[Federal Register Volume 59, Number 204 (Monday, October 24, 1994)]
[Unknown Section]
[Page 0]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 94-26081]
[[Page Unknown]]
[Federal Register: October 24, 1994]
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DEPARTMENT OF DEFENSE
Office of the Secretary
Medical Services Reimbursement Rates for Fiscal Year 1995
Notice is hereby given that the Deputy Comptroller (Financial
Systems) in a memorandum dated September 2, 1994, established the
following reimbursement rates for inpatient and outpatient medical care
to be provided in FY 1995.
Inpatient, Outpatient, and Other Rates and Charges
I. Inpatient Rates\1\,\2\
----------------------------------------------------------------------------------------------------------------
Interagency
International other
Military federal
Per inpatient day Education and agency Other
Training sponsored
(IMET) patients
----------------------------------------------------------------------------------------------------------------
A. Burn Center........................................................... $2,053 $3,532 $3,781
B. Surgical Care Services (Cosmetic Surgery)............................. 473 1,057 1,122
C. All Other Inpatient Services (Based on Diagnosis Related Groups (DRG)
Charges\3\.............................................................. ............. ........... .........
----------------------------------------------------------------------------------------------------------------
Explanations at end of docket.
1. FY 1995 Direct Care Inpatient Reimbursement Rates
----------------------------------------------------------------------------------------------------------------
Interagency Full cost Third
Adjusted Standard Amount IMET party
----------------------------------------------------------------------------------------------------------------
Large urban....................................................... $1,670 $3,679 $3,908 $3,908
Other urban....................................................... 1,954 3,997 4,267 4,267
Rural............................................................. 2,085 4,744 5,066 5,066
Overseas.......................................................... 2,146 4,794 5,089 5,089
----------------------------------------------------------------------------------------------------------------
2. Overview
The FY 1995 inpatient rates are based on the cost per DRG which is
the inpatient full reimbursement rate per hospital discharge, weighted
to reflect the intensity of the principal diagnosis involved. The
average costs per Relative Weighted Product (RWP) for large urban,
other urban, rural, and overseas facilities will be published annually
as an inpatient standardized amount. (See item 1 above). A relative
weight for each DRG using the standardized amount will be the same as
the DRG weights published annually for hospital reimbursement rates
under the Civilian Health and Medical Program of the Uniformed Services
(CHAMPUS) pursuant to 32 CFR 199.14(a)(1) which includes adjustments
for outliers, area wages, and indirect medical education. An example of
how to apply DoD costs to a DRG standardized weight to arrive at DoD
costs is contained in part 3 of Section I.C., below.
3. Example of Adjusted Standardized Amounts for Procedures Performed
Large Urban Area--Example
a. The cost to be recovered is DoD's cost for medical services
provided in a large urban area. Billings will be at the third party
rate.
b. DRG: Nervous System infection except viral meningitis Relative
Weight of Procedure 1.8427
c. The DoD adjusted standardized amount to be recovered is $3,908
(i.e., the third party rate as shown in the table).
d. DoD cost to be recovered is the RWP factor (1.8427) in item 3b,
above, times the amount ($3,908) in 3c, above.
Cost to be recovered is $7,201.
II. Outpatient Rates\1\\2\
----------------------------------------------------------------------------------------------------------------
International Interagency &
Military other Federal
MEPRS code* Per Visit Clinical Service Education And agency- Other
Training sponsored
(IMET) patients
----------------------------------------------------------------------------------------------------------------
A. Medical Care
----------------------------------------------------------------------------------------------------------------
BAA................. Internal medicine.............................. $72 $144 $153
BAC................. Cardiology..................................... 57 114 121
BAF................. Endocrinology.................................. 64 129 138
BAG................. Gastroenterology............................... 68 137 145
BAH................. Hematology..................................... 99 199 210
BAJ................. Nephrology..................................... 67 135 143
BAK................. Neurology...................................... 59 118 126
BAM................. Oncology....................................... 54 108 116
BAN................. Pulmonary disease.............................. 59 118 125
BAO................. Rheumatology................................... 61 123 130
BAP................. Dermatology.................................... 42 85 91
BAQ................. Infectious disease............................. 46 92 98
BAR................. Physical medicine.............................. 56 113 120
BAB................. Allergy........................................ 22 44 49
BAE................. Diabetes....................................... 25 50 54
BAI................. Hypertension................................... 26 52 56
BAL................. Nutrition...................................... 16 33 35
----------------------------------------------------------------------------------------------------------------
B. Surgical Care
----------------------------------------------------------------------------------------------------------------
BBA................. General surgery................................ 67 135 141
BBB................. Cardiovascular/Thoracic surgery................ 81 162 169
BBC................. Neurosurgery................................... 93 187 195
BBD................. Ophthalmology.................................. 53 107 112
BBE................. Organ transplant............................... 128 257 268
BBF................. Otolaryngoloy.................................. 60 121 126
BBG................. Plastic surgery................................ 77 154 160
BBH................. Proctology..................................... 54 108 114
BBI................. Urology........................................ 75 150 158
BBJ................. Pediatric surgery.............................. 30 60 64
----------------------------------------------------------------------------------------------------------------
C. Obstetrical and Gynecological (OB-GYN)
----------------------------------------------------------------------------------------------------------------
BCA................. Family planning................................ 49 99 105
BCB................. Gynecology..................................... 50 100 106
BCC................. Obstetrics..................................... 46 93 99
----------------------------------------------------------------------------------------------------------------
D. Pediatric Care
----------------------------------------------------------------------------------------------------------------
BDA................. Pediatric...................................... 40 80 86
BDB................. Adolescent..................................... 39 78 83
BDC................. Well baby...................................... 25 50 55
----------------------------------------------------------------------------------------------------------------
E. Orthopaedic Care
----------------------------------------------------------------------------------------------------------------
BEA................. Orthopaedic.................................... 67 134 140
BEC................. Hand surgery................................... 37 74 78
BED/BLC............. Neuromuscularskeletal.......................... 26 52 55
BEE................. Orthopaedic appliance.......................... 44 88 93
BEF................. Podiatry....................................... 36 72 77
----------------------------------------------------------------------------------------------------------------
F. Psychiatric and/or Mental Health Care
----------------------------------------------------------------------------------------------------------------
BFB................. Psychology..................................... 49 99 104
BFC................. Child guidance................................. 39 79 84
