2005 Toyota Prius Headlight Bulb, Meniere's Disease – A “CHEER” Database Study of Local and .. About featured snippets•Feedback 2005 Toyota Tacoma Headlight Bulb, CPT® Code 69806 - Incision and/or Destruction .. The provider performs an operation to open and drain the endolymphatic sac; this procedure includes shunt placement for continued pressure relief. 2006 Acura Tsx Headlight Bulb, CPT REFERENCE FOR COMMONLY USED CODES. PDFCPT REFERENCE FOR COMMONLY USED CODES. Sinus Surgery. CPT . insertion under local or topical anesthesia . Endolymphatic sac operation without shunt. 2006 Crv Headlight Bulb, cpt-codes.pdf. PDFJan 30, 2017 — Tracked Codes Report . Insertion of graft, aorta or great vessels; without shunt, . Endolymphatic sac operation; without shunt. 2006 Gmc Sierra Headlight Bulb, Eye and Ocular Adnexa, Auditory System, and Microscope .. Endolymphatic sac operation; with shunt is reported with code 69806. TOPIC 02: Assigning Codes to Ear, Eye, and Microscope Procedures: Inner Ear - Excision.People also askYou will see more English now.What is the difference between CPT code 31535 and 31536?What is the CPT code for shunt placement?What is CPT code 62223?What is CPT code 62258?Feedback 2006 Honda Accord Headlight Bulb Replacement, Outpatient Surgical Procedures – Site of Service: CPT/ .. PDFThis list contains CPT/HCPCS codes for the following: . Endolymphatic sac operation; without shunt . CPT Code. Description. Cardiovascular System. 2006 Honda Crv Headlight Bulb Replacement, Chapter 19 Coding Assignments.docx. The correct codes are assigned to each of the following procedures by using the CPT manual. 1. Endolymphatic sac operation with shunt placement. 69806. 2. 2006 Hyundai Elantra Headlight Bulb, PHYSICIAN SURGERY PROCEDURE CODES. PDFApr 15, 2023 — appended to any CPT codes listed in the Evaluation and Management Services, . 69805 Endolymphatic sac operation; without shunt. 2006 Infiniti G35 Headlight Bulb, AVAILABLE CPT CODES BY AREA AND TYPE For .. PDFMar 30, 2006 — Endolymphatic sac operation; without shunt. 69806. Endolymphatic sac operation; with shunt. EXCISION EAR CANAL. CPT Code. Description. 2006 Prius Headlight Bulb, Division of Neurotology. DOCXIII. available cpt codes by area and type. THE OTOLOGY GROUP . Gain proficiency in complete mastoidectomy for endolymphatic sac surgery. 2006 Subaru Forester Headlight Bulb, Meniere's Disease and Related Disorders: Surgery. Endolymphatic mastoid shunt versus endolymphatic sac decompression for Meniere's disease. Otolaryngol Head Neck Surg. 2007;136(3):415-421. Brookes GB. The role . 2006 Subaru Outback Headlight Bulb, Physician and Other Professional Services Relative Value .. PDFCode. Modifier 1. CPT/HCPCS Code Description. Conversion. Factor/GAAF . TCAT PLACEMENT PHYSIOLOGIC SENSOR ANEURYSMAL SAC . ENDOLYMPHATIC SAC SHUNT. 2007 Acura Tl Headlight Bulb, CODE PROCEDURE CPT PRICE UNIVERSITY .. PDFCODE. PROCEDURE. MOD. CPT PRICE. 0001A. IMM ADMN SARSCOV2 30MCG/0.3ML DIL RECON 1ST DOSE . PR ENDOLYMPH SAC OPERATN,NO SHUNT. 69805. $3,263.00. 2007 Dodge Ram Headlight Bulb, 2020 Physician Fee Schedule. XLS11, Proc Code, Procedure Description, PA Ind, Inpat. Rate (Facility), Outpat. . 6058, 69806, ENDOLYMPHATIC SAC OPERATION; WITH SHUNT, $814.38, $814.38. 2007 Mazda 6 Headlight Bulb, Case Log Coding Guidelines. PDF(code decompression/mastoid and nerve graft harvest separately). Endolymphatic sac decomps + shunts (two codes):. Sac Decompression: 69806. *Mastoidectomy:. 