REVENUE CODE LIST-CPT-HCPCS - Cigna

REVENUE CODE LIST-CPT-HCPCS

For Providers

Effective March 15, 2020

Revenue Code 240 260 261 262

263

264 269

274

280 290 291 292 294 299 300 301 302 303 304 305 306 307 308 309 310 311 312 313 314 315 316 317 318

Description All inclusive ancillary, general Intravenous (IV) therapy Intravenous (IV) therapy, infusion pump Intravenous (IV) therapy, pharmacy services Intravenous (IV) therapeutic drug, supply and delivery Intravenous (IV) therapy, supplies Intravenous (IV) therapy, other Medical/surgical supplies and devices, prosthetic/orthotic devices Oncology Durable medical equipment, general Durable medical equipment, rental Durable medical equipment, purchase of new Durable medical equipment, supplies and drugs Durable medical equipment, other Laboratory, general classification Laboratory, chemistry Laboratory, immunology Laboratory, renal patient (home) Laboratory, dialysis Laboratory, hematology Laboratory, bacteriology and microbiology Laboratory, urology Reserved laboratory Laboratory, other Laboratory, pathology general classification Laboratory pathology cytology Laboratory pathology histology Reserved laboratory pathology Laboratory, pathology biopsy Reserved laboratory, pathology Reserved laboratory, pathology Reserved laboratory, pathology Reserved laboratory, pathology

All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation, including Cigna Health and Life Insurance Company, Connecticut General Life Insurance Company, Cigna Behavioral Health, Inc., and HMO or service company subsidiaries of Cigna Health Corporation. The Cigna name, logo, and other Cigna marks are owned by Cigna Intellectual Property, Inc.

PCOMM-2020-036. ? 2020 Cigna. Some content provided under license.

319

Laboratory, pathology other

320

Radiology, diagnostic general classification

321

Radiology, diagnostic angiocardiology

322

Radiology, diagnostic arthrography

323

Radiology, diagnostic arteriography

324

Radiology, diagnostic chest X-ray

325

Reserved radiology, diagnostic

326

Reserved radiology, diagnostic

327

Reserved radiology, diagnostic

328

Reserved radiology, diagnostic

329

Radiology, diagnostic other

330

Radiology, therapeutic chemotherapy general

classification

Radiology, therapeutic chemotherapy, chemotherapy

331

administration ? injected

Radiology, therapeutic chemotherapy, chemotherapy

332

administration ? oral

333

Radiology, therapeutic chemotherapy, radiation therapy

334

Reserved radiology, therapeutic chemotherapy

Radiology, therapeutic chemotherapy, administration

335

? intravenous (IV)

336

Reserved radiology, therapeutic chemotherapy

337

Reserved radiology, therapeutic chemotherapy

338

Reserved radiology, therapeutic chemotherapy

339

Radiology, therapeutic chemotherapy other

340

Nuclear medicine, general classification

341

Nuclear medicine, diagnostic

342

Nuclear medicine, therapeutic

343

Nuclear medicine, diagnostic radiopharmaceuticals

344

Nuclear medicine, therapeutic radiopharmaceuticals

349

Nuclear medicine, other

350

Computerized axial tomography (CAT) scan, general

351

Computerized axial tomography (CAT) scan, head scan

352

Computerized axial tomography (CAT) scan, body scan

353

Reserved computerized axial tomography (CAT) scan

354

Reserved computerized axial tomography (CAT)

scan

355

Reserved computerized axial tomography (CAT)

scan

356

Reserved computerized axial tomography (CAT)

scan

357

Reserved computerized axial tomography (CAT)

scan

358

Reserved computerized axial tomography (CAT)

scan

All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation, including Cigna Health and Life Insurance Company, Connecticut General Life Insurance Company, Cigna Behavioral Health, Inc., and HMO or service company subsidiaries of Cigna Health Corporation. The Cigna name, logo, and other Cigna marks are owned by Cigna Intellectual Property, Inc.