BFA/BFD............. Mental health.................................. 54 108 114
BFE................. Social work.................................... 40 81 86
BFF................. Substance abuse rehabilitation................. 41 82 87
----------------------------------------------------------------------------------------------------------------
G. Primary Medical Care
----------------------------------------------------------------------------------------------------------------
BGA/BHA............. Family practice/primary........................ 45 90 96
BHB................. Medical examination............................ 43 86 91
BHC................. Optometry...................................... 30 60 64
BHD................. Audiology clinic............................... 25 50 54
BHE................. Speech pathology............................... 39 78 82
BHF................. Community health............................... 35 70 75
BHG................. Occupational health............................ 36 72 76
BHI................. Immediate care clinic.......................... 59 119 125
----------------------------------------------------------------------------------------------------------------
H. Emergency Medical Care
----------------------------------------------------------------------------------------------------------------
BIA................. Emergency care clinic.......................... 72 144 151
----------------------------------------------------------------------------------------------------------------
I. Flight Medicine Clinic
----------------------------------------------------------------------------------------------------------------
BJA................. Flight medicine................................ 63 126 132
----------------------------------------------------------------------------------------------------------------
J. Underseas Medicine Care
----------------------------------------------------------------------------------------------------------------
BKA................. Underseas medicine clinic...................... 42 85 90
----------------------------------------------------------------------------------------------------------------
K. Rehabilitative Services
----------------------------------------------------------------------------------------------------------------
DHB................. Occupational therapy........................... 24 48 51
DHD................. Physical therapy............................... 17 35 38
----------------------------------------------------------------------------------------------------------------
L. Same Day Surgery
----------------------------------------------------------------------------------------------------------------
Same day surgery............................... 169 340 361
----------------------------------------------------------------------------------------------------------------
*The Medical Expense and Performance Reporting System (MEPRS) code is a three digit code which defines the
summary account and the subaccount within a functional category in the DoD medical system. An example of this
hierarchal arrangement is as follows:
Outpatient Care (Functional Category) MEPRScode
Medical Care (Summary Account)........................ BA
Internal Medicine (Subaccount)........................ BAA
MEPRS codes are used to ensure that consistent financial and operating
performance data is reported in the DoD military medical system.
Explanations at end of docket.
III. Other Rates and Charges
----------------------------------------------------------------------------------------------------------------
International Interagency,
Military other federal
Education and agency Other
Training sponsored
(IMET) patients
----------------------------------------------------------------------------------------------------------------
A. Immunizations................................................ $9 $18 $19
B. Hyperbaric services:
1-60 minutes................................................ 81 163 169
61-120 minutes.............................................. 162 325 338
121-180 minutes............................................. 243 488 506
181-240 minutes............................................. 324 650 675
C. Family member rate (Formerly military dependents rate)....... .............. 9.50 ..............
----------------------------------------------------------------------------------------------------------------
(Note: Charges may be prorated based on usage)
D. Third Party Drug Reimbursement Rates\4\
Upon request, a complete list of the FY 1995 third party drug
reimbursement rates may be obtained in electronic format. All requests
for this information should be addressed to: Third Party Collection
Program Officer, OASD(HA)/HSO&R/OMS, The Pentagon, Rm 3E343,
Washington, DC 20301-1200.
The following is a listing of the dosage form description used in
connection with pharmaceuticals being dispensed. See note 4 to
reimbursable rates for cost of dispensing drugs.
----------------------------------------------------------------------------------------------------------------
Dosage form Description Interpretation
----------------------------------------------------------------------------------------------------------------
AA.................. Aerosol............................ Aerosol (ML).
AB.................. Aerosol............................ Aerosol (GM).
AC.................. Aerosol............................ Aerosol (EA).
AD.................. Aer Refill......................... Aerosol Refill (ML).
AE.................. Aer Refill......................... Aerosol Refill (EA).
AF.................. Foam............................... Aerosol Foam.
AG.................. Aer Refill......................... Aerosol Refill (GM).
AH.................. Aer Adap........................... Aerosol w/Adapter (ML).
AI.................. Aer W/Adap......................... Aerosol w/Adapter (EA).
AJ.................. Aer Adap........................... Aerosol wo/Adapter (GM).
AK.................. AR Powder.......................... Aerosol Powder (EA).
AL.................. Ampul-Neb.......................... Ampul for Nebulization (ML).
AM.................. Mist............................... Aerosol, Mist.
AN.................. Vial-Neb........................... Vial Nebulizer.
AP.................. Aero Powd.......................... Aerosol Powder (GM).
AQ.................. Spray.............................. Spray (GM).
AR.................. Spray Rfi.......................... Spray Refill (ML).
AS.................. Spray.............................. Aerosol, Spray (ML).
AT.................. Spray/Pump......................... Aerosol, Spray w/Pump (ML).
AW.................. Foam/appl.......................... Aerosol, Foam with applicator.
CA.................. Capsule............................ Capsule (hard, soft, etc.)
CE.................. Capsule EC......................... Capsule, Enteric Coated.
CK.................. Sprinkle........................... Sprinkle Capsule.
CP.................. Cap Pellet......................... Pellets in Capsule.
CS.................. Capsule SA......................... Capsule, Sustained Action.
CT.................. Capsule SA......................... Capsule, Degradable Controlled-Release.
EA.................. Each............................... Each.
EB.................. Bar................................ Bar.
EC.................. Cake............................... Cake.
ED.................. Med. Soap.......................... Soap, Medicated (EA).
EE.................. Liq Soap........................... Soap, Liquid.
EF.................. Dental Cone........................ Dental Cone.
EG.................. Med. Dress......................... Dressing, Medicated (EA).
EH.................. Stick.............................. Stick.
EJ.................. Plaster............................ Plaster.
EK.................. Poultice........................... Poultice.
EL.................. Med. Swab.......................... Swab, Medicated.
EM.................. Med. Gauze......................... Guaze, Medicated.
EN.................. Med. Tape.......................... Tape, Medicated.
EP.................. Med. Soap.......................... Soap, Medicated (ML).
ER.................. Med. Soap.......................... Soap, Medicated (GM).
ES.................. Med. Dress......................... Dressing, Medicated (GM).
ET.................. Med. Pad........................... Pads, Medicated (EA).
GA.................. Gas................................ Gas.
GH.................. Inhaler............................ Inhaler (ML).
GI.................. Inhaler............................ Inhaler (EA).
GJ.................. Inhaler kit........................ Inhaler Kit (EA).
