CSHCN 2009 > Physician > Benefits, Limitations, and Authorization Requirements

   
 

29.2.22 Hyperbaric Oxygen Therapy (HBOT)

Hyperbaric oxygen is a mode of therapy involving exposure of the body to oxygen under pressure greater than one atmosphere. Treatment is performed in specially constructed hyperbaric chambers that may hold one or several clients. Although oxygen may be administered by mask, cannula, or tube in addition to the hyperbaric treatment, this use of oxygen is not considered hyperbaric oxygen treatment in itself.

The CSHCN Services Program recognizes the following indications for HBOT:

Air or gas embolism

Carbon monoxide poisoning

Compromised skin grafts and flaps

Crush injuries and acute traumatic ischemias

Decompression sickness

Enhanced healing in selected problem wounds

Exceptional blood loss (anemia)

Gas gangrene (clostridial, myositis, and myonecrosis)

Necrotizing soft tissue infections

Radiation tissue damage (osteoradionecrosis)

Refractory osteomyelitis

Thermal burns

Intracranial abscess

Documentation required to be maintained in the client's medical records includes, but is not limited to:

Physician's order for HBOT treatments

Documentation of medical necessity

Established plan of care specifying the goals of HBOT

Estimated number of treatments including revisions made as appropriate and justification for extending treatments

Level of supervision provided

The CSHCN Services Program does not authorize services that are experimental or investigational in nature. Current literature indicates a potential benefit of HBOT for some clients with cerebral palsy, multiple sclerosis, and other types of brain injury; however, final study results in controlled trials are not yet available.

Prior authorization is not required for the diagnoses listed below.

Prior authorization is required for diagnoses not listed in the following table. Providers should submit documentation of medical necessity with the prior authorization request.

When requesting prior authorizations, providers should use the "CSHCN Services Program Authorization and Prior Authorization Request" form on page B-96.

Refer to: Section 4.3, "Prior Authorizations" for detailed information about prior authorization requirements.

HBOT services must be provided in facilities that have experience in HBOT treatment of pediatric clients. The physician must be in constant attendance of hyperbaric oxygen therapy during compression and decompression of the chamber.

HBOT (procedure code 99183 and revenue code 413) are limited to one session per day, per client, any provider.

Physicians who bill for the professional component of HBOT can use procedure code 99183. Procedure code 99183 is limited to one per day.

Use revenue code 413 for reimbursement of the technical component. Procedure code G0167 is included in the charge of revenue code 413 and is not a covered benefit.

HBOT may be reimbursed when billed with the most appropriate diagnosis code listed in the table below:

Diagnosis Code
Description

0383

Septicemia due to anaerobes

0400

Gas gangrene

24970

Secondary diabetes mellitus with peripheral circulatory disorders, not stated as uncontrolled, or unspecified

24971

Secondary diabetes mellitus with peripheral circulatory disorders, uncontrolled

25070

Diabetes with peripheral circulatory disorders, type II or unspecified type, not stated as uncontrolled

25071

Diabetes with peripheral circulatory disorders, type I (juvenile type), not stated as uncontrolled

25072

Diabetes with peripheral circulatory disorders, type II or unspecified type, uncontrolled

25073

Diabetes with peripheral circulatory disorders, type I (juvenile type), uncontrolled

2851

Acute post hemorrhagic anemia

3240

Intracranial abscess

44023

Atherosclerosis of native arteries of the extremities with ulceration

44024

Atherosclerosis of native arteries of the extremities with gangrene

44381

Peripheral angiopathy in diseases classified elsewhere

4540

Varicose veins of lower extremities with ulcer

4542

Varicose veins of lower extremities with ulcer and inflammation

52689

Other specified diseases of the jaw

6396

Embolism following abortion or ectopic and molar pregnancies

68600

Unspecified other local infection of skin and subcutaneous tissue, pyoderma

68601

Pyoderma gangrenosum

68609

Other pyoderma

69513

Stevens-Johnson syndrome

69514

Stevens-Johnson syndrome-toxic epidermal necrolysis overlap syndrome

69515

Toxic epidermal necrolysis

70700

Decubitus ulcer, unspecified site

70710

Ulcer of lower limbs, unspecified

70712

Ulcer of calf

70713

Ulcer of ankle

70714

Ulcer of heel and midfoot

70715

Ulcer of other part of foot

70719

Ulcer of other part of lower limb

70723

Pressure ulcer, stage III

70724

Pressure ulcer, stage IV

70725

Pressure ulcer, unstageable

7078

Chronic ulcer of other specified site

7079

Chronic ulcer of unspecified site

72886

Necrotizing fasciitis

73010

Chronic osteomyelitis, site unspecified

73011

Chronic osteomyelitis, shoulder region

73012

Chronic osteomyelitis, upper arm

73719

Chronic osteomyelitis, multiple sites

7854

Gangrene

8690

Internal injury to unspecified or ill-defined organs without mention of open wound into cavity

