procedure codes considered as office visits - Tufts Health Plan

To assist providers who treat Tufts Health Plan members covered by the Advantage PPO Option, listed beloware the procedure codes that are considered part of an office visit. If you would like more information about theAdvantage PPO Option, please call 1-800-423-8080.PROCEDURE CODES CONSIDERED AS OFFICE VISITSTOS CODE PROCEDURE CODE PROCEDURE DESCRIPTION026 C0092002 EYE EXAM/NEW PT. INTERMEDIATE026 C0092004 EYE EXAM/NEW PT.COMPREHENSIVE026 C0092012 EYE EXAM/ESTAB. PT INTERMEDICATE026 C0092014 EYE EXAM/ESTAB. PT COMPREHENSIVE026 C0092015 DETERMINATION OF REFRAC. STATE026 C0092310 CONTACT LENSES, FITTING026 C0092311 SPECIAL CONTACT LENS FITTING026 C0092312 CONTACT LENSES, FITTING026 C0092314 CONTACT LENSES, FITTING026 C0092316 CONTACT LENSES, FITTING026 C0092325 CONTACT LENSES, FITTING026 C0092499 UNLISTED OPHTH PROC026 C0099024 POST-OP FOLLOW-UP VISIT026 C0099025 INITIAL SURGICAL EVALUATION026 C0099050 NIGHT CALLS026 C0099052 10PM-8AM SVC WKDAYS/SAT026 C0099054 SUNDAY/HOLIDAY CALLS026 C0099058 OFFICE EMERGENCY CARE026 C0099080 SPECIAL REPORTS026 C0099201 OFFICE OR OTHER OUTPATIENT026 C0099202 OFFICE OR OTHER OUTPATIENT026 C0099203 OFFICE OR OTHER OUTPATIENT026 C0099204 OFFICE OR OTHER OUTPATIENT026 C0099205 OFFICE OR OTHER OUTPATIENT026 C0099211 OFFICE OR OTHER OUTPATIENT026 C0099212 OFFICE OR OTHER OUTPATIENT026 C0099213 OFFICE OR OTHER OUTPATIENT026 C0099214 OFFICE OR OTHER OUTPATIENT026 C0099215 OFFICE OR OTHER OUTPATIENT026 C0099241 OFFICE CONSULTATION026 C0099242 OFFICE CONSULTATION026 C0099243 OFFICE CONSULTATION026 C0099244 OFFICE CONSULTATION026 C0099245 OFFICE CONSULTATIONOffice Visit Procedure Codes 1 of 5

026 C0099271 CONFIRMATORY CONSULTATION026 C0099272 CONFIRMATORY CONSULTATION026 C0099273 CONFIRMATORY CONSULTATION026 C0099274 CONFIRMATORY CONSULTATION026 C0099275 CONFIRMATORY CONSULTATION026 C0099354 PROLONGED SERVICE, OFFICE026 C0099355 PROLONGED PHYS SVC EA ADD 30M026 C0099381 INITIAL COMPREH. PREVENT MEDIC026 C0099382 PREVENTIVE MEDICINE SERVICES026 C0099383 PREVENTIVE MEDICINE SERVICES026 C0099384 PREVENTIVE MEDICINE SERVICES026 C0099385 PREVENTIVE MEDICINE SERVICES026 C0099386 PREVENTIVE MEDICINE SERVICES026 C0099387 PREVENTIVE MEDICINE SERVICES026 C0099391 PERIODIC COMP PREVENTIVE MEDIC026 C0099392 PREVENTIVE MEDICINE SERVICES026 C0099393 PREVENTIVE MEDICINE SERVICES026 C0099394 PREVENTIVE MEDICINE SERVICES026 C0099395 PREVENTIVE MEDICINE SERVICES026 C0099396 PREVENTIVE MEDICINE SERVICES026 C0099397 PREVENTIVE MEDICINE SERVICES026 C0099401 PREVENTIVE MEDICINE SERVICES026 C0099402 PREVENTIVE MEDICINE SERVICES026 C0099403 PREVENTIVE MEDICINE SERVICES026 C0099404 PREVENTIVE MEDICINE SERVICES026 C0099411 PREVENTIVE MEDICINE SERVICES026 C0099412 PREVENTIVE MEDICINE SERVICES026 C00G0101 CERVICAL OR VAGINAL CANCER SCR026 C00V2799 VISION SERVICE, MISCELLANEOUS151 C0092002 EYE EXAM/NEW PT. INTERMEDIATE151 C0092004 EYE EXAM/NEW PT. COMPREHENSIVE151 C0092012 EYE EXAM/ESTAB. PT INTERMEDIATE151 C0092014 EYE EXAM/ESTAB. PT COMPREHENSIVE151 C0099058 OFFICE EMERGENCY CARE151 C0099201 OFFICE OR OTHER OUTPATIENT151 C0099202 OFFICE OR OTHER OUTPATIENT151 C0099203 OFFICE OR OTHER OUTPATIENT151 C0099204 OFFICE OR OTHER OUTPATIENT151 C0099205 OFFICE OR OTHER OUTPATIENT151 C0099211 OFFICE OR OTHER OUTPATIENT151 C0099212 OFFICE OR OTHER OUTPATIENT151 C0099213 OFFICE OR OTHER OUTPATIENT151 C0099214 OFFICE OR OTHER OUTPATIENT151 C0099215 OFFICE OR OTHER OUTPATIENT151 C0099241 OFFICE CONSULTATION151 C0099242 OFFICE CONSULTATION151 C0099243 OFFICE CONSULTATION151 C0099244 OFFICE CONSULTATION151 C0099245 OFFICE CONSULTATION151 C0099354 PROLONGED SERVICE, OFFICE151 C0099355 PROLONGED PHYS SVC EA ADD 30MOffice Visit Procedure Codes 2 of 5