GZ.................. Inhaler............................ Inhaler (GM).
HA.................. Infus. Btl......................... Infusion Bottle (EA).
HB.................. Infus. Btl......................... Infusion Bottle (ML).
HC.................. Pipette............................ Pipette (EA).
HD.................. Pipette............................ Pipette (ML).
HE.................. Allergen........................... Allergen.
HH.................. Ampul.............................. Ampul (ML).
HI.................. Cartridge.......................... Cartridge (EA).
HJ.................. Cartridge.......................... Cartridge (ML).
HM.................. IV Soln............................ Intravenous Solution
HN.................. Piggyback.......................... Intravenous Solution, Piggyback (EA).
HP.................. Piggyback.......................... Intravenous Solution, Piggyback (ML).
HQ.................. Disp Syrin......................... Disposable Syringe (ML).
HR.................. Ampul.............................. Ampul (EA).
HS.................. Vial............................... Vial (SDV, MDV or Additive) (EA).
HT.................. Skin Test.......................... Skin Test.
HU.................. Plast. Bag......................... Plastic Bag, Injection (EA).
HV.................. Vial............................... Vial (SDV, MDV or Additive) (ML).
HW.................. Add. Syrin......................... Additive Syringe.
HX.................. Disp Syrin......................... Disposable Syringe (EA).
HY.................. IP Soln............................ Intraperitoneal Solution.
HZ.................. Plast. Bag......................... Plastic Bag, Injection (ML).
JA.................. Jelly.............................. Jelly.
JB.................. Jel................................ Jel (ML).
JC.................. Gel................................ Gel (ML).
JD.................. Jel................................ Jel (GM).
JE.................. Beads.............................. Beads.
JG.................. Gel................................ Gel (ML).
JH.................. Pudding............................ Pudding (EA).
JJ.................. Pudding............................ Pudding (GM).
JV.................. Gel/Appl........................... Gel with Applicator.
JW.................. Jelly/Appl......................... Jelly with Applicator.
KA.................. Cream.............................. Cream.
KL.................. Lubricant.......................... Lubricant.
KP.................. Paste.............................. Paste.
KT.................. Toothpaste......................... Toothpaste.
KW.................. Cream/Appl......................... Cream with Applicator.
OA.................. Ointment........................... Ointment.
OW.................. Oint/Appl.......................... Ointment with Applicator.
PA.................. Powder............................. Powder (GM).
PB.................. Leaves............................. Leaves (GM).
PC.................. Crystals........................... Crystals.
PE.................. Powder Effer....................... Powder Effervescent.
PF.................. Flakes............................. Flakes.
PG.................. Granules........................... Granules, Powder-like, Non-effervescent.
PL.................. Cleanser........................... Cleanser.
PM.................. Lump............................... Lump.
PP.................. Packet............................. Packet.
PS.................. Adh. Patch......................... Adhesive Patch, Medicated.
PT.................. Tooth Powd......................... Tooth Powder.
PU.................. Powder............................. Powder (EA).
QA.................. Suppos............................. Suppository.
QB.................. Insert............................. Insert.
SA.................. Solution........................... Solution, Topical EENT
SB.................. FI Extract......................... Fluid Extract
SC.................. Oral Susp.......................... Suspension, Oral (final dose form) (ML).
SD.................. Douche............................. Douche.
SE.................. Elixir............................. Elixir
SF.................. Enema.............................. Enema (ML).
SG.................. Enema.............................. Enema (EA).
SH.................. Expect............................. Expectorant.
SI.................. Liniment........................... Liniment.
SJ.................. Solution........................... Solution, Oral.
SK.................. Lotion............................. Lotion (ML).
SL.................. Liquid............................. Liquid.
SM.................. Mouthwash.......................... Mouthwash.
SN.................. Powder............................. Powder (ML).
SO.................. Drops.............................. Drops.
SP.................. Spirit............................. Spirit.
SQ.................. Oil................................ Oil.
SR.................. Suspension......................... Suspension, Topical.
SS.................. Shampoo............................ Shampoo.
ST.................. Syrup.............................. Syrup.
SU.................. Emulsion........................... Emulsion.
SV.................. Gran Eff........................... Grnules, Effervescent.
SW.................. Irrig Soln......................... Solution, Irrigating.
SX.................. Tincture........................... Tincture.
SY.................. Oral Conc.......................... Concentrate, Oral.
SZ.................. Lotion............................. Lotion (GM).
TA.................. Tablet............................. Tablet (compressed, sugar coated caplets)
TB.................. Tablet Sol......................... Tablet, Soluble
TC.................. Tab Chew........................... Tablet, Chewable.
TD.................. Disk............................... Disk.
TE.................. Tablet EC.......................... Tablet, Enteric Coated.
TF.................. Tablet, Eff........................ Tablet, Effervescent.
TG.................. Gum................................ Gum.
TH.................. Tablet Hyp......................... Tablet, Hypodermic.
TL.................. Lozenge............................ Lozenge.
TN.................. Granules........................... Granules, Oral Tablet-like or Packets.
TP.................. Pellet............................. Pellet.
TR.................. Tab Part........................... Particles in tablet, pH dependent.
TS.................. Tablet SA.......................... Tablet, Sustained Action.
TT.................. Troche............................. Troche.
TU.................. Tab Subl........................... Tablet, Sublingual.
TV.................. Tab Buccal......................... Tablet, Buccal.
TW.................. Wafer.............................. Wafer.
TX.................. Pill............................... Pill.
TY.................. Tab Buc SA......................... Tablet, Buccal Sustained Action.
UN.................. Unit............................... Unit.
WH.................. Whip............................... Whip.
YA.................. Needle............................. Needle, Reusable.
YB.................. Bulk............................... Bulk.
YC.................. Syringe............................ Syringe, Reusable.
YD.................. Diaphragm.......................... Diaphragm.
YE.................. Dressing........................... Dressing.
YF.................. Lense.............................. Lense.
YG.................. Gauze.............................. Gauze, Non-Medicated.
YH.................. Dis Needle......................... Needle, Disposable.
YI.................. IUD................................ Intrauterine Device.
YJ.................. Crwl Syrin......................... Syringe, Cornwall.
YK.................. Kit................................ Kit.
YL.................. Disp Syrin......................... Syring, Empty Disposable.
YM.................. Pad................................ Pad.
YN.................. Tampon............................. Tampon.
YP.................. IP Set............................. Intraperitoneal Admin. Sets--Paraphernalia.