8691

Internal injury to unspecified or ill-defined organs with open wound into cavity

8871

Traumatic amputation of arm and hand; (complete), (partial), unilateral, below elbow, complicated

8873

Traumatic amputation of arm and hand; (complete), (partial), unilateral, at or above elbow, complicated

8875

Traumatic amputation of arm and hand; (complete), (partial), unilateral, not specified, complicated

8877

Traumatic amputation of arm and hand; (complete), (partial), bilateral (any level), complicated

8971

Traumatic amputation of leg(s), (complete), (partial), unilateral, below knee, complicated

8973

Traumatic amputation of leg(s), (complete), (partial), unilateral, at or above knee, complicated

8975

Traumatic amputation of leg(s), (complete), (partial), unilateral, level not specified, complicated

8977

Traumatic amputation of leg(s), (complete), (partial), bilateral, any level, complicated

9092

Late effect of radiation

9251

Crushing injury of face and scalp

9252

Crushing injury of neck

9260

Crushing injury of external genitalia

9261

Crushing injury of other specified sites of trunk

92611

Crushing injury of back

92612

Crushing injury of buttock

92619

Crushing injury of other specified sites of trunk

9268

Crushing injury of multiple sites of trunk

9269

Crushing injury of unspecified site of trunk

92700

Crushing injury of shoulder region

92701

Crushing injury of scapular region

92702

Crushing injury of axillary region

92703

Crushing injury of upper arm

92709

Crushing injury of multiple sites of upper arm

92710

Crushing injury of forearm

92711

Crushing injury of elbow

92720

Crushing injury of hand(s)

92721

Crushing injury of wrist

9273

Crushing injury of finger(s)

9278

Crushing injury of multiple sites of upper limb

9279

Crushing injury of unspecified site of upper limb

92800

Crushing injury of thigh

92801

Crushing injury of hip

92810

Crushing injury of lower leg

92811

Crushing injury of knee

92820

Crushing injury of foot

92821

Crushing injury of ankle

9283

Crushing injury of toe(s)

9288

Crushing injury of multiple sites of lower limb

9289

Crushing injury of unspecified site of lower limb

9290

Crushing injury of multiple sites, not elsewhere classified

9299

Crushing injury of unspecified site

9400

Chemical burn of eyelids and periocular area

9401

Other burns of eyelids and periocular area

9402

Alkaline chemical burn of cornea and conjunctival sac

9403

Acid chemical burn of cornea and conjunctival sac

9404

Other burn of cornea and conjunctival sac

9405

Burn with resulting rupture and destruction of eyeball

9409

Unspecified burn of eye and adnexa

94100

Burn of unspecified degree of unspecified site of face and head

94102

Burn of unspecified degree of eye (with other parts of face, head, and neck)

94103

Burn of unspecified degree of lip(s)

94105

Burn of unspecified degree of nose (septum)

94106

Burn of unspecified degree of scalp (any part)

94107

Burn of unspecified degree of forehead and cheek

94108

Burn of unspecified degree of neck

94109

Burn of unspecified degree of multiple sites (except with eye) of face, head, and neck

94110

Erythema due to burn (first degree) of unspecified site of face and head

94111

Erythema due to burn (first degree) of ear (any part)

94112

Erythema due to burn (first degree) of eye (with other parts face, head, and neck)

94113

Erythema due to burn (first degree) of lip(s)

94114

Erythema due to burn (first degree) of chin

94115

Erythema due to burn (first degree) of nose (septum)

94116

Erythema due to burn (first degree) of scalp (any part)

94117

Erythema due to burn (first degree) of forehead and cheek

94118

Erythema due to burn (first degree) of neck

94119

Erythema due to burn (first degree) of multiple sites (except with eye) of face, head, and neck

94120

Blisters, with epidermal loss due to burn (second degree) of face and head, unspecified site

94121

Blisters, with epidermal loss due to burn (second degree) of ear (any part)

94122

Blisters, with epidermal loss due to burn (second degree) of eye (with other parts of face, head, and neck)

