 140 141 277 98 382 140 141 278 507 51 140 592 569 279 508 51 140 592 569 280 509 382 140 141 281 510 382 140 141 282 511 382 140 141 283 512 382 140 141 537 541 382 140 141 538 542 382 140 141 539 543 382 140 141 284 513 382 140 141 285 514 382 140 141 286 515 382 140 141 287 516 382 140 141 288 517 382 140 141 289 518 382 140 141 290 519 51 140 141 291 520 51 140 141 292 521 51 140 141 293 522 51 140 141 294 524 51 140 591 571 295 525 51 140 591 571 296 526 51 140 141 297 527 51 140 141 298 528 51 140 141 299 529 51 140 141 300 530 51 140 141 301 531 51 140 141 302 532 51 140 141 303 533 51 140 534 304 110 51 140 535 10 11 12 18 139 138 139 138 52 51 140 141 53 51 140 141 74 51 140 141 54 51 140 141 75 51 140 141 55 51 140 141 556 51 140 141 56 51 140 141 57 51 140 141 58 51 140 141 76 51 140 141 59 51 140 141 60 51 140 141 61 51 140 141 62 51 140 141 63 51 140 141 64 51 140 141 65 51 140 141 77 51 140 141 66 51 140 141 67 51 140 141 78 140 141 68 140 141 79 51 140 141 80 51 140 141 69 51 140 141 81 51 140 141 70 51 140 141 82 51 140 141 71 51 140 141 72 51 140 141 72 51 140 141 73 51 140 141 83 557 140 593 598 84 51 140 593 598 85 51 140 593 598 86 51 140 593 598 87 51 140 593 598 555 51 140 141 88 557 593 598 21 22 139 138 139 138 113 51 140 141 114 51 140 141 115 51 140 141 13 139 138 139 138 110 382 140 141 111 112 14 139 138 139 138 101 382 140 141 102 382 140 141 103 382 140 141 104 382 140 141 105 382 140 141 106 382 140 141 107 382 140 141 108 382 140 141 109 382 140 141 15 5 16 558 51 140 593 598 559 51 140 593 598 560 51 140 593 598 561 564 140 593 598 562 564 140 593 598 563 564 140 593 598 5 17 89 422 90 91 92 93 94 95 374 140 594 598 96 97 98 5 523 595 599 600

6 9 99 139 138 139 138 146 118 51 140 145 147 141 119 51 140 145 147 141 120 51 140 145 147 141 121 51 140 145 147 141 117 51 140 577 147 141 572 5 122 51 140 577 147 141 572 123 51 140 578 147 141 596 124 51 140 578 147 141 596 125 51 140 578 147 141 596 126 51 140 578 147 141 596 127 51 140 578 147 141 596 5 128 51 140 578 147 141 596 129 51 140 443 147 141 596 130 51 140 579 147 141 596 131 51 142 141 147 141 132 51 142 141 147 141 133 51 142 141 147 141 134 51 142 141 147 141 135 51 142 141 147 141 136 51 142 141 147 141 137 51 142 141 147 141 19 139 138 139 138 23 51 140 141 147 141 24 51 140 141 147 141 143 144 140 141 147 141 25 51 140 141 147 141 26 51 140 141 147 141 27 51 140 141 147 141 28 51 140 141 147 141 29 51 140 141 147 141 30 51 140 141 147 141 31 148 140 580 147 141 32 51 140 580 147 141 33 51 140 141 147 141 34 51 140 141 147 141 35 51 140 141 147 141 36 51 140 141 147 141 37 51 140 141 147 141 38 51 140 141 147 141 39 51 140 141 147 141 20 139 138 139 138 40 41 42 43 51 140 581 573 44 45 51 140 581 573 46 47 51 140 582 574 48 49 51 140 582 574 446 544 444 140 453 545 444 140 454 546 444 140 455 547 444 140 456 548 444 140 447 549 444 140 448 550 444 140 449 551 444 140 450 552 444 140 451 553 444 140 452 554 444 140 149 50 444 140 445 5 100 139 138 139 138 323 148 140 583 573 325 148 140 583 573 326 148 140 583 573 327 148 140 583 573 328 148 140 583 573 324 148 140 332 573 329 148 140 330 575 331 148 140 333 575 159 334 51 140 141 575 160 335 51 140 141 575 161 336 51 140 141 575 337 51 140 141 575 338 51 140 141 575 339 51 140 141 575 340 51 140 141 575 341 51 140 141 575 342 51 140 141 575 343 51 140 141 575 344 51 140 141 575 345 51 140 141 575 346 51 140 141 575 347 51 140 141 575 348 51 140 141 575 162 349 51 140 141 575 163 350 51 140 141 575 164 351 51 140 141 575 156 565 51 140 584 573 157 352 51 140 585 573 158 353 51 140 585 573 165 354 51 140 141 575 166 355 51 140 141 575 167 357 51 140 141 575 168 356 51 140 141 575 169 358 51 140 141 575 170 359 51 140 141 575 171 360 51 140 457 576 172 361 51 140 141 575 601 324 51 140 141 575 311 362 51 140 141 575 305 308 51 140 586 573 173 363 51 140 141 575 309 310 51 140 141 575 312 364 51 140 141 575 313 365 51 140 141 575 314 366 51 140 141 575 306 307 51 140 586 573 315 367 51 140 586 573 174 368 51 140 141 175 369 51 140 587 573 176 177 51 140 587 573 178 370 51 140 587 573 179 371 51 140 587 573 180 372 51 140 587 573 181 373 51 140 141 182 375 382 140 588 573 376 382 140 588 573 377 382 140 588 573 378 382 140 588 573 379 382 140 588 573 380 382 140 588 573 381 382 140 588 573 381 51 140 141 183 383 51 140 141 184 384 51 140 141 185 385 51 140 141 186 386 51 140 141 387 331 51 140 589 573 187 388 51 140 588 573 188 389 51 140 588 573 189 390 51 140 588 573 190 391 51 140 141 191 392 374 140 141 192 393 51 140 141 193 394 382 140 141 194 395 51 140 141 195 396 374 140 141 196 397 374 140 141 197 398 374 140 141 198 399 374 140 141 199 400 374 140 141 200 401 374 140 141 201 402 374 140 141 202 403 374 140 141 203 404 374 140 141 204 405 374 140 141 205 406 51 140 141 206 407 51 140 141 207 408 51 140 141 208 409 51 140 141 209 410 51 140 141 210 411 51 140 141 211 412 51 140 141 212 413 51 140 141 213 414 51 140 141 214 415 51 140 141 215 416 51 140 141 216 417 51 140 141 217 418 51 140 419 147 420 597 320 421 51 140 590 566 567 150 113 51 140 141 321 114 382 140 590 147 141 567 322 115 51 140 590 566 567 151 435 51 140 141 152 436 51 140 141 424 429 51 140 141 425 430 51 140 141 426 431 51 140 440 568 439 438 51 140 440 568 427 432 51 140 141 153 428 51 140 141 154 434 51 140 141 155 437 51 140 141 423 433 51 140 441 218 442 51 140 441 219 458 51 140 441 220 459 51 140 441 221 460 51 140 441 222 461 51 140 441 223 462 51 140 441 224 463 51 140 441 225 464 51 140 441 226 465 51 140 441 227 466 51 140 441 316 467 51 140 441 317 468 51 140 441 318 469 51 140 441 319 470 51 140 441 228 471 51 140 441 229 472 51 140 441 230 473 51 140 441 536 540 51 140 441 231 474 51 140 441 232 475 51 140 441 233 476 51 140 441 234 477 51 140 441 235 478 51 140 591 5 569 236 479 51 140 141 237 480 51 140 141 238 101 51 140 141 239 102 51 140 141 240 103 51 140 141 241 104 51 140 141 242 105 51 140 141 243 106 51 140 141 244 107 51 140 141 245 108 51 140 141 246 109 51 140 141 247 481 382 140 141 248 482 382 140 141 249 483 382 140 141 250 484 382 140 141 251 485 382 140 141 252 486 382 140 141 253 487 382 140 141 254 89 382 140 141 255 488 382 140 141 256 90 382 140 141 257 489 382 140 141 258 92 382 140 141 259 490 382 140 141 260 491 382 140 141 261 492 382 140 141 262 493 382 140 141 263 494 382 140 141 264 495 382 140 141 265 496 382 140 141 266 498 497 570 267 499 382 140 141 268 500 382 140 141 269 501 382 140 141 270 502 382 140 141 271 503 382 140 141 272 504 382 140 141 273 505 382 140 141 274 96 382 140 141 275 97 382 140 141 276 506 382 140 141 277 98 382 140 141 278 507 51 140 592 569 279 508 51 140 592 569 280 509 382 140 141 281 510 382 140 141 282 511 382 140 141 283 512 382 140 141 537 541 382 140 141 538 542 382 140 141 539 543 382 140 141 284 513 382 140 141 285 514 382 140 141 286 515 382 140 141 287 516 382 140 141 288 517 382 140 141 289 518 382 140 141 290 519 51 140 141 291 520 51 140 141 292 521 51 140 141 293 522 51 140 141 294 524 51 140 591 571 295 525 51 140 591 571 296 526 51 140 141 297 527 51 140 141 298 528 51 140 141 299 529 51 140 141 300 530 51 140 141 301 531 51 140 141 302 532 51 140 141 303 533 51 140 534 304 110 51 140 535 10 11 12 18 139 138 139 138 52 51 140 141 53 51 140 141 74 51 140 141 54 51 140 141 75 51 140 141 55 51 140 141 556 51 140 141 56 51 140 141 57 51 140 141 58 51 140 141 76 51 140 141 59 51 140 141 60 51 140 141 61 51 140 141 62 51 140 141 63 51 140 141 64 51 140 141 65 51 140 141 77 51 140 141 66 51 140 141 67 51 140 141 78 140 141 68 140 141 79 51 140 141 80 51 140 141 69 51 140 141 81 51 140 141 70 51 140 141 82 51 140 141 71 51 140 141 72 51 140 141 72 51 140 141 73 51 140 141 83 557 140 593 598 84 51 140 593 598 85 51 140 593 598 86 51 140 593 598 87 51 140 593 598 555 51 140 141 88 557 593 598 21 22 139 138 139 138 113 51 140 141 114 51 140 141 115 51 140 141 13 139 138 139 138 110 382 140 141 111 112 14 139 138 139 138 101 382 140 141 102 382 140 141 103 382 140 141 104 382 140 141 105 382 140 141 106 382 140 141 107 382 140 141 108 382 140 141 109 382 140 141 15 5 16 558 51 140 593 598 559 51 140 593 598 560 51 140 593 598 561 564 140 593 598 562 564 140 593 598 563 564 140 593 598 5 17 89 422 90 91 92 93 94 95 374 140 594 598 96 97 98 5 523 595 599 600

