January 2007
Cahaba Government Benefit Administrators (GBA) has a list of procedures considered as “Once in a Lifetime” that was consolidated in November 2006 for all Cahaba GBA Part B Medicare sites. There are edits in the system for these procedures. Please see the following list of procedures that are considered to be “Once In A Lifetime”.
| CPT Code | DESCRIPTION |
|---|---|
| 23900 | Interthoracoscapular amputation (forequarter) |
| 24900 | Amputation arm through humerus |
| 24920 | Amputation arm through humerus |
| 25900 | Amputation forearm |
| 25905 | Amputation forearm |
| 27290 | Interpelviabdominal amputation |
| 27295 | Disarticulation of hip |
| 27590 | Amputation, thigh |
| 27591 | Amputation, thigh |
| 27592 | Amputation, thigh |
| 27880 | Amputation, leg |
| 27881 | Amputation, leg |
| 27882 | Amputation, leg |
| 28800 | Amputation, foot |
| 28805 | Amputation, transmetatarsal |
| 30160 | Rhinectomy, total |
| 31360 | Laryngectomy, total |
| 31365 | Laryngectomy, total |
| 31390 | Pharynolaryngectomy |
| 31395 | Pharynolaryngectomy |
| 31400 | Arytenoidectomy or artenoidopexy |
| 32440, 32442, 32445 | Removal of lung, Total pneumonectomy |
| 38100 | Splenectomy |
| 38102 | Splenectomy (with other procedure) |
| 38120 | Laparoscopy, surgical, splenectomy |
| 41140, 41145 | Complete or total glossectomy |
| 41150 | composite procedure w/ floor mouth/mandibular.resection |
| 41153 | composite procedure w/ floor mouth resection |
| 41155 | composite procedure w/ floor mouth resection |
| 41821 | Operculectomy |
| 42140 | Uvulectomy |
| 42820, 42825 | Tonsillectomy (<12) |
| 42821, 42826 | Tonsillectomy (>12) |
| 42830, 42835 | Adenoidectomy (<12) |
| 42831, 42836 | Adenoidectomy (>12) |
| 42842, 42844, 42845 | Radical resection, tonsils |
| 43107, 43108 | Esophagectomy, total (without thoracotomy) |
| 43112, 43113 | Esophagectomy, total (with thoracotomy) |
| 43620, 43621, 43622 | Total gastrectomy |
| 44150-44156 | Colectomy, total |
| 44160 | Colectomy, partial w/removal terminal ileum and ileocolostomy |
| 44950, 44955, 44960 | Appendectomy |
| 44970 | Lap surgical appendectomy |
| 45110, 45112 | Proctectomy |
| 45119 | Proctectomy with creation of colonic reservoir |
| 45120, 45121 | Procetectomy with pull through procedure/anastomosis |
| 47122 | Hepatectomy; trisegmentectomy |
| 47125 | Hepatectomy; total left lobectomy |
| 47130 | Hepatectomy; trisegmentectomy |
| 47135 | Liver allotransplantation, partial or whole |
| 47562 | Cholecystectomy, laparascopic, surgical |
| 47563 | Cholecystectomy, laparascopic, surgical |
| 47564 | Cholecystectomy, laparascopic, surgical |
| 47600 | Cholecystectomy |
| 47605 | Cholecystectomy |
| 47610 | Cholecystectomy |
| 47612 | Cholecystectomy |
| 47620 | Cholecystectomy |
| 48155 | Pancreatectomy, total |
| 48160 | Pancreatectomy, total or subtotal |
| 50220 | Nephrectomy |
| 50225 | Nephrectomy |
| 50230 | Nephrectomy |
| 50234 | Nephrectomy |
| 50236 | Nephrectomy |
| 51570, 51575, 51580, 51585, 51590, 51595 | Cystectomy, complete |
| 51596 | Cystectomy, complete w/continent diversion |
| 51597 | Pelvic exenteration, complete |
| 52601 | Transurethral resection of prostate |
| 53210 | Urethrectomy, total, female |
| 53215 | Urethrectomy, total, male |
| 54125 | Amputation of penis, complete |
| 54130 | Amputation of penis, radical |
| 54135 | Amputation of penis, radical |
| 54152 | Circumcision, except newborn |
| 54161 | Circumcision, except newborn |
| 54861 | Epididymectomy, bilateral |
| 55810, 55812, 55815, 55821, 55831 | Prostatectomy, perineal radical |
| 55840, 55842, 55845 | Prostatectomy, retropubic radical |
| 57110 | Vaginectomy |
| 57111 | Vaginectomy |
| 57112 | Vaginectomy |
| 57530 | Trachelectomy (cervicectomy) |
| 57531 | Radical trachelectomy |
| 58150 | Total abdominal hysterectomy (w or w/o tube removal) |
| 58152 | Total abdominal hysterectomy w/colpo-urethrocystopexy |
| 58200 | Total abdominal hysterectomy, including partial vaginectomy) |
| 58210 | Radical abdominal hysterectomy |
| 58240 | Pelvic exenteration w/total hysterectomy |
| 58260 | Vaginal hysterectomy (uterus 250 or <) |
| 58262, 58263 | Vaginal hysterectomy (uterus 250 or <, w/ tube removal) |
| 58267, 58270 | Vaginal hysterectomy w/colpo-urethrocystopexy |
| 58275, 58280, 58285 | Vaginal hysterectomy |
| 58290 - 58294 | Vaginal hysterectomy - uterus > 250 grams) |
| 58550, 58552 | Laparoscopy, surgical, with vaginal hysterectomy |
| 58953, 58954 | Bilateral salpingo-oophorectomy |
| 60220 | Total thyroid lobectomy, unilateral |
| 60240 | Thyroidectomy, total |
| 60252 | Thyroidectomy, total or subtotal |
| 60254 | Thyroidectomy, total or subtotal |
| 60260 | Thyroidectomy, removal of remaining tissue after previous removal of a portion of thyroid |
| 60270, 60271 | Thyroidectomy, including substernal thyroid |
| 60520, 60521, 60522 | Thymectomy, partial or total |
| 60540, 60545 | Adrenalectomy, partial or complete |
| 60650 | Laparoscopy, surgical with adrenalectomy |
| 61490 | Craniotomy for lobotomy |
| 65101, 65103, 65105 | Enucleation of eye |