YQ.................. IV Set............................. Intravenous Admin. Sets--Paraphernalia.
YR.................. Strip.............................. Strip.
YS.................. Suture............................. Suture.
YT.................. Tape............................... Tape.
YU.................. Irrig Set.......................... Irrigation Set.
YV.................. Sponge............................. Sponge.
YW.................. Swab............................... Swab, non-Medicated.
YX.................. IV Access.......................... Intravenous Admixture Accessories.
YZ.................. Blood Set.......................... Blood Administration Set.
ZA.................. Miscell............................ Miscellaneous.
ZB.................. Box................................ Box.
ZC.................. Bottle............................. Bottle.
ZD.................. Combo. Pkg......................... Combination Package.
ZE.................. Carton............................. Carton.
ZP.................. Package............................ Package.
ZT.................. Tray............................... Tray.
----------------------------------------------------------------------------------------------------------------
Explanations at end of docket.
E. High Cost Services Requested By External Providers\5\
----------------------------------------------------------------------------------------------------------------
International Interagency
Resource based military other Federal
relative value scale Service provided education and agency sponsored Other
training (IMET) patients
----------------------------------------------------------------------------------------------------------------
0040................ Chest, PA/Lat/Bilat Decub........... $34 $68 $72
0063................ Chest, Portable..................... 35 70 74
0783................ Bilat Ankles & Stress Views......... 41 82 87
1090................ Bilat Hips & Dan Miller............. 43 85 90
1250................ Skeletal Survey..................... 120 240 254
1251................ Skeletal Survey (Exam).............. 73 146 155
1252................ Skeletal Survey (Read).............. 47 94 100
1253................ Arthritic Survey.................... 87 173 184
1254................ Arthritic Survey (Exam)............. 55 110 117
1255................ Arthritic Survey (Read)............. 32 64 67
1256................ Metastatic Bone Survey.............. 120 240 254
1257................ Metastatic Bone Survey (Exam)....... 73 146 155
1258................ Metastatic Bone Survey (Read)....... 47 94 100
3000................ Upper GI Series..................... 34 68 72
3003................ UGI, Air Contrast................... 36 72 77
3046................ UGI, Other.......................... 34 68 72
3050................ Barium Enema........................ 37 74 78
3053................ BE, Air Contrast.................... 50 100 106
3056................ BE, Thru Colostomy.................. 50 100 106
3096................ BE, Other........................... 37 74 78
3109................ Enteroclysis........................ 53 106 113
3110................ Enteroclysis (Exam)................. 32 64 67
3133................ Cholangiogram, Operative............ 51 102 108
3134................ Cholangiogram, Operative (Exam)..... 38 76 80
3136................ Cholangiogram, Transhepatic......... 100 200 213
3137................ Cholangiogram, Transhepatic (E)..... 38 76 80
3138................ Cholangiogram, Transhepatic (R)..... 63 125 132
3140................ Cholangiogram, Percutaneous......... 100 200 213
3141................ Cholangiogram, Percutaneous (E)..... 38 76 80
3142................ Cholangiogram, Percutaneous (R)..... 63 125 132
3143................ Percutaneous Biliary Drain.......... 128 255 271
3144................ Percutaneous Biliary Drain (E)...... 32 64 67
3145................ Percutaneous Biliary Drain (R)...... 96 192 204
3160................ ERCP................................ 128 255 270
3161................ ERCP (Exam)......................... 32 64 67
3162................ ERCP (Read)......................... 96 191 203
3173................ Bronchoscopy, Unilateral............ 55 109 116
3175................ Bronchoscopy, Unilateral, (Read).... 37 74 79
3176................ Bronchoscopy, Bilateral............. 67 134 142
3178................ Bronchoscopy, Bilateral, (Read)..... 40 80 86
3180................ Hysterosalpingogram................. 40 80 85
3183................ Fallopian Tube Dilatation........... 208 416 442
3184................ Fallopian Tube Dilatation (E)....... 104 208 221
3185................ Fallopian Tube Dilatation (R)....... 104 208 221
3200................ Lymphangio, Bilat Extrem............ 236 471 501
3201................ Lymphangio, Bilat Extrem (Exam)..... 125 250 265
3202................ Lymphangio, Bilat Extrem (Read)..... 111 222 236
3203................ Lymphangio, Extremity............... 132 263 279
3204................ Lymphangio, Extremity (Exam)........ 63 125 132
3205................ Lymphangio, Extremity (Read)........ 69 138 147
3210................ Lymphangio, Pelvic, Unilat.......... 132 263 279
3211................ Lymphangio, Pelvic, Unilat (Exam)... 63 125 132
3212................ Lymphangio, Pelvic, Unilat (Read)... 69 138 147
3213................ Lymphangio, Pelvic, Bilat........... 236 471 500
3214................ Lymphangio, Pelvic, Bilat (Exam).... 125 250 265
3215................ Lymphangio, Pelvic, Bilat (Read).... 111 221 235
3216................ Lymphangio, Abd, Unilat............. 132 263 279
3217................ Lymphangio, Abd, Unilat (Exam)...... 63 125 132
3218................ Lymphangio, Abd, Unilat (Read)...... 69 138 147
3220................ Lymphangio, Abd, Bilat.............. 236 471 500
3221................ Lymphangio, Abd, Bilat (Exam)....... 125 250 265
3222................ Lymphangio, Abd, Bilat (Read)....... 111 221 235
3230................ Venogram, Bilat Extremity........... 133 265 281
3231................ Venogram, Bilat Extremity (Exam).... 92 183 194
3232................ Venogram, Bilat Extremity (Read).... 41 82 87
3233................ Venogram, Lt Extremity.............. 74 148 157
3234................ Venogram, Lt Extremity (Exam)....... 46 92 97
3240................ Venogram, Inf Cav W/Serial.......... 116 231 246
