Diagnostic Radiology

 
 
HSC Name Sub-Category Category Group
X 1 Skull - Head Diagnostic Imaging
X 2 Skull (including stereos) - Head Diagnostic Imaging
X 4 Facial bones - Head Diagnostic Imaging
X 5 Mandible - Head Diagnostic Imaging
X 6 Nasal bones - Head Diagnostic Imaging
X 6A Adenoids or nasopharynx - Head Diagnostic Imaging
X 7 Mastoids - Head Diagnostic Imaging
X 8 Sinuses - paranasal - Head Diagnostic Imaging
X 9 Temporo-mandibular joints - Head Diagnostic Imaging
X 10 Sella turcica - Head Diagnostic Imaging
X 12 Orbit - for foreign body - Head Diagnostic Imaging
X 13 Orbit - for foreign body localization - Head Diagnostic Imaging
X 13A Optic foramina - Head Diagnostic Imaging
X 14A Dacryocystography - Head Diagnostic Imaging
X 15 Salivary duct for calculus - Head Diagnostic Imaging
X 16 Sialography - Head Diagnostic Imaging
X 17 Tooth (single) - Head Diagnostic Imaging
X 18 Teeth (half set) - Head Diagnostic Imaging
X 19 Teeth (complete) - Head Diagnostic Imaging
X 20 Chest - single view - Chest Diagnostic Imaging
X 20A Chest - single view - interpretation only - Chest Diagnostic Imaging
X 21 Chest - multiple views - Chest Diagnostic Imaging
X 21A Thoracic inlet views - Chest Diagnostic Imaging
X 22 Ribs - Chest Diagnostic Imaging
X 23 Chest - fluoroscopy - Chest Diagnostic Imaging
X 27A Single lesion - Chest Diagnostic Imaging
X 27B Multiple lesions - Chest Diagnostic Imaging
X 25 Chest - cardiac fluoroscopy including P.A., lateral and oblique views with barium in esophagus - Chest Diagnostic Imaging
X 26 Mammography (one breast) - Chest Diagnostic Imaging
X 26A Mammoductography - Chest Diagnostic Imaging
X 26B Mammocystography - Chest Diagnostic Imaging
X 26C Percutaneous stereotactic core breast biopsy imaging guidance Automated stereotactic-guided large core biopsy (LNCB) Chest Diagnostic Imaging
X 27 Mammography (both breasts) Automated stereotactic-guided large core biopsy (LNCB) Chest Diagnostic Imaging
X 27C Screening mammography (age 40 to 49 years inclusive) Automated stereotactic-guided large core biopsy (LNCB) Chest Diagnostic Imaging
X 27D Screening mammography (age 50 to 74 years inclusive) Automated stereotactic-guided large core biopsy (LNCB) Chest Diagnostic Imaging
X 27E Screening mammography (age 75 years and over) Automated stereotactic-guided large core biopsy (LNCB) Chest Diagnostic Imaging
X 27F Diagnostic mammography, supplementary views Automated stereotactic-guided large core biopsy (LNCB) Chest Diagnostic Imaging
X 27G Screening mammography for patients with the following conditions: implants, augmentation, mammoplasty, and when determined appropriate for screening by a radiologist and/or primary care physician, with the following conditions: post intervention (e.g. biopsy, excision, etc.) Automated stereotactic-guided large core biopsy (LNCB) Chest Diagnostic Imaging
X 28 Sternum and/or sterno-clavicular joint Automated stereotactic-guided large core biopsy (LNCB) Chest Diagnostic Imaging
X 29 Finger - Upper extremity Diagnostic Imaging
X 30 Hand - Upper extremity Diagnostic Imaging
X 31 Wrist or carpal bone (or wrist and hand) - Upper extremity Diagnostic Imaging
X 31A Carpal tunnel view, additional benefit - Upper extremity Diagnostic Imaging
X 32 Radius and ulna - Upper extremity Diagnostic Imaging
X 33 Elbow - Upper extremity Diagnostic Imaging
X 34 Humerus - Upper extremity Diagnostic Imaging
X 35 Clavicle - Upper extremity Diagnostic Imaging
X 36 Shoulder girdle - Upper extremity Diagnostic Imaging
X 36A Scapula - Upper extremity Diagnostic Imaging
