Procedure Code Table - Continuation

CPT or HCPCS Procedure Code : 92620

Short Description:Auditory function 60 min

Covered Benefit : Yes

Prior Authorization Needed: No

CPT or HCPCS Procedure Code : 92621

Short Description:Auditory function + 15 min

Covered Benefit : Yes

Prior Authorization Needed: No

CPT or HCPCS Procedure Code : 92625

Short Description:Tinnitus assessment

Covered Benefit : Yes

Prior Authorization Needed: No

CPT or HCPCS Procedure Code : 92626

Short Description:Eval aud rehab status

Covered Benefit : Yes

Prior Authorization Needed: No

CPT or HCPCS Procedure Code : 92627

Short Description:Eval aud status rehab add-on

Covered Benefit : Yes

Prior Authorization Needed: No

CPT or HCPCS Procedure Code : 92630

Short Description:Aud rehab pre-ling hear loss

Covered Benefit : Yes

Prior Authorization Needed: No

CPT or HCPCS Procedure Code : 92633

Short Description:Aud rehab postling hear loss

Covered Benefit : Yes

Prior Authorization Needed: No

CPT or HCPCS Procedure Code : 92640

Short Description:Aud brainstem implt programg

Covered Benefit : Yes

Prior Authorization Needed: No

CPT or HCPCS Procedure Code : 95861

Short Description:Muscle test 2 limbs

Covered Benefit : Yes

Prior Authorization Needed: No

CPT or HCPCS Procedure Code : 95920

Short Description:Intraop nerve test add-on

Covered Benefit : Yes

Prior Authorization Needed: No

CPT or HCPCS Procedure Code : 95925

Short Description:Somatosensory evoked study - upper limbs

Covered Benefit : Yes

Prior Authorization Needed: No

CPT or HCPCS Procedure Code : 95926

Short Description:Somatosensory study lower limbs

Covered Benefit : Yes

Prior Authorization Needed: No

CPT or HCPCS Procedure Code : 95927

Short Description:Somatosensory study trunk/head

Covered Benefit : Yes

Prior Authorization Needed: No

CPT or HCPCS Procedure Code : 95928

Short Description:C motor evoked uppr limbs

Covered Benefit : Yes

Prior Authorization Needed: No

CPT or HCPCS Procedure Code : 95929

Short Description:C motor evoked lwr limbs

Covered Benefit : Yes

Prior Authorization Needed: No

CPT or HCPCS Procedure Code : 95930

Short Description:Visual evoke potential - cns

Covered Benefit : Yes

Prior Authorization Needed: No.

CPT or HCPCS Procedure Code : 95934

Short Description:H-reflex test

Covered Benefit : Yes

Prior Authorization Needed: No

CPT or HCPCS Procedure Code : 95936

Short Description:H-reflex test

Covered Benefit : Yes

Prior Authorization Needed: No

CPT or HCPCS Procedure Code : 95937

Short Description: Neuromuscular junction testing (repetiti

Covered Benefit : Yes

Prior Authorization Needed: No

CPT or HCPCS Procedure Code : 96111
Short Description: Developmental test extend

Covered Benefit : Yes

Prior Authorization Needed: No

CPT or HCPCS Procedure Code : 97112
Short Description: Neuromuscular reeducation

Covered Benefit : Yes

Prior Authorization Needed: No

CPT or HCPCS Procedure Code : 97201
Short Description: Office/outpatient visit new

Covered Benefit : Yes

Prior Authorization Needed: No

CPT or HCPCS Procedure Code : 97202
Short Description: Office/outpatient visit new

Covered Benefit : Yes

Prior Authorization Needed: No

CPT or HCPCS Procedure Code : 97203
Short Description: Office/outpatient visit new

Covered Benefit : Yes

Prior Authorization Needed: No

CPT or HCPCS Procedure Code : 97204
Short Description: Office/outpatient visit new

Covered Benefit : Yes

Prior Authorization Needed: No

CPT or HCPCS Procedure Code : 97205
Short Description: Office/outpatient visit new

Covered Benefit : Yes

Prior Authorization Needed: No

CPT or HCPCS Procedure Code : 99211
Short Description: Office/outpatient visit est

Covered Benefit : Yes

Prior Authorization Needed: No

CPT or HCPCS Procedure Code : 99212
Short Description: Office/outpatient visit est

Covered Benefit : Yes

Prior Authorization Needed: No

CPT or HCPCS Procedure Code : 99213
Short Description: Office/outpatient visit est

Covered Benefit : Yes

Prior Authorization Needed: No

CPT or HCPCS Procedure Code : 99214
Short Description: Office/outpatient visit est

Covered Benefit : Yes

Prior Authorization Needed: No