3241................ Venogram, Inf Cav W/Serial (E)...... 46 92 97
3242................ Venogram, Inf Cav W/Serial (R)...... 70 140 148
3243................ Venogram, Sup Cav W/Serial.......... 116 231 246
3244................ Venogram, Sup Cav W/Serial (E)...... 46 92 97
3245................ Venogram, Sup Cav W/Serial (R)...... 70 140 148
3246................ Venogram, Bilat Renal............... 191 381 405
3247................ Venogram, Bilat Renal (Exam)........ 92 183 194
3248................ Venogram, Bilat Renal (Read)........ 99 198 210
3250................ Venogram, Lt Renal.................. 126 252 268
3251................ Venogram, Lt Renal ((Exam).......... 46 92 97
3252................ Venogram, Lt Renal (Read)........... 80 160 170
3253................ Venogram, Rt Renal.................. 126 252 268
3254................ Venogram, Rt Renal (Exam)........... 46 92 97
3255................ Venogram, Rt Renal (Read)........... 80 160 170
3256................ Venogram, Bilat Adrenal............. 191 381 405
3257................ Venogram, Bilat Adrenal (Exam)...... 92 183 194
3258................ Venogram, Bilat Adrenal (Read)...... 99 198 210
3260................ Venogram, Lt Adrenal................ 126 252 268
3261................ Venogram, Lt Adrenal (Exam)......... 46 92 97
3262................ Venogram, Lt Adrenal (Read)......... 80 160 170
3263................ Venogram, Rt Adrenal................ 126 252 268
3264................ Venogram, Rt Adrenal (Exam)......... 46 92 97
3265................ Venogram, Rt Adrenal (Read)......... 80 160 170
3266................ Venogram, Azygos (Select)........... 126 252 268
3267................ Venogram, Azygos (Select) (Exam).... 46 92 97
3268................ Venogram, Azygos (Select) (Read).... 80 160 170
3270................ Venogram, Azygos (Nonselect)........ 116 231 245
3271................ Venogram, Azygos (Nonselect) (E).... 46 92 97
3272................ Venogram, Azygos (Nonselect) (R).... 70 139 148
3273................ Venogram, Intraosseous.............. 91 182 193
3274................ Venogram, Intraosseous (Exam)....... 46 92 97
3275................ Venogram, Intraosseous (Read)....... 45 90 95
3276................ Venogram, Sinus..................... 126 252 268
3277................ Venogram, Sinus (Exam).............. 46 92 97
3278................ Venogram, Sinus (Read).............. 80 160 170
3280................ Venogram, Jugular................... 126 252 268
3281................ Venogram, Jugular (Exam)............ 46 92 97
3282................ Venogram, Jugular (Read)............ 80 160 170
3283................ Venogram, Sup Sag Sinus............. 101 202 215
3284................ Venogram, Sup Sag Sinus (Exam)...... 46 92 97
3285................ Venogram, Sup Sag Sinus (Read)...... 55 110 117
3286................ Venogram, Epidural.................. 126 252 268
3287................ Venogram, Epidural (Exam)........... 46 92 97
3288................ Venogram, Epidural (Read)........... 80 160 170
3290................ Venogram, Orbital................... 74 148 157
3291................ Venogram, Orbital (Exam)............ 46 92 97
3300................ Perc Transhep Porto W/Hemo.......... 219 437 464
3301................ Perc Transhep Porto W/Hemo (E)...... 104 208 221
3302................ Perc Transhep Porto W/Hemo (R)...... 115 229 243
3303................ Perc Transhep Porto W/O Hemo........ 220 439 465
3304................ Perc Transhep Porto W/O Hemo (E).... 104 208 221
3305................ Perc Transhep Porto W/O Hemo (R).... 115 229 243
3310................ Hepat Veno, Wed/Free W/Hemo......... 185 369 391
3311................ Hepat Veno, Wed/Free W/Hemo (E)..... 104 208 221
3312................ Hepat Veno, Wed/Free W/Hemo (R)..... 80 160 170
3313................ Hepat Veno, Wed/Free W/O Hemo....... 185 369 391
3314................ Hepat Veno, Wed/Free W/O Hemo (E)... 104 208 221
3315................ Hepat Veno, Wed/Free W/O Hemo (R)... 80 160 170
3320................ Venous Sampling Thru Cath........... 59 118 125
3321................ Venous Sampling Thru Cath (E)....... 46 92 97
3330................ Transcath TX, Embol W/Angio......... 273 545 579
3331................ Transcath TX, Embol W/Angio (E)..... 104 208 221
3332................ Transcath TX, Embol W/Angio (R)..... 169 337 358
3333................ Transcath TX, Infus W/Angio......... 273 545 579
3334................ Transcath TX, Infus W/Angio (E)..... 104 208 221
3335................ Transcath TX, Infus W/Angio (R)..... 169 337 358
3340................ Percu Place IVC Filter.............. 268 535 567
3341................ Percu Place IVC Filter (Exam)....... 83 166 177
3342................ Percu Place IVC Filter (Read)....... 184 368 390
3350................ Transcath Intrav Occ, Temp.......... 273 545 579
3351................ Transcath Intrav Occ, Temp (E)...... 104 208 221
3352................ Transcath Intrav Occ, Temp (R)...... 169 337 358
3353................ Transcath Intrav Occ, Perm.......... 273 545 579
3354................ Transcath Intrav Occ, Perm (E)...... 104 208 221
3355................ Transcath Intrav Occ, Perm (R)...... 169 337 358
3356................ Transcath Retriev, Perc, FX V/A..... 203 406 431
3357................ Transcath Retriev, Perc, FX V/AE.... 104 208 221
3358................ Transcath Retriev, Perc, FX V/AR.... 99 198 210
3360................ Percu Transl Angio, Perip, Art...... 273 545 579
3361................ Percu Transl Angio, Perip, Art (E).. 104 208 221
3362................ Percu Transl Angio, Perip, Art (R).. 169 337 358
3363................ Percu Transl Angio, q Ad Per........ 220 439 465
3364................ Percu Transl Angio, q Ad Per (E).... 104 208 221
3365................ Percu Transl Angio, q Ad Per (R).... 116 231 245
3366................ Percu Transl Angio, Vicer A......... 308 614 652
3367................ Percu Transl Angio, Vicer A (E)..... 104 208 221
3368................ Percu Transl Angio, Vicer A (R)..... 203 406 431
3370................ Transcath BX........................ 173 345 367
3371................ Transcath BX (Exam)................. 104 208 221
3372................ Transcath BX (Read)................. 69 138 146
3380................ Perc Transhep Bil Drain W/Con....... 219 437 464
3381................ Perc Transhep Bil Drain W/Cone...... 104 208 221
3382................ Perc Transhep Bil Drain W/Conr...... 115 229 243