151 C0099356 PROLONGED PHYS SVC , IP, 1ST HR151 C0099381 INITIAL COMPREH. PREVENT MEDIC151 C0099382 PREVENTIVE MEDICINE SERVICES151 C0099383 PREVENTIVE MEDICINE SERVICES151 C0099384 PREVENTIVE MEDICINE SERVICES151 C0099385 PREVENTIVE MEDICINE SERVICES151 C0099386 PREVENTIVE MEDICINE SERVICES151 C0099387 PREVENTIVE MEDICINE SERVICES151 C0099391 PERIODIC COMP PREVENTIVE MEDIC151 C0099392 PREVENTIVE MEDICINE SERVICES151 C0099393 PREVENTIVE MEDICINE SERVICES151 C0099394 PREVENTIVE MEDICINE SERVICES151 C0099395 PREVENTIVE MEDICINE SERVICES151 C0099396 PREVENTIVE MEDICINE SERVICES151 C0099397 PREVENTIVE MEDICINE SERVICES151 C0099401 PREVENTIVE MEDICINE SERVICES151 C0099402 PREVENTIVE MEDICINE SERVICES151 C0099403 PREVENTIVE MEDICINE SERVICES151 C0099404 PREVENTIVE MEDICINE SERVICES151 C00G0101 CERVICAL OR VAGINAL CANCER SCR220 C0090801 PSYCHODIAGNOSTIC CONSULT.220 C0090804 PSYTX, OFFICE (20-30)220 C0090805 PSYTX, OFFICE (20-30) W/E@M220 C0090806 PSYTX, OFFICE (45-50)220 C0090807 PSYTX, OFFICE (45-50) W/E@M220 C0090808 PSYTX, OFFICE (75-80)220 C0090812 INTAC PSYTX, OFFICE (45-50)220 C0090846 SPECIAL FAMILY THERAPY220 C0090847 SPECIAL FAMILY THERAPY220 C0090853 SPECIAL GROUP THERAPY220 C0090857 INTERACTIVE PSYCHOTHERAPY220 C0099244 OFFICE CONSULTATION220 C0099245 OFFICE CONSULTATION221 C0090801 PSYCHODIAGNOSTIC CONSULT.221 C0090802 INTAC PSY DX INTERVIEW221 C0090804 PSYTX, OFFICE (20-30)221 C0090805 PSYTX, OFFICE (20-30) W/E@M221 C0090806 PSYTX, OFFICE (45-50)221 C0090807 PSYTX, OFFICE (45-50) W/E@M221 C0090808 PSYTX, OFFICE (75-80)221 C0090809 PSYTX, OFFICE (75-80) W/E@M221 C0090810 INTAC PSYTX, OFFICE (20-30)221 C0090811 INTAC PSYTX, OFFICE (20-30) W/E@M221 C0090812 INTAC PSYTX, OFFICE (45-50)221 C0090813 INTAC PSYTX, OFFICE (45-50) W/E@M221 C0090814 INTAC PSYTX, OFFICE (75-80)221 C0090843 IND PSYCHOTHERAPY - 30 MIN221 C0090844 IND PSYCHOTHERAPY - 45 MIN221 C0090846 SPECIAL FAMILY THERAPY221 C0090847 SPECIAL FAMILY THERAPY221 C0090849 SPECIAL FAMILY THERAPYOffice Visit Procedure Codes 3 of 5

