ENT Procedure Codes

ENT Procedure Codes

Procedure Code Description

Current Medicaid Reimbursement

Medicaid Reimbursement Rate
Eff 8/1/22

10005

FNA BX W/US GDN 1ST LES

$95.02

$122.74

10006

FNA BX W/US GDN EA ADDL

$45.90

$57.96

11442

EXC FACE-MM B9+MARG 1.1-2 CM

$122.00

$179.73

11446

EXC FACE-MM B9+MARG >4 CM

$250.00

$372.17

15115

Epidermal Autograft, First 100sq cm

$468.50

$768.06

15120

Split-thickness Autograft, First 100sq cm

$603.00

$811.64

15769

Grafting of Autologous Soft Tissue (eg. Fat, Dermis, Fascia)

$309.00

$463.95

21552

Excision of Mass/Tumor, Soft Tissue of Neck, 3cm+

$274.51

$430.16

21555

Excision of Mass/Tumor, Soft Tissue of Neck, < 3cm

$287.00

$404.34

21556

Exc Neck Tum Deep < 5 CM

$290.00

$509.67

30130

Tubinoplasty

$255.00

$372.72

30300

Remove Nasal Foreign Body

$154.00

$176.76

30310

Remove Nasal Foreign Body

$144.00

$192.30

30465

Nasal Valve Repair, Reconstruction

$536.00

$954.01

30520

Septoplasty

$368.00

$613.40

30630

REPAIR OF OPENINGS OF NASAL CARTILAGE

$337.00

$650.20

30802

Ablate Inf Turbinate Submuc

$185.00

$258.67

30901

Control Nasal Hemorrhage, Ant/Simple

$75.00

$134.45

30905

Control Nasal Hemorrhage, Post/Simple-Initial

$155.00

$314.94

31231

Nasal Endoscopy DX

$123.00

$179.37

31237

Nasal/Sinus Endoscopy Surg

$232.00

$239.44

31240

Excision of Concha Bullosa

$146.00

$153.17

31253

Total w/ Frontal

$376.75

$489.91

31254

Anterior Ethmoidectomy

$253.00

$397.98

31257

Total w/ Sphenoid W/O Rem

$335.53

$436.20

31259

Total w/ Sphenoid W/ Rem

$355.58

$461.73

31295

Balloon Maxillary

$1,510.22

$1,726.14

31298

Balloon Frontal & Sphenoid

$2,819.58

$3,290.02

31525

Direct Laryngoscopy, Diagnostic

$179.00

$237.50

31526

Micro Direct Laryngoscopy, Diagnostic

$143.00

$151.09

31535

Direct Laryngoscopy W/ Bx

$173.00

$182.70

31536

Micro Direct Laryngoscopy W/ Bx

$194.00

$203.50

31540

DL W/ Exc of Lesion/Stripping VC

$224.00

$233.88

31541

Micro DL W/ Exc of Lesion/Stripping VC

$245.00

$255.30

31575

Diagnostic Laryngoscopy

$88.00

$114.95

31579

Laryngoscopy Telescopic

$171.00

$181.00

38500

Lymph Node Bx or Excision, Superficial

$220.00

$320.10

38510

Lymph Node Bx or Excision, Deep Cervical

$356.00

$503.25

38724

Lymphadenectomy, Cervical (Mod Radical Dissection)

$734.00

$1,406.36

40806

Incision Of Lip Fold

$58.00

$92.03

40819

Excise Lip Or Cheek Fold

$185.00

$267.20

41100

Tongue Bx, Ant 2/3

$116.00

$164.92

41105

Tongue Bx, Post 1/3

$106.00

$166.73

41520

Reconstruction Tongue Fold

$209.00

$334.75

42140

Excision Of Uvula

$149.00

$263.19

42145

Repair Palate Pharynx/Uvula

$510.00

$665.76

42305

Drainage of Abscess, Parotid (Complicated)

$319.00

$412.72

42330

Sialolithotomy, Intraoral, Simple (Subman/Subling/Parotid)

$153.00

$219.80

42335

Sialolithotomy, Intraoral, Comp. (Submandibular)

$235.00

$381.21

42340

Sialolithotomy, Extroral or Comp. Intraoral, Parotid

$221.00

$470.04

42410

Parotidectomy, Lateal Lobe, W/O Nerve Diss.

