Procedure
Excision of cyst, fibroadenoma, or other benign or malignant tumor, aberrant bre CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC C Arthroscopy, shoulder, surgical; decompression of subacromial space with partial Arthroscopy, knee, surgical; with meniscectomy (medial OR lateral, including any Collection of venous blood by venipuncture Tonsillectomy and adenoidectomy; younger than age 12 Esophagogastroduodenoscopy, flexible, transoral; diagnostic, including collectio Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple Colonoscopy, flexible; diagnostic, including collection of specimen(s) by brushi Colonoscopy, flexible; with biopsy, single or multiple Colonoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) by Colonoscopy, flexible; with endoscopic ultrasound examination limited to the rec MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMIT CERVICAL SPINAL FUSION WITHOUT CC/MCC Laparoscopy, surgical; cholecystectomy Repair initial inguinal hernia, age 5 years or older; reducible Laparoscopy, surgical prostatectomy, retropubic radical, including nerve sparing Routine obstetric care including antepartum care, vaginal delivery (with or with Routine obstetric care including antepartum care, cesarean delivery, and postpar Routine obstetric care including antepartum care, vaginal delivery (with or with Injection(s), of diagnostic or therapeutic substance(s) (eg, anesthetic, antispa Injection(s), of diagnostic or therapeutic substance(s) (eg, anesthetic, antispa Injection(s), anesthetic agent(s) and/or steroid; transforaminal epidural, with Discission of secondary membranous cataract (opacified posterior lens capsule an Extracapsular cataract removal with insertion of intraocular lens prosthesis (1 Computed tomography, head or brain; without contrast material Magnetic resonance (eg, proton) imaging, brain (including brain stem); without c Magnetic resonance (eg, proton) imaging, brain (including brain stem); without c Radiologic examination, chest; single view Radiologic examination, chest; 2 views Radiologic examination, spine, lumbosacral; minimum of 4 views Magnetic resonance (eg, proton) imaging, spinal canal and contents, lumbar; with Computed tomography, pelvis; with contrast material(s) Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without c Computed tomography, abdomen and pelvis; with contrast material(s) UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITHOUT CC/MCC Ultrasound, abdominal, real time with image documentation; complete Ultrasound, pregnant uterus, real time with image documentation, fetal and mater Ultrasound, transvaginal Diagnostic mammography, including computer-aided detection (CAD) when performed; Diagnostic mammography, including computer-aided detection (CAD) when performed; Screening mammography, bilateral (2-view study of each breast), including comput Basic metabolic panel (Calcium, total) This panel must include the following Cal Comprehensive metabolic panel This panel must include the following Albumin (820 Obstetric panel This panel must include the following Blood count, complete (CBC Lipid panel This panel must include the following Cholesterol, serum, total (824 Renal function panel This panel must include the following Albumin (82040) Calci Hepatic function panel This panel must include the following Albumin (82040) Bil Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, k Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, k Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, k Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, k Hemoglobin; glycosylated (A1C) Prostate specific antigen (PSA); total Prostate specific antigen (PSA); free Thyroid stimulating hormone (TSH) Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count) a Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count) Prothrombin time; Thromboplastin time, partial (PTT); plasma or whole blood Psychotherapy, 30 minutes with patient Psychotherapy, 45 minutes with patient Psychotherapy, 60 minutes with patient Family psychotherapy (without the patient present), 50 minutes Family psychotherapy (conjoint psychotherapy) (with patient present), 50 minutes Group psychotherapy (other than of a multiple-family group) Electrocardiogram, routine ECG with at least 12 leads; with interpretation and r Left heart catheterization including intraprocedural injection(s) for left ventr Polysomnography; age 6 years or older, sleep staging with 4 or more additional p Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises t Therapeutic procedure, 1 or more areas, each 15 minutes; neuromuscular reeducati Manual therapy techniques (eg, mobilization/ manipulation, manual lymphatic drai Therapeutic activities, direct (one-on-one) patient contact (use of dynamic acti Office or other outpatient visit for the evaluation and management of a new pati Office or other outpatient visit for the evaluation and management of a new pati Office or other outpatient visit for the evaluation and management of a new pati Office or other outpatient visit for the evaluation and management of a new pati Office or other outpatient visit for the evaluation and management of an establi Office or other outpatient visit for the evaluation and management of an establi Office or other outpatient visit for the evaluation and management of an establi Office or other outpatient visit for the evaluation and management of an establi Office or other outpatient visit for the evaluation and management of an establi Subsequent hospital inpatient or observation care, per day, for the evaluation a Subsequent hospital inpatient or observation care, per day, for the evaluation a Office or other outpatient consultation for a new or established patient, which Office or other outpatient consultation for a new or established patient, which Emergency department visit for the evaluation and management of a patient, which Emergency department visit for the evaluation and management of a patient, which Emergency department visit for the evaluation and management of a patient, which Emergency department visit for the evaluation and management of a patient, which Initial comprehensive preventive medicine evaluation and management of an indivi Initial comprehensive preventive medicine evaluation and management of an indivi Periodic comprehensive preventive medicine reevaluation and management of an ind Periodic comprehensive preventive medicine reevaluation and management of an ind Colorectal cancer screening; colonoscopy on individual not meeting criteria for Direct skilled nursing services of a registered nurse (RN) in the home health or
Plan
All plans First Choice Health network Moda Health