6 9 99 139 138 139 138 146 118 51 140 145 147 141 119 51 140 145 147 141 120 51 140 145 147 141 121 51 140 145 147 141 117 51 140 577 147 141 572 5 122 51 140 577 147 141 572 123 51 140 578 147 141 596 124 51 140 578 147 141 596 125 51 140 578 147 141 596 126 51 140 578 147 141 596 127 51 140 578 147 141 596 5 128 51 140 578 147 141 596 129 51 140 443 147 141 596 130 51 140 579 147 141 596 131 51 142 141 147 141 132 51 142 141 147 141 133 51 142 141 147 141 134 51 142 141 147 141 135 51 142 141 147 141 136 51 142 141 147 141 137 51 142 141 147 141 19 139 138 139 138 23 51 140 141 147 141 24 51 140 141 147 141 143 144 140 141 147 141 25 51 140 141 147 141 26 51 140 141 147 141 27 51 140 141 147 141 28 51 140 141 147 141 29 51 140 141 147 141 30 51 140 141 147 141 31 148 140 580 147 141 32 51 140 580 147 141 33 51 140 141 147 141 34 51 140 141 147 141 35 51 140 141 147 141 36 51 140 141 147 141 37 51 140 141 147 141 38 51 140 141 147 141 39 51 140 141 147 141 20 139 138 139 138 40 41 42 43 51 140 581 573 44 45 51 140 581 573 46 47 51 140 582 574 48 49 51 140 582 574 446 544 444 140 453 545 444 140 454 546 444 140 455 547 444 140 456 548 444 140 447 549 444 140 448 550 444 140 449 551 444 140 450 552 444 140 451 553 444 140 452 554 444 140 149 50 444 140 445 5 100 139 138 139 138 323 148 140 583 573 325 148 140 583 573 326 148 140 583 573 327 148 140 583 573 328 148 140 583 573 324 148 140 332 573 329 148 140 330 575 331 148 140 333 575 159 334 51 140 141 575 160 335 51 140 141 575 161 336 51 140 141 575 337 51 140 141 575 338 51 140 141 575 339 51 140 141 575 340 51 140 141 575 341 51 140 141 575 342 51 140 141 575 343 51 140 141 575 344 51 140 141 575 345 51 140 141 575 346 51 140 141 575 347 51 140 141 575 348 51 140 141 575 162 349 51 140 141 575 163 350 51 140 141 575 164 351 51 140 141 575 156 565 51 140 584 573 157 352 51 140 585 573 158 353 51 140 585 573 165 354 51 140 141 575 166 355 51 140 141 575 167 357 51 140 141 575 168 356 51 140 141 575 169 358 51 140 141 575 170 359 51 140 141 575 171 360 51 140 457 576 172 361 51 140 141 575 601 324 51 140 141 575 311 362 51 140 141 575 305 308 51 140 586 573 173 363 51 140 141 575 309 310 51 140 141 575 312 364 51 140 141 575 313 365 51 140 141 575 314 366 51 140 141 575 306 307 51 140 586 573 315 367 51 140 586 573 174 368 51 140 141 175 369 51 140 587 573 176 177 51 140 587 573 178 370 51 140 587 573 179 371 51 140 587 573 180 372 51 140 587 573 181 373 51 140 141 182 375 382 140 588 573 376 382 140 588 573 377 382 140 588 573 378 382 140 588 573 379 382 140 588 573 380 382 140 588 573 381 382 140 588 573 381 51 140 141 183 383 51 140 141 184 384 51 140 141 185 385 51 140 141 186 386 51 140 141 387 331 51 140 589 573 187 388 51 140 588 573 188 389 51 140 588 573 189 390 51 140 588 573 190 391 51 140 141 191 392 374 140 141 192 393 51 140 141 193 394 382 140 141 194 395 51 140 141 195 396 374 140 141 196 397 374 140 141 197 398 374 140 141 198 399 374 140 141 199 400 374 140 141 200 401 374 140 141 201 402 374 140 141 202 403 374 140 141 203 404 374 140 141 204 405 374 140 141 205 406 51 140 141 206 407 51 140 141 207 408 51 140 141 208 409 51 140 141 209 410 51 140 141 210 411 51 140 141 211 412 51 140 141 212 413 51 140 141 213 414 51 140 141 214 415 51 140 141 215 416 51 140 141 216 417 51 140 141 217 418 51 140 419 147 420 597 320 421 51 140 590 566 567 150 113 51 140 141 321 114 382 140 590 147 141 567 322 115 51 140 590 566 567 151 435 51 140 141 152 436 51 140 141 424 429 51 140 141 425 430 51 140 141 426 431 51 140 440 568 439 438 51 140 440 568 427 432 51 140 141 153 428 51 140 141 154 434 51 140 141 155 437 51 140 141 423 433 51 140 441 218 442 51 140 441 219 458 51 140 441 220 459 51 140 441 221 460 51 140 441 222 461 51 140 441 223 462 51 140 441 224 463 51 140 441 225 464 51 140 441 226 465 51 140 441 227 466 51 140 441 316 467 51 140 441 317 468 51 140 441 318 469 51 140 441 319 470 51 140 441 228 471 51 140 441 229 472 51 140 441 230 473 51 140 441 536 540 51 140 441 231 474 51 140 441 232 475 51 140 441 233 476 51 140 441 234 477 51 140 441 235 478 51 140 591 5 569 236 479 51 140 141 237 480 51 140 141 238 101 51 140 141 239 102 51 140 141 240 103 51 140 141 241 104 51 140 141 242 105 51 140 141 243 106 51 140 141 244 107 51 140 141 245 108 51 140 141 246 109 51 140 141 247 481 382 140 141 248 482 382 140 141 249 483 382 140 141 250 484 382 140 141 251 485 382 140 141 252 486 382 140 141 253 487 382 140 141 254 89 382 140 141 255 488 382 140 141 256 90 382 140 141 257 489 382 140 141 258 92 382 140 141 259 490 382 140 141 260 491 382 140 141 261 492 382 140 141 262 493 382 140 141 263 494 382 140 141 264 495 382 140 141 265 496 382 140 141 266 498 497 570 267 499 382 140 141 268 500 382 140 141 269 501 382 140 141 270 502 382 140 141 271 503 382 140 141 272 504 382 140 141 273 505 382 140 141 274 96 382 140 141 275 97 382 140 141 276 506 382 140 141 277 98 382 140 141 278 507 51 140 592 569 279 508 51 140 592 569 280 509 382 140 141 281 510 382 140 141 282 511 382 140 141 283 512 382 140 141 537 541 382 140 141 538 542 382 140 141 539 543 382 140 141 284 513 382 140 141 285 514 382 140 141 286 515 382 140 141 287 516 382 140 141 288 517 382 140 141 289 518 382 140 141 290 519 51 140 141 291 520 51 140 141 292 521 51 140 141 293 522 51 140 141 294 524 51 140 591 571 295 525 51 140 591 571 296 526 51 140 141 297 527 51 140 141 298 528 51 140 141 299 529 51 140 141 300 530 51 140 141 301 531 51 140 141 302 532 51 140 141 303 533 51 140 534 304 110 51 140 535 10 11 12 18 139 138 139 138 52 51 140 141 53 51 140 141 74 51 140 141 54 51 140 141 75 51 140 141 55 51 140 141 556 51 140 141 56 51 140 141 57 51 140 141 58 51 140 141 76 51 140 141 59 51 140 141 60 51 140 141 61 51 140 141 62 51 140 141 63 51 140 141 64 51 140 141 65 51 140 141 77 51 140 141 66 51 140 141 67 51 140 141 78 140 141 68 140 141 79 51 140 141 80 51 140 141 69 51 140 141 81 51 140 141 70 51 140 141 82 51 140 141 71 51 140 141 72 51 140 141 72 51 140 141 73 51 140 141 83 557 140 593 598 84 51 140 593 598 85 51 140 593 598 86 51 140 593 598 87 51 140 593 598 555 51 140 141 88 557 593 598 21 22 139 138 139 138 113 51 140 141 114 51 140 141 115 51 140 141 13 139 138 139 138 110 382 140 141 111 112 14 139 138 139 138 101 382 140 141 102 382 140 141 103 382 140 141 104 382 140 141 105 382 140 141 106 382 140 141 107 382 140 141 108 382 140 141 109 382 140 141 15 5 16 558 51 140 593 598 559 51 140 593 598 560 51 140 593 598 561 564 140 593 598 562 564 140 593 598 563 564 140 593 598 5 17 89 422 90 91 92 93 94 95 374 140 594 598 96 97 98 5 523 595 599 600