2007 Tahoe Headlight Bulb Size, What is the cpt code for: 1. Inner ear fenestration revision .. Feb 1, 2021 — Endolymphatic sac operation with shunt placement . Current Procedural Terminology (CPT) is a medical code set that is used to report . 2007 Toyota Tacoma Headlight Bulb, Outpatient Facility Nationwide Charges by CPT/HCPCS .. PDFCPT/. HCPCS. Code. Description. Status/. Usage. Indicator 1. Multiple. Surgery . INSERTION THOMAS SHUNT SEPARATE PROCEDURE . ENDOLYMPHATIC SAC W/O SHUNT. 2008 Buick Enclave Headlight Bulb, Health Evidence Review Commission's Value-based .. PDFMar 12, 2020 — Add an additional procedure code for aqueous shunts to the covered . 1) Add CPT 0376T (Insertion of anterior segment aqueous drainage . 2008 Dodge Ram Headlight Bulb, NCCI (National Correct Coding Initiative) MUE (Medically .. PDFJan 1, 2012 — Code. Procedure Description. Effective Date. End Date . PLACEMENT OF A POSTERIOR INTRAFACET IMPLANT(S), UNILATERAL OR BILATERAL, . 2008 Honda Civic Headlight Bulb Size, 114. DOCAll surgery related CPT category III codes are included as a part of this regulation and have an . 69806, 723.86, Endolymphatic sac operation; with shunt. 2008 Kia Sorento Headlight Bulb, Endolymphatic Shunt Placement Technique. Sep 5, 2018 — Endolymphatic sac (ES) shunt surgery is a treatment for medically refractory disabling vertigo in Meniere disease, which is an inner ear .Missing: cpt ‎code 2008 Tahoe Headlight Bulb, 2022 Medical Fee Schedule - Oklahoma.gov. PDFJul 1, 2022 — Surgery Center Ground Rules section. Following is a description of the various columns: a. CODE: The CPT, or HCPCS or CDT. 2008 Toyota Tundra Headlight Bulb, Images for endolymphatic sac operation with shunt placement cpt code. XLS(Px Code), Procedure Name, Procedure Code (CPT / HCPCS), Default Modifier . 5060, 69805, ENDOLYMPHATIC SAC W/O SHUNT, 69805, $ 18,713, $ 6,550, BOTH. Wilfred Aritzia, APPENDIX A: Operating Room Procedure Codes. PDFAPPENDIX A: Operating Room Procedure Codes . ENDOLYMPHATIC SHUNT. 00CB3ZZ . Insertion of Infusion Device into Brain, Open Approach. 2009 Gmc Sierra Headlight Bulb, Billing and Coding: Insertion of anterior segment aqueous .. Effective January 1, 2014 CPT code 66183 should be used for the insertion of anterior segment aqueous drainage device. The appropriate ICD-10-CM codes are .Missing: endolymphatic ‎sac 2009 Hyundai Elantra Headlight Bulb, Products of Ambulatory Surgery 2007 Procedure Codes. PDFFeb 1, 2004 — Incision, drainage of lacrimal sac (dacryocystotomy or dacryocystostomy) . Insertion of Thomas shunt (separate procedure). 2009 Hyundai Santa Fe Headlight Bulb, Physicians as Assistants at Surgery: 2023 Update. PDFCurrent Procedural Terminology (CPT TM). Each organization was asked to review the entire list of codes, including new or revised codes since 2020 and . 2009 Mazda 3 Headlight Bulb, Endolymphatic sac decompression and shunting. The. endolymphatic sc decompression shunt mean WebEndolymphatic sac surgery is a surgery that is used to help maintain the hydrostatic pressure and endolymph . 2010 Buick Enclave Headlight Bulb, 2021 Compilation of Inpatient Only Lists by Specialty. PDFxxxxx Yellow = New CPT/HCPCS Code for CY 2021 . procedure; placement of adjustable gastric . 69805 Endolymphatic sac operation; without shunt. 12 Gauge Vinyl Coated Welded Wire Fencing, Authorization by CPT code November 2008. PDFCode. Prior Authorization Required. Outpatient Facility Place of . INSERTION VASC PEDICLE IN CARPAL . ENDOLYMPHATIC SAC OR; WO SHUNT. 