PCOMM-2020-036. ? 2020 Cigna. Some content provided under license.

359

Computerized axial tomography (CAT) scan, other

360

Operating room services, general

361

Operating room services, minor surgery

362

Operating services, organ transplant other than

kidney

363

Reserved operating room services

364

Reserved operating room services

365

Reserved operating room services

366

Reserved operating room services

367

Operating room services, kidney transplant

368

Reserved operating room services

369

Operating room services

380

Blood and blood products, general

381

Blood and blood products, packed red cells

382

Blood and blood products, whole blood products

383

Blood and blood products, plasma

384

Blood and blood products, platelets

385

Blood and blood products, leukocytes

386

Blood and blood products, other components

387

Blood and blood products, other derivatives

(cryoprecipitate)

388

Blood and blood products, reserved components

389

Blood and blood products, other

390

Blood administration process, storage general

391

Blood administration process, storage

administration

399

Blood, other storage

400

Imaging services, general

401

Imaging services, diagnostic mammography

402

Imaging services, ultrasound

403

Imaging services, screening mammography

404

Imaging services, positron emission tomography

405

Reserved imaging services

406

Reserved imaging services

407

Reserved imaging services

408

Reserved imaging services

409

Imaging services, other

410

Respiratory services, general

411

Reserved respiratory services

412

Respiratory services, inhalation

413

Respiratory services, hyperbaric oxygen therapy

414

Reserved respiratory services

415

Reserved respiratory services

416

Reserved respiratory services

417

Reserved respiratory services

All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation, including Cigna Health and Life Insurance Company, Connecticut General Life Insurance Company, Cigna Behavioral Health, Inc., and HMO or service company subsidiaries of Cigna Health Corporation. The Cigna name, logo, and other Cigna marks are owned by Cigna Intellectual Property, Inc.

PCOMM-2020-036. ? 2020 Cigna. Some content provided under license.

418

Reserved respiratory services

419

Respiratory services, other

420

Physical therapy, general

421

Physical therapy, visit

422

Physical therapy, hourly

423

Physical therapy, group

424

Physical therapy, evaluation or reevaluation

425

Reserved physical therapy

426

Reserved physical therapy

427

Reserved physical therapy

428

Reserved physical therapy

429

Physical therapy, other

430

Occupational therapy, general

431

Occupational therapy, visit

432

Occupational therapy, hourly

433

Occupational therapy, group

434

Occupational therapy, evaluation or reevaluation

435

Reserved occupational therapy

436

Reserved occupational therapy

437

Reserved occupational therapy

438

Reserved occupational therapy

439

Occupational therapy, other

440

Speech therapy, general

441

Speech therapy, visit

442

Speech therapy, hourly

443

Speech therapy, group

444

Speech therapy, evaluation or reevaluation

445

Reserved speech therapy

446

Reserved speech therapy

447

Reserved speech therapy

448

Reserved speech therapy

449

Speech therapy, other

450

Emergency room, general

451

Emergency room, EMTALA emergency medical

screening

452

Emergency room, beyond EMTALA screening

453

Reserved emergency room

454

Reserved emergency room

455

Reserved emergency room

456

Emergency room, urgent care

457

Reserved emergency room

458

Reserved emergency room

459

Emergency room, other

460

Pulmonary function, general

All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation, including Cigna Health and Life Insurance Company, Connecticut General Life Insurance Company, Cigna Behavioral Health, Inc., and HMO or service company subsidiaries of Cigna Health Corporation. The Cigna name, logo, and other Cigna marks are owned by Cigna Intellectual Property, Inc.

PCOMM-2020-036. ? 2020 Cigna. Some content provided under license.