X 37 Arthrogram - any upper extremity joint - Upper extremity Diagnostic Imaging
X 38 Toe - Lower extremity Diagnostic Imaging
X 39 Foot - Lower extremity Diagnostic Imaging
X 40 Ankle - Lower extremity Diagnostic Imaging
X 41 Os calcis - Lower extremity Diagnostic Imaging
X 42 Tibia and fibula - Lower extremity Diagnostic Imaging
X 43 Knee - Lower extremity Diagnostic Imaging
X 43A Additional benefit Skyline or tunnel view of knee Lower extremity Diagnostic Imaging
X 43B Both views, additional benefit Skyline or tunnel view of knee Lower extremity Diagnostic Imaging
X 44 Arthrogram - any lower extremity joint - Lower extremity Diagnostic Imaging
X 45 Femur or thigh - Lower extremity Diagnostic Imaging
X 46 Femur, including hip and knee - Lower extremity Diagnostic Imaging
X 47 Hip - Lower extremity Diagnostic Imaging
X 48 Hip - arthrogram - Lower extremity Diagnostic Imaging
X 50 Hip pinning with fluoroscopy - Lower extremity Diagnostic Imaging
X 51 Pelvis - Lower extremity Diagnostic Imaging
X 52 Pelvis and one hip - Lower extremity Diagnostic Imaging
X 53 Pelvis and both hips - Lower extremity Diagnostic Imaging
X 54 Sacro-iliac joints - Lower extremity Diagnostic Imaging
X 54A - unilateral Stress views of a limb Lower extremity Diagnostic Imaging
X 54B - bilateral Stress views of a limb Lower extremity Diagnostic Imaging
X 55 One area - Spine Diagnostic Imaging
X 56 One area - with obliques - Spine Diagnostic Imaging
X 57 Two areas - Spine Diagnostic Imaging
X 57A Two areas (of the spine) with obliques of each area - Spine Diagnostic Imaging
X 58E More than two areas (of the spine) with obliques of each area - Spine Diagnostic Imaging
X 58 Complete spine - Spine Diagnostic Imaging
X 58A - flexion and extension Flexion and extension or lateral bending views of the spine. Spine Diagnostic Imaging
X 58B - lateral bending Flexion and extension or lateral bending views of the spine. Spine Diagnostic Imaging
X 58D - both Flexion and extension or lateral bending views of the spine. Spine Diagnostic Imaging
X 59 Lumbo sacral spine and pelvis - Spine Diagnostic Imaging
X 60 Lumbo sacral spine and sacro-iliac joints - Spine Diagnostic Imaging
X 61 Lumbo sacral spine and pelvis and sacro-iliac joints - Spine Diagnostic Imaging
X 62 Lumbo sacral spine and one hip - Spine Diagnostic Imaging
X 63 Lumbo sacral spine and both hips - Spine Diagnostic Imaging
X 64 Lumbo sacral spine, pelvis and one hip - Spine Diagnostic Imaging
X 65 Lumbo sacral spine, pelvis and both hips - Spine Diagnostic Imaging
X 66 Myelogram, x-ray and fluoroscopy - Spine Diagnostic Imaging
X 66A Cervical or thoracic myelogram with fluoroscopy - Spine Diagnostic Imaging
X 67 Discography - Spine Diagnostic Imaging
X 68 K.U.B. - Genito urinary Diagnostic Imaging
X 69 Cystography - Genito urinary Diagnostic Imaging
X 70 Urethrography - Genito urinary Diagnostic Imaging
X 71 Excretory pyelography (includes injections of material) - Genito urinary Diagnostic Imaging
X 73 Retrograde pyelogram - Genito urinary Diagnostic Imaging
X 77A Nephrostogram with fluoroscopy, unilateral - Genito urinary Diagnostic Imaging
X 77B Nephrostogram with fluoroscopy, bilateral - Genito urinary Diagnostic Imaging
X 80 Hystero-salpingography (with or without fluoroscopy) - Genito urinary Diagnostic Imaging
X 81 Esophagus with fluoroscopy - Gastrointestinal tract Diagnostic Imaging
X 82 Stomach and duodenum with fluoroscopy - Gastrointestinal tract Diagnostic Imaging