94123

Blisters, with epidermal loss due to burn (second degree) of lip(s)

94124

Blisters, with epidermal loss due to burn (second degree) of chin

94125

Blisters, with epidermal loss due to burn (second degree) of nose (septum)

94126

Blisters, with epidermal loss due to burn (second degree) of scalp (any part)

94127

Blisters, with epidermal loss due to burn (second degree) of forehead and cheek

94128

Blisters, with epidermal loss due to burn (second degree) of neck

94129

Blisters, with epidermal loss due to burn (second degree) of multiple sites (except with eye) of face, head, and neck

94130

Full-thickness skin loss due to burn (third degree NOS) of unspecified site of face and head

94131

Full-thickness skin loss due to burn (third degree NOS) of ear (any part)

94132

Full-thickness skin loss due to burn (third degree NOS) of eye (with other parts of face, head, and neck)

94133

Full-thickness skin loss due to burn (third degree NOS) of lip(s)

94134

Full-thickness skin loss due to burn (third degree NOS) of chin

94135

Full-thickness skin loss due to burn (third degree NOS) of nose (septum)

94136

Full-thickness skin loss due to burn (third degree NOS) of scalp (any part)

94137

Full-thickness skin loss due to burn (third degree NOS) of forehead and cheek

94138

Full-thickness skin loss due to burn (third degree NOS) of neck

94139

Full-thickness skin loss due to burn (third degree NOS) of multiple sites (except with eye) of face, head, and neck

94140

Deep necrosis of underlying tissues due to burn (deep third degree) of unspecified site of face and head, without mention of loss of a body part

94141

Deep necrosis of underlying tissues due to burn (deep third degree) of ear (any part), without mention of loss of a body part

94142

Deep necrosis of underlying tissues due to burn (deep third degree) of eye (with other parts of face, head, and neck), without mention of loss of a body part

94143

Deep necrosis of underlying tissues due to burn (deep third degree) of lip(s), without mention of loss of a body part

94144

Deep necrosis of underlying tissues due to burn (deep third degree) of chin, without mention of loss of a body part

94145

Deep necrosis of underlying tissues due to burn (deep third degree) of nose (septum), without mention of loss of a body part

94146

Deep necrosis of underlying tissues due to burn (deep third degree) of scalp (any part), without mention of loss of a body part

94147

Deep necrosis of underlying tissues due to burn (deep third degree) of forehead and cheek, without mention of loss of a body part

94148

Deep necrosis of underlying tissues due to burn (deep third degree) of neck, without mention of loss of a body part

94149

Deep necrosis of underlying tissues due to burn (deep third degree) of multiple sites (except with eye) of face, head, and neck, without mention of loss of a body part

94150

Deep necrosis of underlying tissues due to burn (deep third degree) of face and head, unspecified site, with loss of a body part

94151

Deep necrosis of underlying tissues due to burn (deep third degree) of ear (any part), with loss of a body part

94152

Deep necrosis of underlying tissues due to burn (deep third degree) of eye (with other parts of face, head, and neck), with loss of a body part

94153

Deep necrosis of underlying tissues due to burn (deep third degree) of lip(s), with loss of a body part

94154

Deep necrosis of underlying tissues due to burn (deep third degree) of chin, with loss of a body part

94155

Deep necrosis of underlying tissues due to burn (deep third degree) of nose (septum), with loss of a body part

94156

Deep necrosis of underlying tissues due to burn (deep third degree) of scalp (any part), with loss of a body part

94157

Deep necrosis of underlying tissues due to burn (deep third degree) of forehead and cheek, with loss of a body part

94158

Deep necrosis of underlying tissues due to burn (deep third degree) of neck, with loss of a body part

94159

Deep necrosis of underlying tissues due to burn (deep third degree) of multiple sites (except eye) of face, head, and neck, with loss of a body part

94200

Burn of unspecified degree of trunk, unspecified site

94201

Burn of trunk, unspecified degree of breast

94202

Burn of trunk, unspecified degree of chest wall, excluding breast and nipple

94203

Burn of trunk, unspecified degree of abdominal wall

94204

Burn of trunk, unspecified degree of back (any part)

94205

Burn of trunk, unspecified degree of genitalia

94209

Burn of trunk, unspecified degree of other and multiple sites

94210

Erythema due to burn (first degree) of unspecified site of trunk

94211

Erythema due to burn (first degree) of breast

94212

Erythema due to burn (first degree) of chest wall, excluding breast and nipple

94213

Erythema due to burn (first degree) of abdominal wall

94214

Erythema due to burn (first degree) of back (any part)