2010 Dodge Ram Headlight Bulb, In this column are the CPT or HCPC codes for outpatient .. PDFcode for outpatient & ambulatory services. In this column is the . recommended for the CPT or HCPCs listed in this tab. See . FETAL SHUNT PLACEMENT, W. 2010 Ford Escape Headlight Bulb, Individual and Family Plan No Prior Authorization List. PDFAnesthesia for procedures on heart, pericardial sac, and great vessels of chest; without pump oxygenator. CPT-I . Endolymphatic sac operation; with shunt. 2011 Chrysler 200 Headlight Bulb Replacement, ACTION: Final DATE: 12/22/2015 9:58 AM ENACTED. PDFSee rule 5160-2-07.2 of the Administrative Code for definitions of hospitals. APPENDIX C . Insertion Thomas shunt . Endolymphatic sac operation w shunt. 2011 Kia Forte Headlight Bulb, BCBSTX Outpatient Surgery Codes with Reimbursement .. PDFApr 1, 2022 — The presence of codes on this list does not necessarily indicate coverage under the . 04/01/22 ENDOLYMPHATIC SAC OPERATION; WITH SHUNT. 2011 Tahoe Headlight Bulb, Maximum Allowable Charge. XLS3, Item Code, Code Type, Description, Maximum Allowable Charge. 4, 10004, CPT . 2215, 36835, CPT, INSERTION THOMAS SHUNT SEPARATE PROCEDURE, $5,602.18. 2012 Cadillac Srx Headlight Bulb Replacement, DESCRIPTION RVS CODE ANNEX 2. LIST OF .. PDFExcision of breast lesion identified by preoperative placement of radiological marker; single lesion . Endolymphatic sac operation; w/o shunt. 2012 Chevy Traverse Headlight Bulb Replacement, Empower Prior Authorization List. XLS***DME codes should follow requirements outlined on the Empower Quick Reference . 5608, CPT, 69805, ENDOLYMPHATIC SAC OPERATION; W/O SHUNT, Surgery, NO. 2012 Hyundai Veloster Headlight Bulb, Code Description Fee 10021 Fine needle aspiration. PDF(List separately in addition to code for primary procedure). $2,797.94 . Endolymphatic sac operation; without shunt. $46,080.04. 2012 Traverse Headlight Bulb Replacement, 2.2 PROCEDURE CODE BOOK. PDFIntravenous infusions (push-in) (patients over two years): Insertion of cannula . only the relating anaesthetic category can be charged for procedure 0473 . 2012 Volkswagen Jetta Headlight Bulb, 2023 Medicare Prior Authorization Grid. PDFCodes may not be categorized in an area that you are familiar, . Codes by Category can be found on the . Endolymphatic sac operation ; without shunt. 2013 Cadillac Ats Headlight Bulb, 2021 Small Group Prior Authorization CPT Code List- .. PDFMar 22, 2021 — SURGERY. No Auth Required. 00147 ANESTH IRIDECTOMY . S codes are not payable under CMS billing guidelines. . ENDOLYMPHATIC SAC SHUNT. 2013 Equinox Headlight Bulb, : Data-Coding 240. CodingMeaningSelectableNodeParentChapter AChapter A ‑ Nervous SystemNo1TopChapter BChapter B ‑ Endocrine System and BreastNo2TopChapter CChapter C ‑ EyeNo3TopView 507 more rows 2013 F150 Headlight Bulb Replacement, Code Description Rate ASST ASC. PDFseparately in addition to code for primary procedure) . sac, without biopsy. 1,233.67 . Insertion of graft, aorta or great vessels; without shunt, or. 2013 Ford Escape Headlight Bulb Size, Ambulatory Surgical Centers (ASC) Fee Schedule .. PDFJan 19, 2022 — Terminology (CPT) Code. 2. Description. • Short Descriptor for the Healthcare Common Procedure Coding System (HCPCS) or. 2013 Kia Optima Headlight Bulb Replacement, Prior Authorization Requirements for Medicaid and CHIP .. PDFDec 21, 2020 — Procedure Code Procedure Code Detail Description . ANES- VASCULAR SHUNT, OR SHUNT REVIS, ANY TYPE . ENDOLYMPHATIC SAC OR; WO SHUNT. 