6 9 99 139 138 139 138 146 118 51 140 145 147 141 119 51 140 145 147 141 120 51 140 145 147 141 121 51 140 145 147 141 117 51 140 577 147 141 572 5 122 51 140 577 147 141 572 123 51 140 578 147 141 596 124 51 140 578 147 141 596 125 51 140 578 147 141 596 126 51 140 578 147 141 596 127 51 140 578 147 141 596 5 128 51 140 578 147 141 596 129 51 140 443 147 141 596 130 51 140 579 147 141 596 131 51 142 141 147 141 132 51 142 141 147 141 133 51 142 141 147 141 134 51 142 141 147 141 135 51 142 141 147 141 136 51 142 141 147 141 137 51 142 141 147 141 19 139 138 139 138 23 51 140 141 147 141 24 51 140 141 147 141 143 144 140 141 147 141 25 51 140 141 147 141 26 51 140 141 147 141 27 51 140 141 147 141 28 51 140 141 147 141 29 51 140 141 147 141 30 51 140 141 147 141 31 148 140 580 147 141 32 51 140 580 147 141 33 51 140 141 147 141 34 51 140 141 147 141 35 51 140 141 147 141 36 51 140 141 147 141 37 51 140 141 147 141 38 51 140 141 147 141 39 51 140 141 147 141 20 139 138 139 138 40 41 42 43 51 140 581 573 44 45 51 140 581 573 46 47 51 140 582 574 48 49 51 140 582 574 446 544 444 140 453 545 444 140 454 546 444 140 455 547 444 140 456 548 444 140 447 549 444 140 448 550 444 140 449 551 444 140 450 552 444 140 451 553 444 140 452 554 444 140 149 50 444 140 445 5 100 139 138 139 138 323 148 140 583 573 325 148 140 583 573 326 148 140 583 573 327 148 140 583 573 328 148 140 583 573 324 148 140 332 573 329 148 140 330 575 331 148 140 333 575 159 334 51 140 141 575 160 335 51 140 141 575 161 336 51 140 141 575 337 51 140 141 575 338 51 140 141 575 339 51 140 141 575 340 51 140 141 575 341 51 140 141 575 342 51 140 141 575 343 51 140 141 575 344 51 140 141 575 345 51 140 141 575 346 51 140 141 575 347 51 140 141 575 348 51 140 141 575 162 349 51 140 141 575 163 350 51 140 141 575 164 351 51 140 141 575 156 565 51 140 584 573 157 352 51 140 585 573 158 353 51 140 585 573 165 354 51 140 141 575 166 355 51 140 141 575 167 357 51 140 141 575 168 356 51 140 141 575 169 358 51 140 141 575 170 359 51 140 141 575 171 360 51 140 457 576 172 361 51 140 141 575 601 324 51 140 141 575 311 362 51 140 141 575 305 308 51 140 586 573 173 363 51 140 141 575 309 310 51 140 141 575 312 364 51 140 141 575 313 365 51 140 141 575 314 366 51 140 141 575 306 307 51 140 586 573 315 367 51 140 586 573 174 368 51 140 141 175 369 51 140 587 573 176 177 51 140 587 573 178 370 51 140 587 573 179 371 51 140 587 573 180 372 51 140 587 573 181 373 51 140 141 182 375 382 140 588 573 376 382 140 588 573 377 382 140 588 573 378 382 140 588 573 379 382 140 588 573 380 382 140 588 573 381 382 140 588 573 381 51 140 141 183 383 51 140 141 184 384 51 140 141 185 385 51 140 141 186 386 51 140 141 387 331 51 140 589 573 187 388 51 140 588 573 188 389 51 140 588 573 189 390 51 140 588 573 190 391 51 140 141 191 392 374 140 141 192 393 51 140 141 193 394 382 140 141 194 395 51 140 141 195 396 374 140 141 196 397 374 140 141 197 398 374 140 141 198 399 374 140 141 199 400 374 140 141 200 401 374 140 141 201 402 374 140 141 202 403 374 140 141 203 404 374 140 141 204 405 374 140 141 205 406 51 140 141 206 407 51 140 141 207 408 51 140 141 208 409 51 140 141 209 410 51 140 141 210 411 51 140 141 211 412 51 140 141 212 413 51 140 141 213 414 51 140 141 214 415 51 140 141 215 416 51 140 141 216 417 51 140 141 217 418 51 140 419 147 420 597 320 421 51 140 590 566 567 150 113 51 140 141 321 114 382 140 590 147 141 567 322 115 51 140 590 566 567 151 435 51 140 141 152 436 51 140 141 424 429 51 140 141 425 430 51 140 141 426 431 51 140 440 568 439 438 51 140 440 568 427 432 51 140 141 153 428 51 140 141 154 434 51 140 141 155 437 51 140 141 423 433 51 140 441 218 442 51 140 441 219 458 51 140 441 220 459 51 140 441 221 460 51 140 441 222 461 51 140 441 223 462 51 140 441 224 463 51 140 441 225 464 51 140 441 226 465 51 140 441 227 466 51 140 441 316 467 51 140 441 317 468 51 140 441 318 469 51 140 441 319 470 51 140 441 228 471 51 140 441 229 472 51 140 441 230 473 51 140 441 536 540 51 140 441 231 474 51 140 441 232 475 51 140 441 233 476 51 140 441 234 477 51 140 441 235 478 51 140 591 5 569 236 479 51 140 141 237 480 51 140 141 238 101 51 140 141 239 102 51 140 141 240 103 51 140 141 241 104 51 140 141 242 105 51 140 141 243 106 51 140 141 244 107 51 140 141 245 108 51 140 141 246 109 51 140 141 247 481 382 140 141 248 482 382 140 141 249 483 382 140 141 250 484 382 140 141 251 485 382 140 141 252 486 382 140 141 253 487 382 140 141 254 89 382 140 141 255 488 382 140 141 256 90 382 140 141 257 489 382 140 141 258 92 382 140 141 259 490 382 140 141 260 491 382 140 141 261 492 382 140 141 262 493 382 140 141 263 494 382 140 141 264 495 382 140 141 265 496 382 140 141 266 498 497 570 267 499 382 140 141 268 500 382 140 141 269 501 382 140 141 270 502 382 140 141 271 503 382 140 141 272 504 382 140 141 273 505 382 140 141 274 96 382 140 141 275 97 382 140 141 276 506 382 140 141 277 98 382 140 141 278 507 51 140 592 569 279 508 51 140 592 569 280 509 382 140 141 281 510 382 140 141 282 511 382 140 141 283 512 382 140 141 537 541 382 140 141 538 542 382 140 141 539 543 382 140 141 284 513 382 140 141 285 514 382 140 141 286 515 382 140 141 287 516 382 140 141 288 517 382 140 141 289 518 382 140 141 290 519 51 140 141 291 520 51 140 141 292 521 51 140 141 293 522 51 140 141 294 524 51 140 591 571 295 525 51 140 591 571 296 526 51 140 141 297 527 51 140 141 298 528 51 140 141 299 529 51 140 141 300 530 51 140 141 301 531 51 140 141 302 532 51 140 141 303 533 51 140 534 304 110 51 140 535 10 11 12 18 139 138 139 138 52 51 140 141 53 51 140 141 74 51 140 141 54 51 140 141 75 51 140 141 55 51 140 141 556 51 140 141 56 51 140 141 57 51 140 141 58 51 140 141 76 51 140 141 59 51 140 141 60 51 140 141 61 51 140 141 62 51 140 141 63 51 140 141 64 51 140 141 65 51 140 141 77 51 140 141 66 51 140 141 67 51 140 141 78 140 141 68 140 141 79 51 140 141 80 51 140 141 69 51 140 141 81 51 140 141 70 51 140 141 82 51 140 141 71 51 140 141 72 51 140 141 72 51 140 141 73 51 140 141 83 557 140 593 598 84 51 140 593 598 85 51 140 593 598 86 51 140 593 598 87 51 140 593 598 555 51 140 141 88 557 593 598 21 22 139 138 139 138 113 51 140 141 114 51 140 141 115 51 140 141 13 139 138 139 138 110 382 140 141 111 112 14 139 138 139 138 101 382 140 141 102 382 140 141 103 382 140 141 104 382 140 141 105 382 140 141 106 382 140 141 107 382 140 141 108 382 140 141 109 382 140 141 15 5 16 558 51 140 593 598 559 51 140 593 598 560 51 140 593 598 561 564 140 593 598 562 564 140 593 598 563 564 140 593 598 5 17 89 422 90 91 92 93 94 95 374 140 594 598 96 97 98 5 523 595 599 600