3383................ Per Pl Cath For Inop Bil Obs........ 247 493 524
3384................ Per Pl Cath For Inop Bil Obse....... 104 208 221
3385................ Per Pl Cath For Inop Bil Obsr....... 143 285 303
3400................ Aortogram, Thoracic (Wo/Ser)........ 183 365 388
3401................ Aortogram, Thoracic (Wo/Ser) (E).... 104 208 221
3402................ Aortogram, Thoracic (Wo/Ser) (R).... 79 157 167
3403................ Aortogram, Thoracic (W/Ser)......... 198 396 420
3404................ Aortogram, Thoracic (W/Ser) (E)..... 104 208 221
3405................ Aortogram, Thoracic (W/Ser) (R)..... 94 188 200
3406................ Aortogram, Translum (W/Ser)......... 183 365 388
3407................ Aortogram, Translum (Wo/Ser) (E).... 104 208 221
3408................ Aortogram, Translum (Wo/Ser) (R).... 79 157 167
3410................ Aortogram, Translum (W/Ser)......... 198 396 420
3411................ Aortogram, Translum (W/Ser) (E)..... 104 208 221
3412................ Aortogram, Translum (W/Ser) (R)..... 94 188 200
3413................ Aortogram, Abd Cath (Wo/Ser)........ 183 365 388
3414................ Aortogram, Abd Cath (Wo/Ser) (E).... 104 208 221
3415................ Aortogram, Abd Cath (Wo/Ser) (R).... 79 157 167
3416................ Aortogram, Abd Cath (W/Ser)......... 198 396 420
3417................ Aortogram, Abd Cath (W/Ser) (E)..... 109 216 231
3418................ Aortogram, Abd Cath (W/Ser) (R)..... 99 196 210
3420................ Aortogr, Abd & Bil Ilfem, Cath...... 207 411 435
3421................ Aortogr, Abd & Bil Ilfem, Cath (E).. 109 216 231
3422................ Aortogr, Abd & Bil Ilfem, Cath (R).. 103 204 218
3430................ Angiogram........................... 213 423 448
3431................ Angiogram (Exam).................... 109 216 231
3432................ Angiogram (Read).................... 109 216 231
3433................ Angiogram, Cerebral................. 228 452 478
3434................ Angiogram, Cerebral (Exam).......... 109 216 231
3435................ Angiogram, Cerebral (Read).......... 124 246 261
3436................ Angiogram, Angioplasty (Art)........ 213 423 448
3437................ Angiogram, Angioplasty (Art)(Ex).... 109 216 231
3438................ Angiogram, Angioplasty (Art)(Re).... 109 216 231
3440................ Angiogram, Angioplasty (Ven)........ 213 423 448
3441................ Angiogram, Angioplasty (Ven)(Ex).... 109 216 231
3442................ Angiogram, Angioplasty (Ven)(Re).... 109 216 231
3443................ Angiogram, Pulmonary................ 232 460 487
3444................ Angiogram, Pulmonary (Exam)......... 109 216 231
3445................ Angiogram, Pulmonary (Read)......... 128 254 270
3446................ Angiogram, Venous Phase............. 155 309 328
3447................ Angiogram, Venous Phase (Exam)...... 104 208 221
3448................ Angiogram, Venous Phase (Read)...... 50 100 107
3450................ Angiogram, Vena Cava................ 219 437 464
3451................ Angiogram, Vena Cava (Exam)......... 104 208 221
3452................ Angiogram, Vena Cava (Read)......... 115 229 243
3453................ Angiogram, Portal Vein.............. 240 479 508
3454................ Angiogram, Portal Vein (Exam)....... 104 208 221
3455................ Angiogram, Portal Vein (Read)....... 136 271 287
3456................ Angiogram, Renal Vein............... 240 479 508
3457................ Angiogram, Renal Vein (Exam)........ 104 208 221
3458................ Angiogram, Renal Vein (Read)........ 136 271 287
3460................ Angiogram, Renal Vein Renins........ 208 416 442
3461................ Angiogram, Renal Vein Renins (E).... 104 208 221
3462................ Angiogram, Renal Vein Renins (R).... 104 208 221
3463................ Angiogram, Subclavian Vein.......... 208 416 442
3464................ Angiogram, Subclavian Vein (Ex)..... 104 208 221
3465................ Angiogram, Subclavian Vein (Re)..... 104 208 221
3466................ Angiogram, Testicular............... 208 416 442
3467................ Angiogram, Testicular (Exam)........ 104 208 221
3468................ Angiogram, Testicular (Read)........ 104 208 221
3470................ Angiogram, Embolization............. 208 416 442
3471................ Angiogram, Embolization (Exam)...... 104 208 221
3472................ Angiogram, Embolization (Read)...... 104 208 221
3473................ Angiogram, Cerebral................. 223 445 473
3474................ Angiogram, Cerebral (Exam).......... 104 208 221
3475................ Angiogram, Cerebral (Read).......... 119 237 252
3490................ Angiogram, Ea Add Run............... 42 84 88
3500................ Arteriogram, Lt Carotid............. 208 416 442
3501................ Arteriogram, Lt Carotid (Exam)...... 104 208 221
3502................ Arteriogram, Lt Carotid (Read)...... 104 208 221
3503................ Arteriogram, Lt Vertebral........... 208 416 442
3504................ Arteriogram, Lt Vertebral (Exam).... 104 208 221
3505................ Arteriogram, Lt Vertebral (Read).... 104 208 221
3506................ Arteriogram, Lt Carot & Vert........ 313 624 662
3507................ Arteriogram, Lt Carot & Vert (E).... 208 416 442
3508................ Arteriogram, Lt Carot & Vert (R).... 104 208 221
3510................ Arteriogram, Rt Carotid............. 208 416 442
3511................ Arteriogram, Rt Carotid (Exam)...... 104 208 221
3512................ Arteriogram, Rt Carotid (Read)...... 104 208 221
3513................ Arteriogram, Rt Vertebral........... 208 416 442
3514................ Arteriogram, Rt Vertebral (Exam).... 104 208 221
3515................ Arteriogram, Rt Vertebral (Read).... 104 208 221
3516................ Arteriogram, Rt Carot & Vert........ 313 624 662
3517................ Arteriogram, Rt Carot & Vert (E).... 208 416 442
3518................ Arteriogram, Rt Carot & Vert (R).... 104 208 221
3520................ Arteriogram, Bilat Carotid.......... 313 624 662
3521................ Arteriogram, Bilat Carotid (Exam)... 208 416 442
3522................ Arteriogram, Bilat Carotid (Read)... 104 208 221
3523................ Arteriogram, Bilat Vertebral........ 313 624 662
3524................ Arteriogram, Bilat Vertebral (E).... 208 416 442
3525................ Arteriogram, Bilat Vertebral (R).... 104 208 221
3526................ Arteriogram, Bilat Carot & Ver...... 417 832 883