94215

Erythema due to burn (first degree) of genitalia

94219

Erythema due to burn (first degree) of other and multiple sites of trunk

94220

Blisters with epidermal loss due to burn (second degree) of unspecified site of trunk

94221

Blisters with epidermal loss due to burn (second degree) of breast

94222

Blisters with epidermal loss due to burn (second degree) of chest wall, excluding breast and nipple

94223

Blisters with epidermal loss due to burn (second degree) of abdominal wall

94224

Blisters with epidermal loss due to burn (second degree) of back (any part)

94225

Blisters with epidermal loss due to burn (second degree) of genitalia

94229

Blisters with epidermal loss due to burn (second degree) of other and multiple sites of trunk

94230

Full-thickness skin loss due to burn (third degree NOS) of unspecified site of trunk

94231

Full-thickness skin loss due to burn (third degree NOS) of breast

94232

Full-thickness skin loss due to burn (third degree NOS) of chest wall, excluding breast and nipple

94233

Full-thickness skin loss due to burn (third degree NOS) of abdominal wall

94234

Full-thickness skin loss due to burn (third degree NOS) of back (any part)

94235

Full-thickness skin loss due to burn (third degree NOS) of genitalia

94239

Full-thickness skin loss due to burn (third degree NOS) of other and multiple sites of trunk

94240

Deep necrosis of underlying tissues due to burn (deep third degree) of trunk, unspecified site, without mention of loss of a body part

94241

Deep necrosis of underlying tissues due to burn (deep third degree) of breast, without mention of loss of a body part

94242

Deep necrosis of underlying tissues due to burn (deep third degree) of chest wall, excluding breast and nipple, without mention of loss of a body part

94243

Deep necrosis of underlying tissues due to burn (deep third degree) of abdominal wall, without mention of loss of a body part

94244

Deep necrosis of underlying tissues due to burn (deep third degree) of back (any part), without mention of loss of a body part

94245

Deep necrosis of underlying tissues due to burn (deep third degree) of genitalia, without mention of loss of a body part

94249

Deep necrosis of underlying tissues due to burn (deep third degree) of other and multiple sites of trunk, without mention of loss of a body part

94250

Deep necrosis of underlying tissues due to burn (deep third degree) of unspecified site of trunk, with loss of a body part

94251

Deep necrosis of underlying tissues due to burn (deep third degree) of breast, with loss of a body part

94252

Deep necrosis of underlying tissues due to burn (deep third degree) of chest wall, excluding breast and nipple, with loss of a body part

94253

Deep necrosis of underlying tissues due to burn (deep third degree) of abdominal wall with loss of a body part

94254

Deep necrosis of underlying tissues due to burn (deep third degree) of back (any part), with loss of a body part

94255

Deep necrosis of underlying tissues due to burn (deep third degree) of genitalia, with loss of a body part

94259

Deep necrosis of underlying tissues due to burn (deep third degree) of other and multiple sites of trunk, with loss of a body part

94300

Burn of unspecified degree of unspecified site of upper limb

94301

Burn of unspecified degree of forearm

94302

Burn of unspecified degree of elbow

94303

Burn of unspecified degree of upper arm

94304

Burn of unspecified degree of axilla

94305

Burn of unspecified degree of shoulder

94306

Burn of unspecified degree of scapular region

94309

Burn of unspecified degree multiple sites of upper limb, except wrist and hand

94310

Erythema due to burn (first degree) of unspecified site of upper limb

94311

Erythema due to burn (first degree) of forearm

94312

Erythema due to burn (first degree) of elbow

94313

Erythema due to burn (first degree) of upper arm

94314

Erythema due to burn (first degree) of axilla

94315

Erythema due to burn (first degree) of shoulder

94316

Erythema due to burn (first degree) of scapular region

94319

Erythema due to burn (first degree) of multiple sites of upper limb, except wrist and hand

94320

Blisters with epidermal loss due to burn (second degree) of unspecified site of upper limb

94321

Blisters with epidermal loss due to burn (second degree) of forearm

94322

Blisters with epidermal loss due to burn (second degree) of elbow

94323

Blisters with epidermal loss due to burn (second degree) of upper arm

94324

Blisters with epidermal loss due to burn (second degree) of axilla

94325

Blisters with epidermal loss due to burn (second degree) of shoulder

94326

Blisters with epidermal loss due to burn (second degree) of scapular region

94329

Blisters with epidermal loss due to burn (second degree) of multiple sites of upper limb, except wrist and hand