3 Coat Stucco System, NH Vocational Rehabilitation Fee Schedule. PDFThe CPT code set is designed to communicate uniform information about medical . anesthesia services in the operating room or an equivalent area and ends . 2013 Nissan Pathfinder Headlight Bulb, 114.3 cmr 16.00: surgery and anesthesia services. PDFSep 14, 2012 — All surgery related CPT category III codes are included as a part . Anesthesia for procedures on heart, pericardial sac, and great vessels . 2013 Tahoe Headlight Bulb, Perfusion hcpcs code. WebNew, Revised and Deleted CPT® Codes for Oncology This resource is a summary of the coding . 69805 : Endolymphatic sac operation; without shunt . 2014 Cadillac Ats Headlight Bulb, Medicaid Fee Schedule 2013. PDFProcedure code. Description. Medicaid fee. 2013. 0035T. PLACEMENT OF PROXIMAL . ANESTHESIA FOR PROCEDURES ON HEART, PERICARDIAL SAC, AND GREAT VESSELS OF. 2014 Cadillac Ats Headlight Bulb Replacement, CPT-4 Tabular list to procedures/services. PDFCPT-4 Tabular list to procedures/services . separately in addition to code for primary procedure) . 69805 Endolymphatic sac operation; without shunt. 2014 Cadillac Srx Headlight Bulb Replacement, ANNEX 2. LIST OF PROCEDURE CASE RATES ( .. PDFANNEX 2. LIST OF PROCEDURE CASE RATES (REVISION 2.0). RVS CODE. DESCRIPTION. FIRST CASE RATE. 24516. Open treatment of humeral shaft fracture, w/ insertion . 2014 Grand Cherokee Headlight Bulb, codedescriptions.txt. 06050 SURGICAL PLACEMENT: TRANSOSTEAL IMPLANT Dental Procedure code. . UNABLE TO DETERMINE NUMBER PLACENTA OR AMNIOT SAC DiagCd 66091 OBSTRUCT LABOR . 3m Guide Coat, Ambulatory Surgery Center Maximum Allowable Fee Schedule. PDFPROC - THE PROCEDURE CODE RECOGNIZED BY WISCONSIN MEDICAID TO IDENTIFY THE . 0079T PLACEMENT OF VISCERAL EXTENSION PROSTHESIS FOR ENDOVASCULAR REPAIR OF . 2014 Mazda 3 Headlight Bulb, Physicians as Assistants at Surgery: 2016 Update. PDFIt should be noted that unlisted procedure codes are not included in this table because . 33330 Insertion of graft, aorta or great vessels; without shunt, . 2014 Ram 2500 Headlight Bulb, Sheet1 - General Surgery Residency. XLS600, 49425, Insertion of peritoneal-venous shunt, ABDOMEN-GENERAL, 3050, OTHER MAJOR AB-GENERAL . 4801, 69806, Endolymphatic sac operation; with shunt . 2014 Silverado Headlight Bulb Size, Chargemaster 11-2018. XLS1, Name, CPT® Code (Procedure), Standard Fee. 2, Anesthesia Time, 500.00 . 4013, ENDOLYMPHATIC SAC W/O SHUNT, 69805, 12,565.00. 4014, ENDOLYMPHATIC SAC . 4 In 1 Coat, Same-day ACHI Procedure Codes. XLSThe list of Same-day ACHI Procedure Codes is predominantly based on the . Insertion of other nasolacrimal tube/stent into lacrimal/conjunctival sac for . 2015 Camaro Headlight Bulb, WA Surprise Billing Dataset - February 2023. XLS104, After removing all claims with procedure modifier codes affecting payment, . 3885, 69806, ENDOLYMPHATIC SAC SHUNT, Other, In Network, <11 claims, . 2015 Dodge Dart Headlight Bulb Replacement, South Dakota Medicaid Physician Services Fee Schedule. PDFJul 1, 2023 — Separately In Addition To Code For Primary Procedure) . Endolymphatic Sac Operation; Without Shunt. $958.25. Adidas Forum Low Cream White Black, PB. XLS1, Procedure Master#, Procedure Record Name, CPT/HCPCS Code, Unit Charge . 6445, 69806, ENDOLYMPH SAC OP W SHUNT, 69806, $10,344.00. 2015 Hyundai Sonata Headlight Bulb Replacement, SHP Professional Fee Schedule Draft v2.0 06132019 FINAL. PDFJun 14, 2019 — The appearance of a code on this fee schedule is not a guarantee of coverage or payment. . ENDOLYMPHATIC SAC OPERATION; WITHOUT SHUNT. 