$465.00

$603.56

42415

Parotidectomy, Lateal Lobe, W/ Nerve Diss.

$827.00

$1,023.51

42420

Parotidectomy, Total, W/ Nerve Diss.

$953.00

$1,150.76

42440

Excison of Submandibular Gland

$361.00

$397.60

42700

Drainage Of Tonsil Abscess

$121.00

$180.22

42800

Oropharyngeal Bx

$101.00

$148.58

42804

Oropharyngeal Bx, Visible Lesion

$72.00

$185.26

42820

Removal of tonsils and adenoids, < age 12

$225.00

$278.17

42821

Removal of tonsils and adenoids, age 12+

$248.00

$290.09

42825

Tonsillectomy < age 12

$206.00

$252.18

42826

Tonsillectomy age 12+

$211.00

$241.67

42830

Adenoidectomy, Primary < age 12

$149.00

$199.08

42831

Adenoidectomy, Primary age 12+

$161.00

$215.31

42835

Adenoidectomy, Secondary < age 12

$139.00

$184.21

42836

Adenoidectomy, Secondary age 12+

$179.00

$231.23

60210

Partial Lobectomy, Unilateral

$534.00

$685.24

60220

Total Lobectomy, Unilateral

$593.00

$684.14

60240

Thyroidectomy, Total or Complete

$726.00

$892.31

60252

Thyroidectomy, For Malignancy, W/ Limited Neck Diss.

$938.00

$1,284.20

60260

Thyroidectomy, Rem of All Remaining Tissue (Subq. Proc.)

$561.00

$1,060.57

60500

Explore Parathyroid Glands

$774.00

$938.92

60502

Re-Explore Parathyroids

$805.00

$1,258.44

60512

Autotransplant Parathyroid

$189.00

$237.49

61782

Navigation

$143.29

$170.46

69205

Removal of Foreign Body, External Auditory Canal

$76.00

$92.67

69222

Clean Out Mastoid Cavity

$145.00

$197.57

69421

Incision Of Eardrum

$112.00

$140.56

69433

Create Eardrum Opening

$129.00

$185.15

69436

Tympanostomy W/ Tube Placement

$123.00

$149.95

69610

Repair of Tymp Perforation, W/ or W/O Paper Patch

$287.00

$358.73

69631

Repair Eardrum Structures

$627.00

$836.24

69706

Dilation of Canal Between Middle Ear and Throat (Eustachian Tube) on Both Sides of Body, Using Endoscope Inserted Through Nose

$217.05

$236.65

69930

Implant Cochlear Device

$923.00

$1,170.04

92504

Ear Microscopy Examination

$18.00

$26.96

92540

Basic Vestibular Evaluation

$64.78

$103.15

92552

Pure Tone Audiometry Air

$14.00

$28.49

92553

Audiometry Air & Bone

$17.00

$34.58

92555

Speech Threshold Audiometry

$11.00

$21.43

92556

Speech Audiometry Complete

$15.00

$34.26

92557

Comprehensive Hearing Test

$35.00

$36.86

92567

Tympanometry

$14.00

$15.17

92612

Endoscopy Swallow (Fees) Vid

$109.00

$186.48

95004

Percut Allergy Skin Tests

$2.48

$3.82

95024

Icut Allergy Test Drug/Bug

$4.00

$7.35

95027

Icut Allergy Titrate-Airborn

$4.00

$4.47

95165

Antigen Therapy Services

$6.20

$13.33

96372

Ther/Proph/Diag Inj SC/IM

$10.00

$13.45