461

Reserved pulmonary function

462

Reserved pulmonary function

463

Reserved pulmonary function

464

Reserved pulmonary function

465

Reserved pulmonary function

466

Reserved pulmonary function

467

Reserved pulmonary function

468

Reserved pulmonary function

469

Pulmonary function, other

470

Audiology, general

471

Audiology, diagnostic

472

Audiology, treatment

473

Reserved audiology

474

Reserved audiology

475

Reserved audiology

476

Reserved audiology

477

Reserved audiology

478

Reserved audiology

479

Audiology, other

480

Cardiology, general

481

Cardiology, cardiac catheterization laboratory

482

Cardiology, stress test

483

Cardiology, echocardiology

484

Reserved cardiology

485

Reserved cardiology

486

Reserved cardiology

487

Reserved cardiology

488

Reserved cardiology

489

Cardiology, other

490

Ambulatory surgery

499

Other, ambulatory surgery

500

Outpatient services

510

Clinic, other

511

Clinic, chronic pain center

512

Clinic, dental

513

Clinic, psychiatric

514

Clinic, obstetrics/gynecology (OB/GYN)

515

Clinic, pediatric

516

Clinic, urgent care

517

Clinic, family practice

518

Reserved clinic

519

Clinic, other

521

Rural clinic

526

Urgent care clinic

All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation, including Cigna Health and Life Insurance Company, Connecticut General Life Insurance Company, Cigna Behavioral Health, Inc., and HMO or service company subsidiaries of Cigna Health Corporation. The Cigna name, logo, and other Cigna marks are owned by Cigna Intellectual Property, Inc.

PCOMM-2020-036. ? 2020 Cigna. Some content provided under license.

529

Other

530

Osteopathic services, general

531

Osteopathic services, therapy

532

Reserved osteopathic services

533

Reserved osteopathic services

534

Reserved osteopathic services

535

Reserved osteopathic services

536

Reserved osteopathic services

537

Reserved osteopathic services

538

Reserved osteopathic services

539

Osteopathic services, other

540

Ambulance, general

541

Ambulance, supplies

542

Ambulance, medical transport

543

Ambulance, heart mobile

544

Ambulance, oxygen

545

Ambulance, air

546

Ambulance, neonatal services

547

Ambulance, pharmacy

548

Ambulance, electrocardiogram (EKG) transmission

549

Ambulance, other

550

Skilled nursing

551

Skilled nursing, visit

561

Home health medical, social services, general

571

Aide/home health visit

601

Home health, oxygen, general

610

Magnetic resonance technology, general

611

Magnetic resonance technology, brain/brain stem

612

Magnetic resonance technology, spinal cord/spine

613

Magnetic resonance technology reserved

614

Magnetic resonance technology, other magnetic

resonance imaging (MRI)

615

Magnetic resonance technology, head and neck

616

Magnetic resonance technology, lower extremities

617

Magnetic resonance technology reserved

618

Magnetic resonance technology, other

619

Magnetic resonance technology, other

621

Medical surgical supplies incidentals, radiology

622

Medical surgical supplies incidental to other

diagnostic services

624

U.S. Food and Drug Administration (FDA)

investigational devices

631

Drug, single

632

Drug, multi

634

Pharmacy, extension of 025X erythropoietin (EPO)

less than 10,000 units

All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation, including Cigna Health and Life Insurance Company, Connecticut General Life Insurance Company, Cigna Behavioral Health, Inc., and HMO or service company subsidiaries of Cigna Health Corporation. The Cigna name, logo, and other Cigna marks are owned by Cigna Intellectual Property, Inc.

PCOMM-2020-036. ? 2020 Cigna. Some content provided under license.