94330

Full-thickness skin loss due to burn (third degree NOS) of unspecified site of upper limb

94331

Full-thickness skin loss due to burn (third degree NOS) of forearm

94332

Full-thickness skin loss due to burn (third degree NOS) of elbow

94333

Full-thickness skin loss due to burn (third degree NOS) of upper arm

94334

Full-thickness skin loss due to burn (third degree NOS) of axilla

94335

Full-thickness skin loss due to burn (third degree NOS) of shoulder

94336

Full-thickness skin loss due to burn (third degree NOS) of scapular region

94339

Full-thickness skin loss due to burn (third degree NOS) of multiple sites of upper limb, except wrist and hand

94340

Deep necrosis of underlying tissues due to burn (deep third degree) of unspecified site of upper limb, without mention of loss of a body part

94341

Deep necrosis of underlying tissues due to burn (deep third degree) of forearm, without mention of loss of a body part

94342

Deep necrosis of underlying tissues due to burn (deep third degree) of elbow, without mention of loss of a body part

94343

Deep necrosis of underlying tissues due to burn (deep third degree) of upper arm, without mention of loss of a body part

94344

Deep necrosis of underlying tissues due to burn of axilla, without mention of loss of a body part

94345

Deep necrosis of underlying tissues due to burn (deep third degree) of shoulder, without mention of loss of a body part

94346

Deep necrosis of underlying tissues due to burn (deep third degree) of scapular region, without mention of loss of a body part

94349

Deep necrosis of underlying tissues due to burn (deep third degree) of multiple sites of upper limb, except wrist and hand, without mention of loss of a body part

94350

Deep necrosis of underlying tissues due to burn (deep third degree) of unspecified site of upper limb, with loss of a body part

94351

Deep necrosis of underlying tissues due to burn (deep third degree) of forearm, with loss of a body part

94352

Deep necrosis of underlying tissues due to burn (deep third degree) of elbow, with loss of a body part

94353

Deep necrosis of underlying tissues due to burn (deep third degree) of upper arm, with loss of upper arm

94354

Deep necrosis of underlying tissues due to burn (deep third degree) of axilla, with loss of a body part

94355

Deep necrosis of underlying tissues due to burn (deep third degree) of shoulder, with loss of a body part

94356

Deep necrosis of underlying tissues due to burn (deep third degree) of scapular region, with loss of a body part

94359

Deep necrosis of underlying tissues due to burn (deep third degree) of multiple sites of upper limb, except wrist and hand, with loss of a body part

94400

Burn of unspecified degree of unspecified site of hand

94401

Burn of unspecified degree of single digit (finger [nail]) other than thumb

94402

Burn of unspecified degree of thumb (nail)

94403

Burn of unspecified degree of two or more digits of hand, not including thumb

94404

Burn of unspecified degree of two or more digits of hand, including thumb

94405

Burn of unspecified degree of palm of hand

94406

Burn of unspecified degree of back of hand

94407

Burn of unspecified degree of wrist

94408

Burn of unspecified degree of multiple sites of wrist(s) and hand(s)

94410

Erythema due to burn (first degree) of unspecified site of hand

94411

Erythema due to burn (first degree) of single digit (finger [nail]) other than thumb

94412

Erythema due to burn (first degree) of thumb (nail)

94413

Erythema due to burn (first degree) of two or more digits of hand, not including thumb

94414

Erythema due to burn (first degree) of two or more digits of hand including thumb

94415

Erythema due to burn (first degree) of palm of hand

94416

Erythema due to burn (first degree) of back of hand

94417

Erythema due to burn (first degree) of wrist

94418

Erythema due to burn (first degree) of multiple sites of wrist(s) and hand(s)

94420

Blisters with epidermal loss due to burn (second degree) of unspecified site of hand

94421

Blisters with epidermal loss due to burn (second degree) of single digit (finger [nail]) other than thumb

94422

Blisters with epidermal loss due to burn (second degree) of thumb (nail)

94423

Blisters with epidermal loss due to burn (second degree) of two or more digits of hand, not including thumb

94424

Blisters with epidermal loss due to burn (second degree) of two or more digits of hand including thumb

94425

Blisters with epidermal loss due to burn (second degree) of palm of hand

94426

Blisters with epidermal loss due to burn (second degree) of back of hand

94427

Blisters with epidermal loss due to burn (second degree) of wrist

94428

Blisters with epidermal loss due to burn (second degree) of multiple sites of wrist(s) and hand(s)