• CHIP requires authorization if greater than 12 visits Cosmetic Procedures or Surgeries External Defibrillators Hearing Aids for adults 21 and over Implantable devices (e.g., Interspinous Process Decompressors) - includes trials Insulin Pumps/Continuous Glucose Monitoring Systems , Mammoplasty (Male and Female) Otoplasty (including Microtia Repair) Rhinoplasty / Septoplasty Varicose Vein Treatment Behavioral Health (BH) / Chemical Dependency (CD) / Substance Abuse Residential Treatment (BH/CD) Inpatient Services (Includes Detox/ Rehab) Intensive Outpatient Services (Includes Outpatient Detox/ Rehab) ECT (Electro Convulsive Therapy) / TMS (Transcranial Magnetic Stimulation) Psychological / Neuropsychological Testing – if testing is greater than 8 hours/year • Bone or Spinal Cord Stimulators • Insulin Pumps/Continuous Glucose Monitoring Systems • Hospital Grade Breast Pumps – after the initial 60 day rental period Sleep Studies Personal Care Services (PCS) NA* Private Duty Nursing (PDN) Day Activity Health Services MDCP: Employment Assistance Supported Employment Flexible Family Support Services Respite Care (in home or out of home) Financial Management Services Transition Assistance Services Adaptive Aids Minor Home Modifications Vehicle Modifications Community First Choice: Personal Assistance Services Habilitation Emergency Response Services Support Management Prescribed Pediatric Extended Care Centers (PPECC) Skilled Nursing Obesity Treatment and Surgery x 2 Out-of-Network Specialists: • Any non-urgent referral for Out-of-Network specialty office visits • 2nd Opinions Out-of-Network Implantable pumps (Baclofen/fentanyl) Spinal Cord and other Nerve Stimulators – includes trials Examples includes the following medications: • Aflibercept (Eylea) • Eteplirsen (Exondys-51) • Histrelin implant (Supprelin LA) • IVIG (immune globulin) • Natalizumab (Tysabri) • Nusinersen (Spinraza) • Omalizumab (Xolair) • Onabotulinumtoxin A (Botox) • Pembrolizumab (Keytruda) • Romiplostim (NPlate) Supplies: Telemonitoring ALL Services for Transplantation: solid organ and stem cell transplants (pre-transplant evaluation and transplant procedures) Transportation

• CHIP requires authorization if greater than 12 visits Cosmetic Procedures or Surgeries External Defibrillators Hearing Aids for adults 21 and over Implantable devices (e.g., Interspinous Process Decompressors) - includes trials Insulin Pumps/Continuous Glucose Monitoring Systems , Mammoplasty (Male and Female) Otoplasty (including Microtia Repair) Rhinoplasty / Septoplasty Varicose Vein Treatment Behavioral Health (BH) / Chemical Dependency (CD) / Substance Abuse Residential Treatment (BH/CD) Inpatient Services (Includes Detox/ Rehab) Intensive Outpatient Services (Includes Outpatient Detox/ Rehab) ECT (Electro Convulsive Therapy) / TMS (Transcranial Magnetic Stimulation) Psychological / Neuropsychological Testing – if testing is greater than 8 hours/year • Bone or Spinal Cord Stimulators • Insulin Pumps/Continuous Glucose Monitoring Systems • Hospital Grade Breast Pumps – after the initial 60 day rental period Sleep Studies Personal Care Services (PCS) NA* Private Duty Nursing (PDN) Day Activity Health Services MDCP: Employment Assistance Supported Employment Flexible Family Support Services Respite Care (in home or out of home) Financial Management Services Transition Assistance Services Adaptive Aids Minor Home Modifications Vehicle Modifications Community First Choice: Personal Assistance Services Habilitation Emergency Response Services Support Management Prescribed Pediatric Extended Care Centers (PPECC) Skilled Nursing Obesity Treatment and Surgery x 2 Out-of-Network Specialists: • Any non-urgent referral for Out-of-Network specialty office visits • 2nd Opinions Out-of-Network Implantable pumps (Baclofen/fentanyl) Spinal Cord and other Nerve Stimulators – includes trials Examples includes the following medications: • Aflibercept (Eylea) • Eteplirsen (Exondys-51) • Histrelin implant (Supprelin LA) • IVIG (immune globulin) • Natalizumab (Tysabri) • Nusinersen (Spinraza) • Omalizumab (Xolair) • Onabotulinumtoxin A (Botox) • Pembrolizumab (Keytruda) • Romiplostim (NPlate) Supplies: Telemonitoring ALL Services for Transplantation: solid organ and stem cell transplants (pre-transplant evaluation and transplant procedures) Transportation

– thickener does not require authorization for Medicaid (STAR & STAR Kids)

For Medicaid - with Modifiers U1-U5 and (for Enteral Nutritional Supplies) are excluded from requiring authorization if within the allowable limits

TMHP ie Checked STAR in GOLD- Code not in non covered SG 10.12.18 AR STAR - Codes moved to PA term. AR 10.12.18 Removed in GOLD. AR 10.12.18 Added term date in CPT / Svccode table of 12/31/2015 STAR - Not in STAR non covered SG. AR 10.12.18 This code is configured in STAR beneit term MED ALLERGY IMMUNOTHERAPY ADMIN and set to require PA in GOLD Validated not in Medicaid Non Covered list - GOLD AR 10.17.18 Yes, code in w/PA benefit terms - AR 10.17.18 Validated in w PA term. AR 10.17.18 Validated still listed in TMHP Medicaid Non Covered Per TMH Manual may be reimbursed, verify in QNXT, does not show up in Ben Term Sheet Star Per Amysis not a covered MA , Deny XZ, Verify in QNXT does not show in Noncovered for STAR - add to Medicaid Non Covered List Per Amysis not a covered MA , Deny XZ, Verify in QNXT does not show in Noncovered for STAR Per TMH is a covered service w/ Auth - need to remove from noncovered in QNXT for STAR - COMPLETE Per TMHP Manual is covered w/ auth- Remove from QNXT Noncovered list - COMPLETE QNXT set up under BEN AUTH SURGERY Cosmetic is that okay? Per TMHP Manual maybe covered for injury or trauma - Remove from QNXT Noncovered List - COMPLETE PER TMHP Manual is limited to 2 svc per lifetime (only for breast reconstruction)- Remove from QNXT is noncovered, PA flag set in QNXT for STAR - COMPLETE PER TMHP Manual is limited to 2 svc per lifetime (only for breast reconstruction)- Remove from QNXT noncovered, PA flag set in QNXT for STAR - COMPLETE Per TMHP Manual is covered - Remove from QNXT noncovered - COMPLETE Remove from QNXT noncovered - is set for PA on STAR Term - COMPLETE Noncovered for STAR - Should be added to QNXT noncovered - COMPLETE Remove from QNXT noncovered - is set for PA on STAR Term - COMPLETE. Remove from noncovered list QNXT Need to remove from QNXT non covered Need to removed from QNXT Noncovered - Needs PA Set Need to set PA Flag in QNXT Needs to be added to PA QNXT - is covered per TMHP - is on Noncovered list for QNXT Add to STAR TMHP Non Covered SG - Ann 10.12.18 Removed code form STAR TMHP Non Covered SG Added to CHIP Non Covered SG 10.17.18 AR Code added to PA terms in GOLD 10.17.18 AR Validated STAR TMHP Non Covered SG…. Code is Not listed in GOLD AR 10.17.18 I see it listed as Non Covered for Commercial fg CPT Codes Descriptions PA Set in QNXT Yes or No Oncology drugs when utilized for off label use UFCP UFCP ONLY Video EEG Monitoring Unlisted laparoscopy procedure, biliary tract Unlisted procedure, stomach Anesthesia for intraperitoneal procedures in upper abdomen including laparoscopy; gastric restrictive procedure for morbid obesity Vagus nerve blocking therapy (morbid obesity); laparoscopic implantation of neurostimulator electrode array, anterior and posterior vagal trunks adjacent to esophagogastric junction (EGJ), with implantation of pulse generator, includes programming Vagus nerve blocking therapy (morbid obesity); laparoscopic revision or replacement of vagal trunk neurostimulator electrode array, including connection to existing pulse generator Vagus nerve blocking therapy (morbid obesity); laparoscopic removal of vagal trunk neurostimulator electrode array and pulse generator Vagus nerve blocking therapy (morbid obesity); removal of pulse generator Vagus nerve blocking therapy (morbid obesity); replacement of pulse generator Vagus nerve blocking therapy (morbid obesity); neurostimulator pulse generator electronic analysis, includes reprogramming when performed Face-to-face behavioral counseling for obesity, 15 minutes Face-to-face behavioral counseling for obesity, group (2-10), 30 minutes Cancer Chemotherapy: requires preauthorization for allowable charges >$500 per dose Out-of -Network Bone Growth Stimulators Long Term Support Services (LTSS) – per State benefit Gastrectomy, total; with esophagoenterostomy with Roux-hyphenen-hyphenY reconstruction with formation of intestinal pouch, any type Gastrectomy, partial, distal; with