3527................ Arteriogram, Bilat Carot & Ver (Ex). 313 624 662
3528................ Arteriogram, Bilat Carot & Ver (Re). 104 208 221
3530................ Arteriogram, Brachial............... 208 416 442
3531................ Arteriogram, Brachial (Exam)........ 104 208 221
3532................ Arteriogram, Brachial (Read)........ 104 208 221
3533................ Arteriogram, Subclavian............. 208 416 442
3534................ Arteriogram, Subclavian (Exam)...... 104 208 221
3535................ Arteriogram, Subclavian (Read)...... 104 208 221
3536................ Arteriogram, Gastroduodenal......... 208 416 442
3537................ Arteriogram, Gastroduodenal (E)..... 104 208 221
3538................ Arteriogram, Gastroduodenal (R)..... 104 208 221
3540................ Arteriogram, Lt Gastric............. 208 416 442
3541................ Arteriogram, Lt Gastric (Exam)...... 104 208 221
3542................ Arteriogram, Lt Gastric (Read)...... 104 208 221
3543................ Arteriogram, Hepatic................ 208 416 442
3544................ Arteriogram, Hepatic (Exam)......... 104 208 221
3545................ Arteriogram, Hepatic (Read)......... 104 208 221
3546................ Arteriogram, Celiac Axis............ 208 416 442
3547................ Arteriogram, Celiac Axis (Exam)..... 104 208 221
3548................ Arteriogram, Celiac Axis (Read)..... 104 208 221
3550................ Arteriogram, Iliac.................. 208 416 442
3551................ Arteriogram, Iliac (Exam)........... 104 208 221
3552................ Arteriogram, Iliac (Read)........... 104 208 221
3553................ Arteriogram, IMA.................... 208 416 442
3554................ Arteriogram, IMA (Exam)............. 104 208 221
3555................ Arteriogram, IMA (Read)............. 104 208 221
3556................ Arteriogram, SMA.................... 208 416 442
3557................ Arteriogram, SMA (Exam)............. 104 208 221
3558................ Arteriogram, SMA (Read)............. 104 208 221
3560................ Arteriogram, IMA & SMA.............. 313 624 662
3561................ Arteriogram, IMA & SMA (Exam)....... 208 416 442
3562................ Arteriogram, IMA & SMA (Read)....... 104 208 221
3563................ Arteriogram, Renal.................. 208 416 442
3564................ Arteriogram, Renal (Exam)........... 104 208 221
3565................ Arteriogram, Renal (Read)........... 104 208 221
3566................ Arteriogram, Femoral Runoff......... 208 416 442
3567................ Arteriogram, Femoral Runoff (E)..... 104 208 221
3568................ Arteriogram, Femoral Runoff (R)..... 104 208 221
3576................ Arteriogram/Intervent, Other........ 208 416 442
3577................ Arteriogram/Intervent, Oth (E)...... 104 208 221
3578................ Arteriogram/Intervent, Oth (R)...... 104 208 221
3600................ IVP................................. 32 64 67
3603................ IVP, Hypertensive................... 35 69 73
3610................ IVP, Infusion....................... 35 70 74
3613................ IVP, Retrograde..................... 40 79 84
3614................ IVP, Retrograde (Exam).............. 32 64 67
3616................ IVP W/Tomograms..................... 37 74 79
3620................ Renal Cyst Puncture................. 146 291 308
3621................ Renal Cyst Puncture (Exam).......... 83 166 177
3622................ Renal Cyst Puncture (Read).......... 62 124 132
3623................ Nephrostomy......................... 225 449 477
3624................ Nephrostomy (Exam).................. 104 208 221
3625................ Nephrostomy (Read).................. 121 241 256
3626................ Nephrotomograms, No Contrast........ 54 108 115
3627................ Nephrotomograms, No Contrast (E).... 42 84 88
3630................ Nephrostogram....................... 225 449 477
3631................ Nephrostogram (Exam)................ 104 208 221
3632................ Nephrostogram (Read)................ 121 241 256
3636................ Cystogram, Retrograde............... 32 64 68
3640................ Cystogram, Vcug..................... 35 70 74
3643................ Cystogram, Chain.................... 32 64 68
3646................ Urethrogram, Retrograde............. 32 64 68
3650................ Peri-Urethrogram.................... 32 64 68
3653................ Basket Extraction................... 208 416 442
3654................ Basket Extraction (Exam)............ 104 208 221
3655................ Basket Extraction (Read)............ 104 208 221
3656................ Stent Replacement/Removal........... 104 208 221
3673................ Mammogram, (Localization)........... 55 109 116
3674................ Mammogram, (Localization) (Exam).... 32 64 67
3676................ Mammillary Stereotaxic Biopsy....... 53 105 111
3677................ Mammillary Stereotaxic Biop (E)..... 32 64 67
3693................ Mammogram, Bilat (Localize)......... 80 160 170
3694................ Mammogram, Bilat (Localize) (Ex).... 45 89 95
3695................ Mammogram, Bilat (Localize) (Re).... 36 72 76
3696................ Mammillary Ductogram, Bilat......... 70 140 149
3697................ Mammillary Ductogram, Bilat (Exam).. 44 88 94
3700................ Myelogram, Cervical................. 128 256 272
3701................ Myelogram, Cervical (Exam).......... 49 98 104
3702................ Myelogram, Cervical (Read).......... 79 158 168
3703................ Myelgram, Thoracic.................. 128 256 272
3704................ Myelogram, Thoracic (Exam).......... 49 98 104
3705................ Myelogram, Thoracic (Read).......... 79 158 168
3706................ Myelogram, Lumbar................... 126 252 268
3707................ Myelogram, Lumbar (Exam)............ 47 94 100
3708................ Myelogram, Lumbar (Read)............ 79 158 168
3713................ Myelogram, Other.................... 128 256 272
3714................ Myelogram, Other (Exam)............. 49 98 104
3715................ Myelogram, Other (Read)............. 79 158 168
3716................ Arthrogram, Wrist................... 48 96 102
3720................ Arthrogram, Elbow................... 55 109 116
3723................ Arthrogram, Shoulder................ 55 109 116
3726................ Arthrogram, Ankle................... 55 109 116
3730................ Arthrogram, Knee.................... 64 128 135