94430

Full-thickness skin loss due to burn (third degree NOS) of unspecified site of hand

94431

Full-thickness skin loss due to burn (third degree NOS) of single digit (finger [nail]) other than thumb

94432

Full-thickness skin loss due to burn (third degree NOS) of thumb (nail)

94433

Full-thickness skin loss due to burn (third degree NOS) of two or more digits of hand, not including thumb

94434

Full-thickness skin loss due to burn (third degree NOS) of two or more digits of hand including thumb

94435

Full-thickness skin loss due to burn (third degree NOS) of palm of hand

94436

Full-thickness skin loss due to burn (third degree NOS) of back of hand

94437

Full-thickness skin loss due to burn (third degree NOS) of wrist

94438

Full-thickness skin loss due to burn (third degree NOS) of multiple sites of wrist(s) and hand(s)

94500

Burn of unspecified degree of unspecified site of lower limb (leg)

94501

Burn of unspecified degree of toe(s) (nail)

94502

Burn of unspecified degree of foot

94503

Burn of unspecified degree of ankle

94504

Burn of unspecified degree of lower leg

94505

Burn of unspecified degree of knee

94506

Burn of unspecified degree of thigh (any part)

94509

Burn of unspecified degree of multiple sites of lower limb(s)

94510

Erythema due to burn (first degree) of unspecified site of lower limb (leg)

94511

Erythema due to burn (first degree) of toe(s) (nail)

94512

Erythema due to burn (first degree) of foot

94513

Erythema due to burn (first degree) of ankle

94514

Erythema due to burn (first degree) of lower leg

94515

Erythema due to burn (first degree) of knee

94516

Erythema due to burn (first degree) of thigh (any part)

94519

Erythema due to burn (first degree) of multiple sites of lower limb(s)

94520

Blisters, epidermal loss (second degree) of unspecified site of lower limb (leg)

94521

Blisters with epidermal loss due to burn (second degree) of toe(s) (nail)

94522

Blisters with epidermal loss due to burn (second degree) of foot

94523

Blisters with epidermal loss due to burn (second degree) of ankle

94524

Blisters with epidermal loss due to burn (second degree) of lower leg

94525

Blisters with epidermal loss due to burn (second degree) of knee

94526

Blisters with epidermal loss due to burn (second degree) of thigh (any part)

94529

Blisters with epidermal loss due to burn (second degree) of multiple sites of lower limb(s)

94530

Full-thickness skin loss due to burn (third degree NOS) of unspecified site of lower limb

94531

Full-thickness skin loss due to burn (third degree NOS) of toe(s) (nail)

94532

Full-thickness skin loss due to burn (third degree NOS) of foot

94533

Full-thickness skin loss due to burn (third degree NOS) of ankle

94534

Full-thickness skin loss due to burn (third degree NOS) of lower leg

94535

Full-thickness skin loss due to burn (third degree NOS) of knee

94536

Full-thickness skin loss due to burn (third degree NOS) of thigh (any part)

94539

Full-thickness skin loss due to burn (third degree NOS) of multiple sites of lower limb(s)

94540

Deep necrosis of underlying tissues due to burn (deep third degree) of unspecified site of lower limb (leg), without mention of loss of a body part

94541

Deep necrosis of underlying tissues due to burn (deep third degree) of toe(s) (nail), without mention of loss of a body part

94542

Deep necrosis of underlying tissues due to burn (deep third degree) of foot, without mention of loss of a body part

94543

Deep necrosis of underlying tissues due to burn (deep third degree) of ankle, without mention of loss of a body part

94544

Deep necrosis of underlying tissues due to burn (deep third degree) of lower leg, without mention of loss of a body part

94545

Deep necrosis of underlying tissues due to burn (deep third degree) of knee, without mention of loss of a body part

94546

Deep necrosis of underlying tissues due to burn (deep third degree) of thigh (any part), without mention of a body part

94549

Deep necrosis of underlying tissues due to burn (deep third degree) of multiple sites of lower limb(s), without mention of loss of a body part

94550

Deep necrosis of underlying tissues due to burn (deep third degree) of unspecified site lower limb (leg), with loss of a body part

94551

Deep necrosis of underlying tissues due to burn (deep third degree) of toe(s) (nail), with loss of a body part

94552

Deep necrosis of underlying tissues due to burn (deep third degree) of foot, with loss of a body part

94553

Deep necrosis of underlying tissues due to burn (deep third degree) of ankle, with loss of a body part