gastroduodenostomy with gastrojejunostomy with formation of intestinal pouch Vagotomy when performed with partial distal gastrectomy (List separately in addition to code(s) for primary procedure) Biopsy of liver, needle; percutaneous [in the absence of signs or symptoms of liver disease (e.g., elevated liver enzymes, enlarged liver)] Biopsy of liver, needle; when done for indicated purpose at tine of other major procedure (list separately in addition to code for primary procedure) [in the absence of signs or symptoms of liver disease (e.g., elevated liver disease, enlarged liver)] Biopsy of liver, wedge [in the absence of signs or symptoms of liver disease (e.g., elevated liver disease, enlarged liver)] Cholecystectomy with exploration of common duct; with transduodenal sphincterotomy or sphincteroplasty, with or without cholangiography Cholecystectomy with exploration of common duct; with choledochoenterostomy Cholecystectomy with exploration of common duct; Cholecystectomy; with cholangiography Cholecystectomy; Laparoscopy, surgical; cholecystoenterostomy Laparoscopy, surgical; cholecystectomy with exploration of common duct Laparoscopy, surgical; cholecystectomy with cholangiography Laparoscopy, surgical; cholecystectomy Adjustment of gastric band diameter via subcutaneous port by injection or aspiration of saline Weight management classes, non-hyphenphysician provider, per session Exercise classes, non-hyphenphysician provider, per session Nutrition classes, non-hyphenphysician provider, per session Per 2019 Auth List Obesity Treatment and Surgery - ALL obesity treatment and surgery must be performed at University Hospital See important Endnotes. STAR

TMHP ie Checked STAR in GOLD- Code not in non covered SG 10.12.18 AR STAR - Codes moved to PA term. AR 10.12.18 Removed in GOLD. AR 10.12.18 Added term date in CPT / Svccode table of 12/31/2015 STAR - Not in STAR non covered SG. AR 10.12.18 This code is configured in STAR beneit term MED ALLERGY IMMUNOTHERAPY ADMIN and set to require PA in GOLD Validated not in Medicaid Non Covered list - GOLD AR 10.17.18 Yes, code in w/PA benefit terms - AR 10.17.18 Validated in w PA term. AR 10.17.18 Validated still listed in TMHP Medicaid Non Covered Per TMH Manual may be reimbursed, verify in QNXT, does not show up in Ben Term Sheet Star Per Amysis not a covered MA , Deny XZ, Verify in QNXT does not show in Noncovered for STAR - add to Medicaid Non Covered List Per Amysis not a covered MA , Deny XZ, Verify in QNXT does not show in Noncovered for STAR Per TMH is a covered service w/ Auth - need to remove from noncovered in QNXT for STAR - COMPLETE Per TMHP Manual is covered w/ auth- Remove from QNXT Noncovered list - COMPLETE QNXT set up under BEN AUTH SURGERY Cosmetic is that okay? Per TMHP Manual maybe covered for injury or trauma - Remove from QNXT Noncovered List - COMPLETE PER TMHP Manual is limited to 2 svc per lifetime (only for breast reconstruction)- Remove from QNXT is noncovered, PA flag set in QNXT for STAR - COMPLETE PER TMHP Manual is limited to 2 svc per lifetime (only for breast reconstruction)- Remove from QNXT noncovered, PA flag set in QNXT for STAR - COMPLETE Per TMHP Manual is covered - Remove from QNXT noncovered - COMPLETE Remove from QNXT noncovered - is set for PA on STAR Term - COMPLETE Noncovered for STAR - Should be added to QNXT noncovered - COMPLETE Remove from QNXT noncovered - is set for PA on STAR Term - COMPLETE. Remove from noncovered list QNXT Need to remove from QNXT non covered Need to removed from QNXT Noncovered - Needs PA Set Need to set PA Flag in QNXT Needs to be added to PA QNXT - is covered per TMHP - is on Noncovered list for QNXT Add to STAR TMHP Non Covered SG - Ann 10.12.18 Removed code form STAR TMHP Non Covered SG Added to CHIP Non Covered SG 10.17.18 AR Code added to PA terms in GOLD 10.17.18 AR Validated STAR TMHP Non Covered SG…. Code is Not listed in GOLD AR 10.17.18 I see it listed as Non Covered for Commercial fg CPT Codes Descriptions PA Set in QNXT Yes or No Oncology drugs when utilized for off label use UFCP UFCP ONLY Video EEG Monitoring Unlisted laparoscopy procedure, biliary tract Unlisted procedure, stomach Anesthesia for intraperitoneal procedures in upper abdomen including laparoscopy; gastric restrictive procedure for morbid obesity Vagus nerve blocking therapy (morbid obesity); laparoscopic implantation of neurostimulator electrode array, anterior and posterior vagal trunks adjacent to esophagogastric junction (EGJ), with implantation of pulse generator, includes programming Vagus nerve blocking therapy (morbid obesity); laparoscopic revision or replacement of vagal trunk neurostimulator electrode array, including connection to existing pulse generator Vagus nerve blocking therapy (morbid obesity); laparoscopic removal of vagal trunk neurostimulator electrode array and pulse generator Vagus nerve blocking therapy (morbid obesity); removal of pulse generator Vagus nerve blocking therapy (morbid obesity); replacement of pulse generator Vagus nerve blocking therapy (morbid obesity); neurostimulator pulse generator electronic analysis, includes reprogramming when performed Face-to-face behavioral counseling for obesity, 15 minutes Face-to-face behavioral counseling for obesity, group (2-10), 30 minutes Cancer Chemotherapy: requires preauthorization for allowable charges >$500 per dose Out-of -Network Bone Growth Stimulators Long Term Support Services (LTSS) – per State benefit Gastrectomy, total; with esophagoenterostomy with Roux-hyphenen-hyphenY reconstruction with formation of intestinal pouch, any type Gastrectomy, partial, distal; with gastroduodenostomy with gastrojejunostomy with formation of intestinal pouch Vagotomy when performed with partial distal gastrectomy (List separately in addition to code(s) for primary procedure) Biopsy of liver, needle; percutaneous [in the absence of signs or symptoms of liver disease (e.g., elevated liver enzymes, enlarged liver)] Biopsy of liver, needle; when done for indicated purpose at tine of other major procedure (list separately in addition to code for primary procedure) [in the absence of signs or symptoms of liver disease (e.g., elevated liver disease, enlarged liver)] Biopsy of liver, wedge [in the absence of signs or symptoms of liver disease (e.g., elevated liver disease, enlarged liver)] Cholecystectomy with exploration of common duct; with transduodenal sphincterotomy or sphincteroplasty, with or without cholangiography Cholecystectomy with exploration of common duct; with choledochoenterostomy Cholecystectomy with exploration of common duct; Cholecystectomy; with cholangiography Cholecystectomy; Laparoscopy, surgical; cholecystoenterostomy Laparoscopy, surgical; cholecystectomy with exploration of common duct Laparoscopy, surgical; cholecystectomy with cholangiography Laparoscopy, surgical; cholecystectomy Adjustment of gastric band diameter via subcutaneous port by injection or aspiration of saline Weight management classes, non-hyphenphysician provider, per session Exercise classes, non-hyphenphysician provider, per session Nutrition classes, non-hyphenphysician provider, per session Per 2019 Auth List Obesity Treatment and Surgery - ALL obesity treatment and surgery must be performed at University Hospital See important Endnotes. STAR