X 82A Double contrast examination of stomach - additional fee to X 82 and X 84 - Gastrointestinal tract Diagnostic Imaging
X 84 Stomach, duodenum and small bowel follow through and with fluoroscopy (includes follow-up film taken next day if necessary) - Gastrointestinal tract Diagnostic Imaging
X 85 Small bowel only with fluoroscopy - Gastrointestinal tract Diagnostic Imaging
X 85B Small bowel studies including fluoroscopy following selective intubation and administration of cholinergic drugs (enteroclysis) - Gastrointestinal tract Diagnostic Imaging
X 86 Colon (with fluoroscopy and films) - Gastrointestinal tract Diagnostic Imaging
X 87 Colon (with fluoroscopy and films) combined with air contrast examination - Gastrointestinal tract Diagnostic Imaging
X 88 Colon - separate air contrast (fluoroscopy and films) - Gastrointestinal tract Diagnostic Imaging
X 88A Barium enema for the reduction of intussusception - Gastrointestinal tract Diagnostic Imaging
X 94 Trans-hepatic percutaneous cholangiography - Gastrointestinal tract Diagnostic Imaging
X 94B Hepatic venogram - hepatic wedge pressure - Gastrointestinal tract Diagnostic Imaging
X 95 Operative cholangiogram (includes cost of contrast media) - Gastrointestinal tract Diagnostic Imaging
X 96 T-tube cholangiogram (includes injection and cost of contrast material) - Gastrointestinal tract Diagnostic Imaging
X 97 Splenoportography (excludes injection of contrast media) - Gastrointestinal tract Diagnostic Imaging
X 98 Abdomen - single view - Gastrointestinal tract Diagnostic Imaging
X 99 Abdomen - multiple views - Gastrointestinal tract Diagnostic Imaging
X100 Abdomen for obstruction or perforation - Gastrointestinal tract Diagnostic Imaging
X102 Skull, shoulder, chest, spine and pelvis - Skeletal survey for secondary neoplasms etc. Diagnostic Imaging
X103 Chest, spine and pelvis - Skeletal survey for secondary neoplasms etc. Diagnostic Imaging
X104 Plus all long bones - additional - Skeletal survey for secondary neoplasms etc. Diagnostic Imaging
X105 Planogram (tomogram, laminogram) - including stereos and fluoroscopy when necessary - any area - Special techniques Diagnostic Imaging
X105A Multi-directional tomography, any area - Special techniques Diagnostic Imaging
X106 Scanogram (including stereos and fluoroscopy) - Special techniques Diagnostic Imaging
X107 Fluoroscopy of a joint with image intensification (including spot films) - Special techniques Diagnostic Imaging
X107A Fluoroscopy performed during special diagnostic or therapeutic procedures, including biopsy, endoscopy, intubation, pacemaker insertion and bougienage, etc. - Special techniques Diagnostic Imaging
X128 Bone mineral content determination dual photon absorptiometry with or without vertebral fracture assessment (VFA) - Special techniques Diagnostic Imaging
X108 Guidance of right heart catheterization - Heart Diagnostic Imaging
X109 Guidance of left heart catheterization - Heart Diagnostic Imaging
X110 Guidance combined left and right - Heart Diagnostic Imaging
X111 Guidance of pacemaker - Heart Diagnostic Imaging
X111A Guidance of extracardiac vascular catheterization without angiography - Heart Diagnostic Imaging
X112 Artery or vein - Peripheral Angiography
X113 Lymphangiography - unilateral - Peripheral Angiography
X114 Lymphangiography - bilateral - Peripheral Angiography
X115 Abdominal angiography - Abdominal Angiography
X116 Selective abdominal angiography - Abdominal Angiography
X117 Combined abdominal and selective abdominal - Abdominal Angiography
X118 Thoracic angiography - Thoracic Angiography