221 C0090853 SPECIAL GROUP THERAPY221 C0090857 INTERACTIVE PSYCHOTHERAPY221 C0099242 OFFICE CONSULTATION221 C0099243 OFFICE CONSULTATION221 C0099244 OFFICE CONSULTATION221 C0099245 OFFICE CONSULTATION221 C0099275 CONFIRMATORY CONSULTATION222 C0090801 PSYCHODIAGNOSTIC CONSULT.222 C0090804 PSYTX, OFFICE (20-30)222 C0090805 PSYTX, OFFICE (20-30) W/E@M222 C0090806 PSYTX, OFFICE (45-50)222 C0090807 PSYTX, OFFICE (45-50) W/E@M222 C0090808 PSYTX, OFFICE (75-80)222 C0090812 INTAC PSYTX, OFFICE (45-50)222 C0090847 SPECIAL FAMILY THERAPY222 C0090853 SPECIAL GROUP THERAPY222 C0099241 OFFICE CONSULTATION222 C0099242 OFFICE CONSULTATION222 C0099243 OFFICE CONSULTATION222 C0099244 OFFICE CONSULTATION222 C0099245 OFFICE CONSULTATION222 C0099275 CONFIRMATORY CONSULTATION041 C0059425 ANTEPARTUM CARE ONLY041 C0059426 ANTEPARTUM CARE ONLY041 C0059430 POST-PARTUM CARE225 C0090862 PHARMOCOLOGY MANAGEMENT526 C0090030 OFFICE/OP VISIT, EST. MINIM526 C0092002 EYE EXAM/NEW PT. INTERMEDIATE526 C0092004 EYE EXAM/NEW PT. COMPREHENSIVE526 C0092012 EYE EXAM/ESTAB.PT INTERMEDIATE526 C0092014 EYE EXAM/ESTAB. PT COMPREHENSIVE526 C0099024 POST-OP FOLLOW-UP VISIT526 C0099025 INITIAL SURGICAL EVALUATION526 C0099058 OFFICE EMERGENCY CARE526 C0099080 SPECIAL REPORTS526 C0099201 OFFICE OR OTHER OUTPATIENT526 C0099202 OFFICE OR OTHER OUTPATIENT526 C0099203 OFFICE OR OTHER OUTPATIENT526 C0099204 OFFICE OR OTHER OUTPATIENT526 C0099205 OFFICE OR OTHER OUTPATIENT526 C0099211 OFFICE OR OTHER OUTPATIENT526 C0099212 OFFICE OR OTHER OUTPATIENT526 C0099213 OFFICE OR OTHER OUTPATIENT526 C0099214 OFFICE OR OTHER OUTPATIENT526 C0099215 OFFICE OR OTHER OUTPATIENT526 C0099241 OFFICE CONSULTATION526 C0099242 OFFICE CONSULTATION526 C0099243 OFFICE CONSULTATION526 C0099244 OFFICE CONSULTATION526 C0099245 OFFICE CONSULTATION526 C0099272 CONFIRMATORY CONSULTATIONOffice Visit Procedure Codes 4 of 5

526 C0099273 CONFIRMATORY CONSULTATION526 C0099274 CONFIRMATORY CONSULTATION526 C0099275 CONFIRMATORY CONSULTATION526 C0099354 PROLONGED SERVICE, OFFICE526 C0099355 PROLONGED SERVICE, SVC EA ADD 30M526 C0099381 INITIAL COMPREH. PREVENT MEDIC526 C0099384 PREVENTIVE MEDICINE SERVICES526 C0099385 PREVENTIVE MEDICINE SERVICES526 C0099394 PREVENTIVE MEDICINE SERVICES526 C0099395 PREVENTIVE MEDICINE SERVICES526 C0099404 PREVENTIVE MEDICINE SERVICES651 C0099205 OFFICE OR OTHER OUTPATIENT651 C0099381 INITIAL COMPREH. PREVENT MEDIC651 C0099384 PREVENTIVE MEDICINE SERVICES651 C0099395 PREVENTIVE MEDICINE SERVICES065 C0092002 EYE EXAM/NEW PT. INTERMEDIATE065 C0092004 EYE EXAM/NEW PT. COMPREHENSIVE065 C0092012 EYE EXAM/ESTAB. PT INTERMEDIATE065 C0092014 EYE EXAM/ESTAB. PT COMPREHENSIVE065 C0099201 OFFICE OR OTHER OUTPATIENT065 C0099202 OFFICE OR OTHER OUTPATIENT065 C0099203 OFFICE OR OTHER OUTPATIENT065 C0099204 OFFICE OR OTHER OUTPATIENT065 C0099205 OFFICE OR OTHER OUTPATIENT065 C0099211 OFFICE OR OTHER OUTPATIENT065 C0099212 OFFICE OR OTHER OUTPATIENT065 C0099213 OFFICE OR OTHER OUTPATIENT065 C0099214 OFFICE OR OTHER OUTPATIENT065 C0099215 OFFICE OR OTHER OUTPATIENT065 C0099242 OFFICE CONSULTATION065 C0099243 OFFICE CONSULTATION065 C0099244 OFFICE CONSULTATION065 C0099245 OFFICE CONSULTATIONOffice Visit Procedure Codes 5 of 5