TMHP ie Checked STAR in GOLD- Code not in non covered SG 10.12.18 AR STAR - Codes moved to PA term. AR 10.12.18 Removed in GOLD. AR 10.12.18 Added term date in CPT / Svccode table of 12/31/2015 STAR - Not in STAR non covered SG. AR 10.12.18 This code is configured in STAR beneit term MED ALLERGY IMMUNOTHERAPY ADMIN and set to require PA in GOLD Validated not in Medicaid Non Covered list - GOLD AR 10.17.18 Yes, code in w/PA benefit terms - AR 10.17.18 Validated in w PA term. AR 10.17.18 Validated still listed in TMHP Medicaid Non Covered Per TMH Manual may be reimbursed, verify in QNXT, does not show up in Ben Term Sheet Star Per Amysis not a covered MA , Deny XZ, Verify in QNXT does not show in Noncovered for STAR - add to Medicaid Non Covered List Per Amysis not a covered MA , Deny XZ, Verify in QNXT does not show in Noncovered for STAR Per TMH is a covered service w/ Auth - need to remove from noncovered in QNXT for STAR - COMPLETE Per TMHP Manual is covered w/ auth- Remove from QNXT Noncovered list - COMPLETE QNXT set up under BEN AUTH SURGERY Cosmetic is that okay? Per TMHP Manual maybe covered for injury or trauma - Remove from QNXT Noncovered List - COMPLETE PER TMHP Manual is limited to 2 svc per lifetime (only for breast reconstruction)- Remove from QNXT is noncovered, PA flag set in QNXT for STAR - COMPLETE PER TMHP Manual is limited to 2 svc per lifetime (only for breast reconstruction)- Remove from QNXT noncovered, PA flag set in QNXT for STAR - COMPLETE Per TMHP Manual is covered - Remove from QNXT noncovered - COMPLETE Remove from QNXT noncovered - is set for PA on STAR Term - COMPLETE Noncovered for STAR - Should be added to QNXT noncovered - COMPLETE Remove from QNXT noncovered - is set for PA on STAR Term - COMPLETE. Remove from noncovered list QNXT Need to remove from QNXT non covered Need to removed from QNXT Noncovered - Needs PA Set Need to set PA Flag in QNXT Needs to be added to PA QNXT - is covered per TMHP - is on Noncovered list for QNXT Add to STAR TMHP Non Covered SG - Ann 10.12.18 Removed code form STAR TMHP Non Covered SG Added to CHIP Non Covered SG 10.17.18 AR Code added to PA terms in GOLD 10.17.18 AR Validated STAR TMHP Non Covered SG…. Code is Not listed in GOLD AR 10.17.18 I see it listed as Non Covered for Commercial fg CPT Codes Descriptions PA Set in QNXT Yes or No Oncology drugs when utilized for off label use UFCP UFCP ONLY Video EEG Monitoring Unlisted laparoscopy procedure, biliary tract Unlisted procedure, stomach Anesthesia for intraperitoneal procedures in upper abdomen including laparoscopy; gastric restrictive procedure for morbid obesity Vagus nerve blocking therapy (morbid obesity); laparoscopic implantation of neurostimulator electrode array, anterior and posterior vagal trunks adjacent to esophagogastric junction (EGJ), with implantation of pulse generator, includes programming Vagus nerve blocking therapy (morbid obesity); laparoscopic revision or replacement of vagal trunk neurostimulator electrode array, including connection to existing pulse generator Vagus nerve blocking therapy (morbid obesity); laparoscopic removal of vagal trunk neurostimulator electrode array and pulse generator Vagus nerve blocking therapy (morbid obesity); removal of pulse generator Vagus nerve blocking therapy (morbid obesity); replacement of pulse generator Vagus nerve blocking therapy (morbid obesity); neurostimulator pulse generator electronic analysis, includes reprogramming when performed Face-to-face behavioral counseling for obesity, 15 minutes Face-to-face behavioral counseling for obesity, group (2-10), 30 minutes Cancer Chemotherapy: requires preauthorization for allowable charges >$500 per dose Out-of -Network Bone Growth Stimulators Long Term Support Services (LTSS) – per State benefit Gastrectomy, total; with esophagoenterostomy with Roux-hyphenen-hyphenY reconstruction with formation of intestinal pouch, any type Gastrectomy, partial, distal; with gastroduodenostomy with gastrojejunostomy with formation of intestinal pouch Vagotomy when performed with partial distal gastrectomy (List separately in addition to code(s) for primary procedure) Biopsy of liver, needle; percutaneous [in the absence of signs or symptoms of liver disease (e.g., elevated liver enzymes, enlarged liver)] Biopsy of liver, needle; when done for indicated purpose at tine of other major procedure (list separately in addition to code for primary procedure) [in the absence of signs or symptoms of liver disease (e.g., elevated liver disease, enlarged liver)] Biopsy of liver, wedge [in the absence of signs or symptoms of liver disease (e.g., elevated liver disease, enlarged liver)] Cholecystectomy with exploration of common duct; with transduodenal sphincterotomy or sphincteroplasty, with or without cholangiography Cholecystectomy with exploration of common duct; with choledochoenterostomy Cholecystectomy with exploration of common duct; Cholecystectomy; with cholangiography Cholecystectomy; Laparoscopy, surgical; cholecystoenterostomy Laparoscopy, surgical; cholecystectomy with exploration of common duct Laparoscopy, surgical; cholecystectomy with cholangiography Laparoscopy, surgical; cholecystectomy Adjustment of gastric band diameter via subcutaneous port by injection or aspiration of saline Weight management classes, non-hyphenphysician provider, per session Exercise classes, non-hyphenphysician provider, per session Nutrition classes, non-hyphenphysician provider, per session Per 2019 Auth List Obesity Treatment and Surgery - ALL obesity treatment and surgery must be performed at University Hospital See important Endnotes. STAR

TMHP ie Checked STAR in GOLD- Code not in non covered SG 10.12.18 AR STAR - Codes moved to PA term. AR 10.12.18 Removed in GOLD. AR 10.12.18 Added term date in CPT / Svccode table of 12/31/2015 STAR - Not in STAR non covered SG. AR 10.12.18 This code is configured in STAR beneit term MED ALLERGY IMMUNOTHERAPY ADMIN and set to require PA in GOLD Validated not in Medicaid Non Covered list - GOLD AR 10.17.18 Yes, code in w/PA benefit terms - AR 10.17.18 Validated in w PA term. AR 10.17.18 Validated still listed in TMHP Medicaid Non Covered Per TMH Manual may be reimbursed, verify in QNXT, does not show up in Ben Term Sheet Star Per Amysis not a covered MA , Deny XZ, Verify in QNXT does not show in Noncovered for STAR - add to Medicaid Non Covered List Per Amysis not a covered MA , Deny XZ, Verify in QNXT does not show in Noncovered for STAR Per TMH is a covered service w/ Auth - need to remove from noncovered in QNXT for STAR - COMPLETE Per TMHP Manual is covered w/ auth- Remove from QNXT Noncovered list - COMPLETE QNXT set up under BEN AUTH SURGERY Cosmetic is that okay? Per TMHP Manual maybe covered for injury or trauma - Remove from QNXT Noncovered List - COMPLETE PER TMHP Manual is limited to 2 svc per lifetime (only for breast reconstruction)- Remove from QNXT is noncovered, PA flag set in QNXT for STAR - COMPLETE PER TMHP Manual is limited to 2 svc per lifetime (only for breast reconstruction)- Remove from QNXT noncovered, PA flag set in QNXT for STAR - COMPLETE Per TMHP Manual is covered - Remove from QNXT noncovered - COMPLETE Remove from QNXT noncovered - is set for PA on STAR Term - COMPLETE Noncovered for STAR - Should be added to QNXT noncovered - COMPLETE Remove from QNXT noncovered - is set for PA on STAR Term - COMPLETE. Remove from noncovered list QNXT Need to remove from QNXT non covered Need to removed from QNXT Noncovered - Needs PA Set Need to set PA Flag in QNXT Needs to be added to PA QNXT - is covered per TMHP - is on Noncovered list for QNXT Add to STAR TMHP Non Covered SG - Ann 10.12.18 Removed code