X119 Selective thoracic angiography - Thoracic Angiography
X120 Combined thoracic and selective thoracic - Thoracic Angiography
X121 Inferior or superior vena cavography - Thoracic Angiography
X122 Angiocardiography - Thoracic Angiography
X123 Pulmonary angiography - Thoracic Angiography
X124 Cerebral - unilateral - Head and neck Angiography
X125 Cerebral - bilateral - Head and neck Angiography
X140 Thyroid scan - Thyroid studies Nuclear Medicine
X151 Liver scan - Liver studies Nuclear Medicine
X151A Combined liver and spleen scan - Liver studies Nuclear Medicine
X151B Dynamic liver and/or spleen scan including static views - Liver studies Nuclear Medicine
X153 Whole body scanning - Liver studies Nuclear Medicine
X170 Thallium myocardial perfusion imaging (rest study) - Cardiac studies Nuclear Medicine
X171 Thallium myocardial perfusion imaging (rest and exercise) - Cardiac studies Nuclear Medicine
X172 Gated cardiac imaging (rest study) - Cardiac studies Nuclear Medicine
X173 Gated cardiac imaging (rest and exercise) - Cardiac studies Nuclear Medicine
X156 Brain scan - Brain studies Nuclear Medicine
X157 Bone scan - Bone studies Nuclear Medicine
X158 Lung scan - Lung studies Nuclear Medicine
X158A Lung scan with unilateral venogram (to include injection of radionuclide) - Lung studies Nuclear Medicine
X158B Lung scan with bilateral venogram (to include injection of radionuclide) - Lung studies Nuclear Medicine
X158D Xenon ventilation imaging - Lung studies Nuclear Medicine
X159 Splenic scan - Spleen studies Nuclear Medicine
X174 Gastrointestinal imaging - Gastrointestinal studies Nuclear Medicine
X175 M.I.B.G. (I-131) adrenal imaging - Adrenal imaging Nuclear Medicine
X176 M.I.B.G. (I-123) adrenal imaging - Adrenal imaging Nuclear Medicine
X160 Heart, aorta, or great vessel scan - Miscellaneous Nuclear Medicine
X161 Dynamic heart imaging - Miscellaneous Nuclear Medicine
X162 Glomerular filtration rate - Miscellaneous Nuclear Medicine
X163 Dynamic renal transplant imaging studies - Miscellaneous Nuclear Medicine
X164 Renal flow studies - Miscellaneous Nuclear Medicine
X165 Cisternography - Miscellaneous Nuclear Medicine
X166 Dynamic brain studies (including static views) - Miscellaneous Nuclear Medicine
X167 Radionuclide cystography - Miscellaneous Nuclear Medicine
X168 Radionuclide dacrocystogram - Miscellaneous Nuclear Medicine
X169 Radionuclide venogram, unilateral (to include injection of radionuclide) - Miscellaneous Nuclear Medicine
X169A Radionuclide venogram, bilateral (to include injection of radionuclide) - Miscellaneous Nuclear Medicine
X255 Renogram - Miscellaneous Nuclear Medicine
X256 Renal scan - Miscellaneous Nuclear Medicine
X301 Ultrasound, thyroid or parathyroid - Head and neck Diagnostic Ultrasound
X302 Ultrasound, salivary gland(s) - Head and neck Diagnostic Ultrasound
X303 Ultrasound, head and/or neck, soft tissue - Head and neck Diagnostic Ultrasound
X304 Ultrasound, carotid and/or vertebral artery, bilateral study - Head and neck Diagnostic Ultrasound
X305 Ultrasound, thorax (chest wall or pleura) - Thorax Diagnostic Ultrasound
X306 Ultrasound, heart, echocardiogram, complete study - Thorax Diagnostic Ultrasound
X307 Ultrasound, heart, Echocardiogram, limited - Thorax Diagnostic Ultrasound
X308 Ultrasound, breast - Thorax Diagnostic Ultrasound
X309 Ultrasound, axilla - Thorax Diagnostic Ultrasound
X310 Ultrasound, abdominal, complete or at least two abdominal organs - Abdomen and Retroperitoneum Diagnostic Ultrasound