94554

Deep necrosis of underlying tissues due to burn (deep third degree) of lower leg, with loss of a body part

94555

Deep necrosis of underlying tissues due to burn (deep third degree) of knee, with loss of a body part

94556

Deep necrosis of underlying tissues due to burn (deep third degree) of thigh (any part), with loss of a body part

94559

Deep necrosis of underlying tissues due to burn (deep third degree) of multiple sites of lower limb(s), with loss of a body part

9460

Burns of multiple specified sites, unspecified degree

9461

Erythema due to burn (first degree) of multiple specified sites

9462

Blisters with epidermal loss due to burn (second degree) of multiple specified sites

9463

Full-thickness skin loss due to burn (third degree NOS) of multiple specified sites

9464

Deep necrosis of underlying tissues due to burn (deep third degree) of multiple specified sites, without mention of loss of a body part

9465

Deep necrosis of underlying tissues due to burn (deep third degree) of multiple specified sites, with loss of a body part

9470

Burn of mouth and pharynx

9471

Burn of larynx, trachea, and lung

9472

Burn of esophagus

9473

Burn of gastrointestinal tract

9474

Burn of vagina and uterus

9478

Burn of other specified sites of internal organs

9479

Burn of internal organs, unspecified site

94800

Burn (any degree) involving less than 10% of body surface with third degree burn of less than 10% or unspecified amount

94810

Burn (any degree) involving 10-19% of body surface with third degree burn of less than 10% or unspecified amount

94811

Burn (any degree) involving 10-19% of body surface with third degree burn of 10-19%

94820

Burn (any degree) involving 20-29% of body surface with third degree burn of less than 10% or unspecified amount

94821

Burn (any degree) involving 20-29% of body surface with third degree burn of 10-19%

94822

Burn (any degree) involving 20-29% of body surface with third degree burn of 20-29%

94830

Burn (any degree) involving 30-39% of body surface with third degree burn of less than 10% or unspecified amount

94831

Burn (any degree) involving 30-39% of body surface with third degree burn of 10-19%

94832

Burn (any degree) involving 30-39% of body surface with third degree burn of 20-29%

94833

Burn (any degree) involving 30-39% of body surface with third degree burn of 30-39%

94840

Burn (any degree) involving 40-49% of body surface with third degree burn of less than 10% or unspecified amount

94841

Burn (any degree) involving 40-49% of body surface with third degree burn of 10-19%

94842

Burn (any degree) involving 40-49% of body surface with third degree burn of 20-29%

94843

Burn (any degree) involving 40-49% of body surface with third degree burn of 30-39%

94844

Burn (any degree) involving 40-49% of body surface with third degree burn of 40-49%

94850

Burn (any degree) involving 50-59% of body surface with third degree burn of less than 10% or unspecified amount

94851

Burn (any degree) involving 50-59% of body surface with third degree burn of 10-19%

94852

Burn (any degree) involving 50-59% of body surface with third degree burn of 20-29%

94853

Burn (any degree) involving 50-59% of body surface with third degree burn of 30-39%

94854

Burn (any degree) involving 50-59% of body surface with third degree burn of 40-49%

94855

Burn (any degree) involving 50-59% of body surface with third degree burn of 50-59%

94860

Burn (any degree) involving 60-69% of body surface with third degree burn of less than 10% or unspecified amount

94861

Burn (any degree) involving 60-69% of body surface with third degree burn of 10-19%

94862

Burn (any degree) involving 60-69% of body surface with third degree burn of 20-29%

94863

Burn (any degree) involving 60-69% of body surface with third degree burn of 30-39%

94864

Burn (any degree) involving 60-69% of body surface with third degree burn of 40-49%

94865

Burn (any degree) involving 60-69% of body surface with third degree burn of 50-59%

94866

Burn (any degree) involving 60-69% of body surface with third degree burn of 60-69%

94870

Burn (any degree) involving 70-79% of body surface with third degree burn of less than 10% or unspecified amount

94871

Burn (any degree) involving 70-79% of body surface with third degree burn of 10-19%

94872

Burn (any degree) involving 70-79% of body surface with third degree burn of 20-29%

94873

Burn (any degree) involving 70-79% of body surface with third degree burn of 30-39%

94874

Burn (any degree) involving 70-79% of body surface with third degree burn of 40-49%

94875

Burn (any degree) involving 70-79% of body surface with third degree burn of 50-59%

94876

Burn (any degree) involving 70-79% of body surface with third degree burn of 60-69%

94877

Burn (any degree) involving 70-79% of body surface with third degree burn of 70-79%