form STAR TMHP Non Covered SG Added to CHIP Non Covered SG 10.17.18 AR Code added to PA terms in GOLD 10.17.18 AR Validated STAR TMHP Non Covered SG…. Code is Not listed in GOLD AR 10.17.18 I see it listed as Non Covered for Commercial fg CPT Codes Descriptions PA Set in QNXT Yes or No Oncology drugs when utilized for off label use UFCP UFCP ONLY Video EEG Monitoring Unlisted laparoscopy procedure, biliary tract Unlisted procedure, stomach Anesthesia for intraperitoneal procedures in upper abdomen including laparoscopy; gastric restrictive procedure for morbid obesity Vagus nerve blocking therapy (morbid obesity); laparoscopic implantation of neurostimulator electrode array, anterior and posterior vagal trunks adjacent to esophagogastric junction (EGJ), with implantation of pulse generator, includes programming Vagus nerve blocking therapy (morbid obesity); laparoscopic revision or replacement of vagal trunk neurostimulator electrode array, including connection to existing pulse generator Vagus nerve blocking therapy (morbid obesity); laparoscopic removal of vagal trunk neurostimulator electrode array and pulse generator Vagus nerve blocking therapy (morbid obesity); removal of pulse generator Vagus nerve blocking therapy (morbid obesity); replacement of pulse generator Vagus nerve blocking therapy (morbid obesity); neurostimulator pulse generator electronic analysis, includes reprogramming when performed Face-to-face behavioral counseling for obesity, 15 minutes Face-to-face behavioral counseling for obesity, group (2-10), 30 minutes Cancer Chemotherapy: requires preauthorization for allowable charges >$500 per dose Out-of -Network Bone Growth Stimulators Long Term Support Services (LTSS) – per State benefit Gastrectomy, total; with esophagoenterostomy with Roux-hyphenen-hyphenY reconstruction with formation of intestinal pouch, any type Gastrectomy, partial, distal; with gastroduodenostomy with gastrojejunostomy with formation of intestinal pouch Vagotomy when performed with partial distal gastrectomy (List separately in addition to code(s) for primary procedure) Biopsy of liver, needle; percutaneous [in the absence of signs or symptoms of liver disease (e.g., elevated liver enzymes, enlarged liver)] Biopsy of liver, needle; when done for indicated purpose at tine of other major procedure (list separately in addition to code for primary procedure) [in the absence of signs or symptoms of liver disease (e.g., elevated liver disease, enlarged liver)] Biopsy of liver, wedge [in the absence of signs or symptoms of liver disease (e.g., elevated liver disease, enlarged liver)] Cholecystectomy with exploration of common duct; with transduodenal sphincterotomy or sphincteroplasty, with or without cholangiography Cholecystectomy with exploration of common duct; with choledochoenterostomy Cholecystectomy with exploration of common duct; Cholecystectomy; with cholangiography Cholecystectomy; Laparoscopy, surgical; cholecystoenterostomy Laparoscopy, surgical; cholecystectomy with exploration of common duct Laparoscopy, surgical; cholecystectomy with cholangiography Laparoscopy, surgical; cholecystectomy Adjustment of gastric band diameter via subcutaneous port by injection or aspiration of saline Weight management classes, non-hyphenphysician provider, per session Exercise classes, non-hyphenphysician provider, per session Nutrition classes, non-hyphenphysician provider, per session Per 2019 Auth List Obesity Treatment and Surgery - ALL obesity treatment and surgery must be performed at University Hospital See important Endnotes. STAR

TMHP ie Checked STAR in GOLD- Code not in non covered SG 10.12.18 AR STAR - Codes moved to PA term. AR 10.12.18 Removed in GOLD. AR 10.12.18 Added term date in CPT / Svccode table of 12/31/2015 STAR - Not in STAR non covered SG. AR 10.12.18 This code is configured in STAR beneit term MED ALLERGY IMMUNOTHERAPY ADMIN and set to require PA in GOLD Validated not in Medicaid Non Covered list - GOLD AR 10.17.18 Yes, code in w/PA benefit terms - AR 10.17.18 Validated in w PA term. AR 10.17.18 Validated still listed in TMHP Medicaid Non Covered Per TMH Manual may be reimbursed, verify in QNXT, does not show up in Ben Term Sheet Star Per Amysis not a covered MA , Deny XZ, Verify in QNXT does not show in Noncovered for STAR - add to Medicaid Non Covered List Per Amysis not a covered MA , Deny XZ, Verify in QNXT does not show in Noncovered for STAR Per TMH is a covered service w/ Auth - need to remove from noncovered in QNXT for STAR - COMPLETE Per TMHP Manual is covered w/ auth- Remove from QNXT Noncovered list - COMPLETE QNXT set up under BEN AUTH SURGERY Cosmetic is that okay? Per TMHP Manual maybe covered for injury or trauma - Remove from QNXT Noncovered List - COMPLETE PER TMHP Manual is limited to 2 svc per lifetime (only for breast reconstruction)- Remove from QNXT is noncovered, PA flag set in QNXT for STAR - COMPLETE PER TMHP Manual is limited to 2 svc per lifetime (only for breast reconstruction)- Remove from QNXT noncovered, PA flag set in QNXT for STAR - COMPLETE Per TMHP Manual is covered - Remove from QNXT noncovered - COMPLETE Remove from QNXT noncovered - is set for PA on STAR Term - COMPLETE Noncovered for STAR - Should be added to QNXT noncovered - COMPLETE Remove from QNXT noncovered - is set for PA on STAR Term - COMPLETE. Remove from noncovered list QNXT Need to remove from QNXT non covered Need to removed from QNXT Noncovered - Needs PA Set Need to set PA Flag in QNXT Needs to be added to PA QNXT - is covered per TMHP - is on Noncovered list for QNXT Add to STAR TMHP Non Covered SG - Ann 10.12.18 Removed code form STAR TMHP Non Covered SG Added to CHIP Non Covered SG 10.17.18 AR Code added to PA terms in GOLD 10.17.18 AR Validated STAR TMHP Non Covered SG…. Code is Not listed in GOLD AR 10.17.18 I see it listed as Non Covered for Commercial fg CPT Codes Descriptions PA Set in QNXT Yes or No Oncology drugs when utilized for off label use UFCP UFCP ONLY Video EEG Monitoring Unlisted laparoscopy procedure, biliary tract Unlisted procedure, stomach Anesthesia for intraperitoneal procedures in upper abdomen including laparoscopy; gastric restrictive procedure for morbid obesity Vagus nerve blocking therapy (morbid obesity); laparoscopic implantation of neurostimulator electrode array, anterior and posterior vagal trunks adjacent to esophagogastric junction (EGJ), with implantation of pulse generator, includes programming Vagus nerve blocking therapy (morbid obesity); laparoscopic revision or replacement of vagal trunk neurostimulator electrode array, including connection to existing pulse generator Vagus nerve blocking therapy (morbid obesity); laparoscopic removal of vagal trunk neurostimulator electrode array and pulse generator Vagus nerve blocking therapy (morbid obesity); removal of pulse generator Vagus nerve blocking therapy (morbid obesity); replacement of pulse generator Vagus nerve blocking therapy (morbid obesity); neurostimulator pulse generator electronic analysis, includes reprogramming when performed Face-to-face behavioral counseling for obesity, 15 minutes Face-to-face behavioral counseling for obesity, group (2-10), 30 minutes Cancer Chemotherapy: requires preauthorization for allowable charges >$500 per dose Out-of -Network Bone Growth Stimulators Long Term Support Services (LTSS) – per State benefit Gastrectomy, total; with esophagoenterostomy with Roux-hyphenen-hyphenY reconstruction with formation of intestinal pouch, any type