X311 Ultrasound, kidneys, ureters and bladder - Abdomen and Retroperitoneum Diagnostic Ultrasound
X312 Ultrasound, abdominal, single organ study, limited or follow up - Abdomen and Retroperitoneum Diagnostic Ultrasound
X313 Ultrasound, abdominal wall, hernia or appendix study - Abdomen and Retroperitoneum Diagnostic Ultrasound
X314 Ultrasound, pelvis, female, including endo-vaginal (EV) scan - Obstetrics Gynecology and Female Pelvis Diagnostic Ultrasound
X315 Ultrasound, pelvis, female, transvesical scan - Obstetrics Gynecology and Female Pelvis Diagnostic Ultrasound
X316 Ultrasound, urinary bladder, female - Obstetrics Gynecology and Female Pelvis Diagnostic Ultrasound
X317 Ultrasound, obstetrical, first trimester, excluding detailed fetal assessment or nuchal translucency measurement - Obstetrics Gynecology and Female Pelvis Diagnostic Ultrasound
X318 Ultrasound, obstetrical, first trimester, excluding detailed fetal assessment or nuchal translucency measurement - Obstetrics Gynecology and Female Pelvis Diagnostic Ultrasound
X319 Ultrasound, obstetrical, first trimester/early fetal screening - Obstetrics Gynecology and Female Pelvis Diagnostic Ultrasound
X320 Ultrasound, obstetrical, second or third trimester, general fetal assessment - Obstetrics Gynecology and Female Pelvis Diagnostic Ultrasound
X321 Ultrasound, obstetrical, second or third trimester, for example, significant maternal disease (i.e. diabetes), fetal anomaly, fetal markers, Intrauterine Growth Retardation (IUGR), oligohydramnios, growth discordance in twins, suspected fetal anemia, genetics, fetal therapy - Obstetrics Gynecology and Female Pelvis Diagnostic Ultrasound
X322 Ultrasound, obstetrical, biophysical profile, third trimester only - Obstetrics Gynecology and Female Pelvis Diagnostic Ultrasound
X323 Ultrasound, heart (Echocardiogram), fetal, complete study - Obstetrics Gynecology and Female Pelvis Diagnostic Ultrasound
X324 Ultrasound, pelvis, female, translabial or endo-vaginal (EV), additional benefit - Obstetrics Gynecology and Female Pelvis Diagnostic Ultrasound
X325 Ultrasound head, pediatric scan through open fontanel - Pediatrics Diagnostic Ultrasound
X326 Ultrasound, hips, bilateral, pediatric, newborn to 16 years of age - Pediatrics Diagnostic Ultrasound
X327 Ultrasound, spine, pediatric, newborn to 16 years of age - Pediatrics Diagnostic Ultrasound
X328 Ultrasound, pelvis, male - Male Genitourinary Tract Diagnostic Ultrasound
X329 Ultrasound, prostate, transrectal - Male Genitourinary Tract Diagnostic Ultrasound
X330 Ultrasound, scrotal - Male Genitourinary Tract Diagnostic Ultrasound
X331 Ultrasound, arterial screening, peripheral - Peripheral Vascular System Diagnostic Ultrasound
X332 Ultrasound, arterial complete mapping, peripheral - Peripheral Vascular System Diagnostic Ultrasound
X333 Ultrasound, venous, peripheral - Peripheral Vascular System Diagnostic Ultrasound
X334 Ultrasound, other than shoulder including joints, tendons, ligaments, muscles, single anatomic site - Musculo-Skeletal Diagnostic Ultrasound
X335 Ultrasound shoulder, dedicated rotator cuff and bicep - Musculo-Skeletal Diagnostic Ultrasound
X337 Doppler, quantitative spectral analysis with directional flow and/or Doppler measurements (e.g. renal artery, portal venous system, resistivity index, etc.), additional benefit - Miscellaneous Diagnostic Ultrasound
X338 Ultrasound, limited soft-tissue study, site unspecified, any single site, not organ related - Miscellaneous Diagnostic Ultrasound

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