MEDICALLY NECESSARY
95992, 97012, 97014, 97016, 97018, 97022, 97024, 97028, 97032, 97033, 97034, 97035, 97036, 97110, 97112, 97113, 97116, 97124, 97129, 97130, 97140, 97150, 97161, 97162, 97163, 97164, 97165, 97166, 97167, 97168, 97530, 97533, 97535, 97537, 97542, 97750, 97755, 97760, 97761, 97763
THE FOLLOWING UNLISTED CODES SHOULD BE USED ONLY WHEN THERE IS NO APPROPRIATE CODE AVAILABLE:
97039, 97139, 97799
BENEFIT EXCLUSION
97169, 97170, 97171, 97172, 97545, 97546
EXPERIMENTAL/INVESTIGATIONAL
97026, 97037
THE FOLLOWING CODE IS USED TO REPRESENT DRY HYDROTHERAPY (e.g. AquaMED, Sidmar)
THE FOLLOWING SERVICE IS NOT ELIGIBLE FOR SEPARATE REIMBURSEMENT:
97010