Gastrectomy, partial, distal; with gastroduodenostomy with gastrojejunostomy with formation of intestinal pouch Vagotomy when performed with partial distal gastrectomy (List separately in addition to code(s) for primary procedure) Biopsy of liver, needle; percutaneous [in the absence of signs or symptoms of liver disease (e.g., elevated liver enzymes, enlarged liver)] Biopsy of liver, needle; when done for indicated purpose at tine of other major procedure (list separately in addition to code for primary procedure) [in the absence of signs or symptoms of liver disease (e.g., elevated liver disease, enlarged liver)] Biopsy of liver, wedge [in the absence of signs or symptoms of liver disease (e.g., elevated liver disease, enlarged liver)] Cholecystectomy with exploration of common duct; with transduodenal sphincterotomy or sphincteroplasty, with or without cholangiography Cholecystectomy with exploration of common duct; with choledochoenterostomy Cholecystectomy with exploration of common duct; Cholecystectomy; with cholangiography Cholecystectomy; Laparoscopy, surgical; cholecystoenterostomy Laparoscopy, surgical; cholecystectomy with exploration of common duct Laparoscopy, surgical; cholecystectomy with cholangiography Laparoscopy, surgical; cholecystectomy Adjustment of gastric band diameter via subcutaneous port by injection or aspiration of saline Weight management classes, non-hyphenphysician provider, per session Exercise classes, non-hyphenphysician provider, per session Nutrition classes, non-hyphenphysician provider, per session Per 2019 Auth List Obesity Treatment and Surgery - ALL obesity treatment and surgery must be performed at University Hospital See important Endnotes. STAR

TMHP ie Checked STAR in GOLD- Code not in non covered SG 10.12.18 AR STAR - Codes moved to PA term. AR 10.12.18 Removed in GOLD. AR 10.12.18 Added term date in CPT / Svccode table of 12/31/2015 STAR - Not in STAR non covered SG. AR 10.12.18 This code is configured in STAR beneit term MED ALLERGY IMMUNOTHERAPY ADMIN and set to require PA in GOLD Validated not in Medicaid Non Covered list - GOLD AR 10.17.18 Yes, code in w/PA benefit terms - AR 10.17.18 Validated in w PA term. AR 10.17.18 Validated still listed in TMHP Medicaid Non Covered Per TMH Manual may be reimbursed, verify in QNXT, does not show up in Ben Term Sheet Star Per Amysis not a covered MA , Deny XZ, Verify in QNXT does not show in Noncovered for STAR - add to Medicaid Non Covered List Per Amysis not a covered MA , Deny XZ, Verify in QNXT does not show in Noncovered for STAR Per TMH is a covered service w/ Auth - need to remove from noncovered in QNXT for STAR - COMPLETE Per TMHP Manual is covered w/ auth- Remove from QNXT Noncovered list - COMPLETE QNXT set up under BEN AUTH SURGERY Cosmetic is that okay? Per TMHP Manual maybe covered for injury or trauma - Remove from QNXT Noncovered List - COMPLETE PER TMHP Manual is limited to 2 svc per lifetime (only for breast reconstruction)- Remove from QNXT is noncovered, PA flag set in QNXT for STAR - COMPLETE PER TMHP Manual is limited to 2 svc per lifetime (only for breast reconstruction)- Remove from QNXT noncovered, PA flag set in QNXT for STAR - COMPLETE Per TMHP Manual is covered - Remove from QNXT noncovered - COMPLETE Remove from QNXT noncovered - is set for PA on STAR Term - COMPLETE Noncovered for STAR - Should be added to QNXT noncovered - COMPLETE Remove from QNXT noncovered - is set for PA on STAR Term - COMPLETE. Remove from noncovered list QNXT Need to remove from QNXT non covered Need to removed from QNXT Noncovered - Needs PA Set Need to set PA Flag in QNXT Needs to be added to PA QNXT - is covered per TMHP - is on Noncovered list for QNXT Add to STAR TMHP Non Covered SG - Ann 10.12.18 Removed code form STAR TMHP Non Covered SG Added to CHIP Non Covered SG 10.17.18 AR Code added to PA terms in GOLD 10.17.18 AR Validated STAR TMHP Non Covered SG…. Code is Not listed in GOLD AR 10.17.18 I see it listed as Non Covered for Commercial fg CPT Codes Descriptions PA Set in QNXT Yes or No Oncology drugs when utilized for off label use UFCP UFCP ONLY Video EEG Monitoring Unlisted laparoscopy procedure, biliary tract Unlisted procedure, stomach Anesthesia for intraperitoneal procedures in upper abdomen including laparoscopy; gastric restrictive procedure for morbid obesity Vagus nerve blocking therapy (morbid obesity); laparoscopic implantation of neurostimulator electrode array, anterior and posterior vagal trunks adjacent to esophagogastric junction (EGJ), with implantation of pulse generator, includes programming Vagus nerve blocking therapy (morbid obesity); laparoscopic revision or replacement of vagal trunk neurostimulator electrode array, including connection to existing pulse generator Vagus nerve blocking therapy (morbid obesity); laparoscopic removal of vagal trunk neurostimulator electrode array and pulse generator Vagus nerve blocking therapy (morbid obesity); removal of pulse generator Vagus nerve blocking therapy (morbid obesity); replacement of pulse generator Vagus nerve blocking therapy (morbid obesity); neurostimulator pulse generator electronic analysis, includes reprogramming when performed Face-to-face behavioral counseling for obesity, 15 minutes Face-to-face behavioral counseling for obesity, group (2-10), 30 minutes Cancer Chemotherapy: requires preauthorization for allowable charges >$500 per dose Out-of -Network Bone Growth Stimulators Long Term Support Services (LTSS) – per State benefit Gastrectomy, total; with esophagoenterostomy with Roux-hyphenen-hyphenY reconstruction with formation of intestinal pouch, any type Gastrectomy, partial, distal; with gastroduodenostomy with gastrojejunostomy with formation of intestinal pouch Vagotomy when performed with partial distal gastrectomy (List separately in addition to code(s) for primary procedure) Biopsy of liver, needle; percutaneous [in the absence of signs or symptoms of liver disease (e.g., elevated liver enzymes, enlarged liver)] Biopsy of liver, needle; when done for indicated purpose at tine of other major procedure (list separately in addition to code for primary procedure) [in the absence of signs or symptoms of liver disease (e.g., elevated liver disease, enlarged liver)] Biopsy of liver, wedge [in the absence of signs or symptoms of liver disease (e.g., elevated liver disease, enlarged liver)] Cholecystectomy with exploration of common duct; with transduodenal sphincterotomy or sphincteroplasty, with or without cholangiography Cholecystectomy with exploration of common duct; with choledochoenterostomy Cholecystectomy with exploration of common duct; Cholecystectomy; with cholangiography Cholecystectomy; Laparoscopy, surgical; cholecystoenterostomy Laparoscopy, surgical; cholecystectomy with exploration of common duct Laparoscopy, surgical; cholecystectomy with cholangiography Laparoscopy, surgical; cholecystectomy Adjustment of gastric band diameter via subcutaneous port by injection or aspiration of saline Weight management classes, non-hyphenphysician provider, per session Exercise classes, non-hyphenphysician provider, per session Nutrition classes, non-hyphenphysician provider, per session Per 2019 Auth List Obesity Treatment and Surgery - ALL obesity treatment and surgery must be performed at University Hospital See important Endnotes. STAR

For Medicaid - with Modifiers U1-U5 and (for Enteral Nutritional Supplies) are excluded from requiring authorization if within the allowable limits