2015 Kia Forte Headlight Bulb, PB Charge List and CPT Frequency by Fee Schedule. XLS7, CPT(R)/HCPCS Code, Procedure Description, Unit Price . 2087, 69805, PR ENDOLYMPH SAC OPERATN,NO SHUNT, 2,314.00. 2088, 69806, PR ENDOLYMPH SAC OP W . A & A Coating, OUTPATIENT SURGERY FEE SCHEDULE. PDFJul 27, 2012 — 11960 INSERTION OF TISSUE EXPANDERS . 15936 EXV SAC PRE ULCER W MUS-MYOCUT FLAP CLOS . 36835 INSERTION OF THOMAS SHUNT SEPARATE PROC. 2015 Scion Tc Headlight Bulb, Sheet1. XLS157, 159, AMB REFERRAL TO ORAL MAXILLOFACIAL SURGERY, REF59 . 457, 519, FULL CODE, COD2 . 7329, 18324, PR ENDOLYMPH SAC OPERATN,NO SHUNT, 69805.complete list. XLS7, Code, Operation, LOS, Surgeon, Anesthetist, Consultant, Hospital I . 49, A9805G, A, 9805, G, Endolymphatic sac operation: with or without shunt .CPT Codes. XLS35, CPT_CODE, Procedure code authed (see cpt code tab), 8 A/N, 8, 639, 646 . 45, DRUG_CODE, National drug code (natl_drug_code list to large to attach) .CPT Description Amount. PDF0376T Insertion of anterior segment aqueous drainage device, . 20670 REMOVAL IMPLANT SUPERFICIAL SEPARATE PROCEDURE . 69806 ENDOLYMPHATIC SAC SHUNT.Florida Medicaid. PDFJan 1, 2012 — Codes identified as “separate procedure” in the most recent. Physician's Current Procedural Terminology (CPT) code book,.Bupa Schedule of Procedures. XLS371, A5300, Drainage of spinal canal (including insertion of shunt), 3 Spine, . 518, D2610, Operation(s) on endolymphatic sac, 5 Ear, nose and throat .SHP Professional Fee Schedule. XLS2, ***If a CPT code is not listed in the attached it means the service is not . 8033, S2P, 69806, $1,394.45, ENDOLYMPHATIC SAC OPERATION; WITH SHUNT.CDM. XLS1, CPT CODE, HB Procedure Name, PB Procedure Name, HB Unit Price, PB Unit Price . 5692, 69806, #N/A, PR ENDOLYMPH SAC OP W SHUNT, #N/A, $3,699.50.Clinical Policy Bulletin: Evoked Potential Studies. PDFMar 25, 2015 — a. Chiari malformation surgery b. Correction of cerebral vascular aneurysms c. Deep brain stimulation d. Endolymphatic shunt for Meniere's .The Collaborative Surgery Center - Green Mountain Care Board. PDFJul 30, 2021 — very common procedure, like placement of ear tubes, can cost patients and . when compared to HOPD rates for top 20 CPT codes performed).NYCHH Charges. XLS1, Revenue Code, CPT Code, Procedure Description, Charge Amount . 8723, 69805, ENDOLYMPHATIC SAC OPERATION; W, $7,243.23. 8724, 69806, ENDOLYMPHATIC SAC .UPFS CODE BOOK 2020. XLS(this interpretation code is included in procedure 1233), A . 1768, 2613, Foetal shunt placement, C, C . 2387, 3240, Endolymphatic sac surgery, C, D.Outpatient and Surgical Day Care List July 2021. PDFCPT Code. Description. Operations on the Cardiovascular System . Endolymphatic sac operation; without shunt. 69806. Endolymphatic sac operation .TABLE OF SURGICAL PROCEDURES. PDFFeb 1, 2021 — Revision surgery codes apply to revision performed at the same level as primary operation. If procedure is performed for adjacent segment .CCHI-BS Code Set. XLSSep 27, 2020 — 41, 42, Insertion and removal of spinal cerebrospinal fluid shunt . unilateral, Decompression of endolymphatic sac with shunt, unilateral .induced endolymphatic hydrops: Topics by .. In conclusion, endolymphatic sac surgery does not always alleviate . Hearing outcome after concurrent endolymphatic shunt and vestibular nerve section.MMP Services that require prior auth list 10-01-2018.xlsx. PDFOct 1, 2018 — HAP's Benefit Coverage Policies and Procedure Reference Lists apply to all HAP lines of business . Endolymphatic sac operation; with shunt.Surgery (trigger bundle). XLS16, 10035, PLACEMENT OF SOFT TISSUE LOCALIZATION DEVICE(S) (EG, CLIP, . 