635

Pharmacy extension of 025X erythropoietin (EPO)

10,000 or more units

636

Pharmacy 025x extension drugs requiring detailed

coding

650

Hospice

651

Hospice, routine home care

652

Hospice, continuous home care

656

Hospice, general inpatient care (non-respite)

722

Labor room delivery, delivery room

723

Labor room delivery, circumcision

724

Labor room delivery birthing center

729

Labor room delivery, other

730

Electrocardiogram (EKG), electroencephalogram

(EEG)

731

Electrocardiogram (EKG), electroencephalogram

(EEG), Holter monitor

732

Telemetry

739

Electrocardiogram (EKG), electroencephalogram

(EEG), other

740

Electroencephalogram (EEG), general

741

Reserved electroencephalogram (EEG)

742

Reserved electroencephalogram (EEG)

743

Reserved electroencephalogram (EEG)

744

Reserved electroencephalogram (EEG)

745

Reserved electroencephalogram (EEG)

746

Reserved electroencephalogram (EEG)

747

Reserved electroencephalogram (EEG)

748

Reserved electroencephalogram (EEG)

749

Reserved electroencephalogram (EEG)

750

Gastrointestinal (GI) services general

751

Reserved gastrointestinal (GI) services

752

Reserved gastrointestinal (GI) services

753

Reserved gastrointestinal (GI) services

754

Reserved gastrointestinal (GI) services

755

Reserved gastrointestinal (GI) services

756

Reserved gastrointestinal (GI) services

757

Reserved gastrointestinal (GI) services

758

Reserved gastrointestinal (GI) services

759

Reserved gastrointestinal (GI) services

760

Specialty room, general

761

Specialty room, treatment room

769

Specialty room, other rooms

770

Preventive care services, general

771

Preventive care services, vaccine administration

772

Reserved preventive care services

773

Reserved preventive care services

All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation, including Cigna Health and Life Insurance Company, Connecticut General Life Insurance Company, Cigna Behavioral Health, Inc., and HMO or service company subsidiaries of Cigna Health Corporation. The Cigna name, logo, and other Cigna marks are owned by Cigna Intellectual Property, Inc.

PCOMM-2020-036. ? 2020 Cigna. Some content provided under license.

774

Reserved preventive care services

775

Reserved preventive care services

776

Reserved preventive care services

777

Reserved preventive care services

778

Reserved preventive care services

779

Reserved preventive care services

780

Telemedicine, general

781

Reserved telemedicine

782

Reserved telemedicine

783

Reserved telemedicine

784

Reserved telemedicine

785

Reserved telemedicine

786

Reserved telemedicine

787

Reserved telemedicine

788

Reserved telemedicine

789

Reserved telemedicine

790

Extra-corporeal shock wave therapy, general

791

Reserved extra-corporeal shock wave therapy

792

Reserved extra-corporeal shock wave therapy

793

Reserved extra-corporeal shock wave therapy

794

Reserved extra-corporeal shock wave therapy

795

Reserved extra-corporeal shock wave therapy

796

Reserved extra-corporeal shock wave therapy

797

Reserved extra-corporeal shock wave therapy

798

Reserved extra-corporeal shock wave therapy

799

Reserved extra-corporeal shock wave therapy

811

Acquisition of body components, living donor

812

Acquisition of body components, cadaver donor

813

Acquisition of body components, unknown donor

814

Acquisition of body components unsuccessful organ

search, donor bank charges

819

Other, donor

820

Hemodialysis, outpatient or home general

821

Hemodialysis, composite or other rate

829

Hemodialysis, other

831

Peritoneal dialysis, outpatient or home composite or

other rate

851

Continuous cycling peritoneal dialysis, outpatient or

home composite or other rate

880

Dialysis, miscellaneous

900

Behavioral health treatment services, general

901

Behavioral health treatment services, electroshock

902

Behavioral health treatment services, milieu therapy

903

Behavioral health treatment services, play therapy

904

Behavioral health treatment services, activity

Therapy

All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation, including Cigna Health and Life Insurance Company, Connecticut General Life Insurance Company, Cigna Behavioral Health, Inc., and HMO or service company subsidiaries of Cigna Health Corporation. The Cigna name, logo, and other Cigna marks are owned by Cigna Intellectual Property, Inc.

PCOMM-2020-036. ? 2020 Cigna. Some content provided under license.

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