94880

Burn (any degree) involving 80-89% of body surface with third degree burn of less than 10% or unspecified amount

94881

Burn (any degree) involving 80-89% of body surface with third degree burn of 10-19%

94882

Burn (any degree) involving 80-89% of body surface with third degree burn of 20-29%

94883

Burn (any degree) involving 80-89% of body surface with third degree burn of 30-39%

94884

Burn (any degree) involving 80-89% of body surface with third degree burn of 40-49%

94885

Burn (any degree) involving 80-89% of body surface with third degree burn of 50-59%

94886

Burn (any degree) involving 80-89% of body surface with third degree burn of 60-69%

94887

Burn (any degree) involving 80-89% of body surface with third degree burn of 70-79%

94888

Burn (any degree) involving 80-89% of body surface with third degree burn of 80-89%

94890

Burn (any degree) involving 90% or more of body surface with third degree burn of less than 10% or unspecified amount

94891

Burn (any degree) involving 90% or more of body surface with third degree burn of 10-19%

94892

Burn (any degree) involving 90% or more of body surface with third degree burn of 20-29%

94893

Burn (any degree) involving 90% or more of body surface with third degree burn of 30-39%

94894

Burn (any degree) involving 90% or more of body surface with third degree burn of 40-49%

94895

Burn (any degree) involving 90% or more of body surface with third degree burn of 50-59%

94896

Burn (any degree) involving 90% or more of body surface with third degree burn of 60-69%

94897

Burn (any degree) involving 90% or more of body surface with third degree burn of 70-79%

94898

Burn (any degree) involving 90% or more of body surface with third degree burn of 80-89%

94899

Burn (any degree) involving 90% or more of body surface with third degree burn of 90% or more of body surface

9490

Burn of unspecified site, unspecified degree

9491

Erythema due to burn (first degree), unspecified site

9492

Blisters with epidermal loss due to burn (second degree), unspecified site

9493

Full-thickness skin loss due to burn (third degree NOS), unspecified site

9494

Deep necrosis of underlying tissue due to burn (deep third degree), unspecified site without mention of loss of a body part

9495

Deep necrosis of underlying tissues due to burn (deep third degree, unspecified site with loss of a body part

9580

Air embolism as an early complication of trauma

9584

Traumatic shock

986

Toxic effect of carbon monoxide

9895

Toxic effect of venom

990

Effects of radiation unspecified

9933

Caisson disease

99652

Mechanical complication due to graft of other tissue, not elsewhere classified

99660

Infection and inflammatory reaction due to unspecified device, implant, and graft

99661

Infection and inflammatory reaction due to cardiac device, implant, and graft

99662

Infection and inflammatory reaction due to other vascular device, implant, graft

99663

Infection and inflammatory reaction due to nervous system device, implant, graft

99664

Infection and inflammatory reaction due to indwelling urinary catheter

99665

Infection and inflammatory reaction due to other genitourinary device, implant, graft

99666

Infection and inflammatory reaction due to internal joint prosthetics

99667

Infection and inflammatory reaction due to other internal orthopedic devices, implant, and graft

99668

Infection and inflammatory reaction due to peritoneal dialysis catheter

99669

Infection and inflammatory reaction due to other internal prosthetic device, implant, and graft

99670

Other complications due to unspecified device, implant, and graft

99671

Other complications due to heart valve prosthesis

99672

Other complications due to other cardiac device, implant, and graft

99673

Other complications due to renal dialysis device, implant, and graft

99674

Other complications due to other vascular device, implant, and graft

99675

Other complications due to nervous system device, implant, and graft

99676

Other complications due to genitourinary device, implant, and graft

99677

Other complications due to internal joint prosthesis

99678

Other complications due to other internal orthopedic device, implant, and graft

99679

Other complications due to other internal prosthetic device, implant, and graft

99690

Complications of unspecified reattached extremity

99691

Complications of reattached forearm

99692

Complications of reattached hand

99693

Complications of reattached finger(s)

99694

Complications of reattached upper extremity, other and unspecified

99695

Complication of reattached foot and toe(s)

99696

Complication of reattached lower extremity, other and unspecified

99699

Complication of other specified reattached body part

9980

Postoperative shock, not elsewhere classified

99859

Other postoperative infection

9991

Air embolism as complication of medical care, not elsewhere classified

V423

Skin replaced by transplant


Texas Medicaid & Healthcare Partnership
CPT only copyright 2008 American Medical Association. All rights reserved.
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