3774, 69805, ENDOLYMPHATIC SAC OPERATION; WITHOUT SHUNT, $3,424.55, 10/01/2017.2013 Utah State-Level Ambulatory Surgery Procedures. PDF00130:ALIMENTARY TESTS AND SIMPLE TUBE PLACEMENT . DE-SAC. Page 77 of 891. 07/26/2023. 2013 Utah State-Level Ambulatory . 2071 :ENDOLYMPHATIC SHUNT.Code Description Fee 0001M Infectious disease, HCV, six .. PDFseparately in addition to code for primary procedure performed). 0197T. Intra-fraction localization and . Endolymphatic sac operation; without shunt.Cayman Islands Health Services Authority Charge Master. PDFRow # Bill Code. Modifier. CPT-4. HCPCS. CPT/HCPCS Long Description . Anesthesia for transvenous insertion or replacement of pacing.CPT Codes | PDF. CPT_CODE 10021 10022 10040 10060 10061 10080 10081 10120 10121 10140 10160 10180 . ENDOLYMPHATIC SAC OPERATION; WITHOUT SHUNT ENDOLYMPHATIC SAC OPERATION; .40th Annual MidWinter Meeting. PDFWhy do we need stem cells in cochlear implant surgery? One of the main challenges is poor . endolymphatic sac operation, the next operative step.REIMBURSEMENT POLICY Disclaimer. PDFJun 1, 2017 — duplication/multiplication is trans) (List separately in addition to code for primary procedure). 1. 0075T. Transcatheter placement of .Daman Published Rates. PDFProcedures). HCPCS = Healthcare Common Procedure Coding System. Code . CPT. 00560. Anesthesia for procedures on heart, pericardial sac, and.Wellfleet Final List. XLS1, CPT, 2018 Descriptor, Wellfleet List. 2, 15734, Muscle, myocutaneous, . 3260, 69806, Endolymphatic sac operation; with shunt, Almost Never.Aetna international Doctors Fees. PDFCreation of ventriculoperitoneal shunt . Drainage of spinal canal (including insertion of shunt). Major Plus . Operation(s) on endolymphatic sac.MA PreAuth List 5.13.20. XLS15, 00176, cpt, Anesthesia for surgery on mouth, This code is on the . 112, 0219T, cpt, Insertion of upper spine facet joint implants, This code is on the .Medical Procedures - Discovery. XLSOct 1, 2020 — 3, R0.00: Discovery Health does not pay for this procedure code. . 180, 5080, Transjugular intrahepatic porto-systemic shunt, 93.750 .2015 ASC Coding Update for Glaucoma Surgery. Feb 1, 2015 — The codes for aqueous shunt placement (CPT code 66179) + scleral reinforcement (CPT code 67255) + modifier 59 to break the NCCI bundles should .Missing: endolymphatic ‎sacItem Master CPT Code Charge 6090610 .. PDFCPT Code Charge . 2336558 ANS PLACEMENT OF CENTRAL VENOUS CATHETER . 1269805 ENDOLYMPHATIC SAC OPERATION W/O SHUNT.The Massachusetts Register. PDFMar 5, 2010 — The Division may publish procedure code updates and . Any use of CPT outside the fee . Endolymphatic sac operation; without shunt.Understanding Current Procedural Terminology and HCPCS .. Mary Jo Bowie · 2018 · ‎Business & Economics. Instructions: Using the CPT manual, assign the correct code to each of the following procedures. 1. Endolymphatic sac operation with shunt placement 2.Summary Sheet. XLS1104, 176, 1, INSERTION, REVISION & REPLACEMENTS OF PACEMAKER & OTHER CARDI . 5862, 69805, Endolymphatic sac operation, wo shunt, 1,739.03, 15,793.44.Service Bundle. XLSJul 1, 2022 — 51, Avera St. Luke's Hospital, Knee Arthroscopy/Surgery . 459, Avera St. Luke's Hospital, Endolymphatic Sac Operation; With Shunt .1 Dec. 6, 2017 Procedure Code List for Preauthorization for .. PDFDec 6, 2017 — Procedure Code List for Preauthorization for. Blue Cross and Blue Shield of New Mexico. Medicare Advantage Members Only.