3731................ Arthrogram, Knee (Exam)............. 32 64 67
3732................ Arthrogram, Knee (Read)............. 32 64 68
3733................ Arthrogram, Hip..................... 55 109 116
3736................ Arthrogram, TMJ..................... 60 120 128
3738................ Arthrogram, TMJ (Read).............. 35 70 74
3770................ Sialogram........................... 45 89 95
3773................ Sialogram, Parotidm................. 45 89 95
3776................ Sialogram, Submandibular............ 45 89 95
3780................ Laryngogram......................... 48 95 101
3790................ Sinogram............................ 58 116 124
3792................ Sinogram (Read)..................... 42 84 88
3800................ Fistulagram......................... 58 116 124
3802................ Fistulagram, (Read)................. 42 84 88
3810................ Dacrocystogram, (Bilat)............. 65 130 138
3812................ Dacrocystogram, (Bilat) (Read)...... 43 85 90
3813................ Dacrocystogram, Unilat.............. 33 65 69
3896................ Specials, Other..................... 58 116 124
3897................ Specials, Other (Exam).............. 42 84 88
3898................ Special, Other (Read)............... 58 116 124
3980................ Tomogram, Single Plane.............. 54 108 115
3981................ Tomogram, Single Plane (Exam)....... 42 84 88
3983................ Tomogram, Cmplx Motion (Unil)....... 108 216 230
3984................ Tomogram, Cmplx Motion (Unil) (E)... 83 166 177
3986................ Tomogram, Cmplx Motion (Bilat)...... 125 250 265
3987................ Tomogram, Cmplx Motion (Bilat) (E).. 100 200 212
4000................ US, Head............................ 37 74 79
4100................ US, Pelvis.......................... 35 69 73
4120................ US, Kidney (Unilat)................. 41 82 87
4126................ US, Bilat Kidney.................... 58 115 122
4127................ US, Bilat Kidney (Exam)............. 32 64 68
4140................ US, Pancreas........................ 43 85 90
4160................ US, Spleen.......................... 43 85 90
4180................ US, Liver........................... 43 85 90
4200................ US, Breast (Bilat).................. 51 192 108
4210................ US, Superficial Lesions............. 37 74 79
4300................ US, Knee (Bilat).................... 62 123 131
4301................ US, Knee (Bilat) (Exam)............. 33 66 71
4400................ US. Abdominal Aorta................. 43 85 90
4440................ US, Iliacs.......................... 37 74 79
4480................ US, Renals.......................... 41 82 87
4520................ US, Abdomen (Complete).............. 93 185 196
4521................ US, Abdomen (Complete) (Exam)....... 50 100 106
4522................ US, Abdomen (Complete) (Read)....... 43 85 90
4540................ US, Testicular...................... 33 66 71
4560................ US, Gall Bladder.................... 43 85 90
4563................ US, Biliary Ducts................... 43 85 90
4580................ US, Pelvis.......................... 35 69 73
4600................ US, OB.............................. 48 96 102
4620................ US, Gestational Age................. 38 75 79
4640................ US, Fetal Evaluation................ 42 84 88
4660................ US, Amniocentesis................... 61 122 129
4662................ US, Amniocentesis (Read)............ 43 85 90
4700................ US, Dynamic Mass Study.............. 124 247 262
4702................ US, Dynamic Mass Study (Read)....... 105 210 223
4720................ US, Cyst Aspiration................. 84 167 177
4722................ US, Cyst Aspiration (Read).......... 65 130 137
4726................ US, Thoracenthesis.................. 56 112 119
4728................ US, Thoracenthesis (Read)........... 38 75 79
4729................ US, Biopsy.......................... 83 166 176
4731................ US, Biopsy (Read)................... 65 130 139
4996................ US, Other........................... 35 69 73
5000................ CT, Head/Brain (W/O Contrast)....... 83 166 176
5001................ CT, Head/Brain (W/O Contrast) (E)... 63 126 135
5003................ CT, Head/Brain (W/Contrast)......... 102 204 217
5004................ CT, Head/Brain (W/Contrast) (Ex).... 76 152 161
5006................ CT, Head/Brain (W W/O Contrast)..... 166 332 352
5007................ CT, Head/Brain (W W/O Contrast) (E). 95 190 202
5020................ CT, Post Fossa (W/O Contrast)....... 93 186 197
5021................ CT, Post Fossa (W/O Contrast) (E)... 63 126 134
5023................ CT, Post Fossa (W/Contrast)......... 108 216 230
5024................ CT, Post Fossa (W/Contrast) (Ex).... 76 152 161
5025................ CT, Post Fossa (W/Contrast) (Re).... 32 64 68
5026................ CT, Post Fossa (W/Wo Contrast)...... 129 257 273
5027................ CT, Post Fossa (W/Wo Contrast) E.... 95 190 202
5028................ CT, Post Fossa (W/Wo Contrast) R.... 34 68 72
5040................ CT, Sella Wo/Contrast............... 93 186 196
5041................ CT, Sella Wo/Contrast (Exam)........ 63 126 134
5043................ CT, Sella W/Contrast................ 108 216 228
5044................ CT, Sella W/Contrast (Exam)......... 76 152 161
5045................ CT, Sella W/Contrast (Read)......... 32 64 69
5046................ CT, Sella Wo/W Contrast............. 129 257 273
5047................ CT, Sella Wo/W Contrast (Exam)...... 95 190 202
5048................ CT, Sella Wo/W Contrast (Read)...... 34 68 73
5080................ CT, Orbits Wo/Contrast.............. 93 186 197
5081................ CT, Orbits Wo/Contrast (Exam)....... 63 126 134
5083................ CT, Orbits W/Contrast............... 93 186 197
5084................ CT, Orbits W/Contrast (Exam)........ 63 126 134
5086................ CT, Orbits Wo/W Contrast............ 129 257 273
5087................ CT, Orbits Wo/W Contrast (Exam)..... 95 190 202
5088................ CT, Orbits Wo/W Contrast (Read)..... 34 68 73
5100................ CT, Sinus Wo/ Contrast.............. 90 179 190
5101................ CT, Sinus Wo/Contrast (Exam)........ 63 126 134
5103................ CT, Sinus W/Contrast................ 106 212 225
5104................ CT, Sinus W/Contrast (Exam)......... 76 152 161
5106................ CT, Sinus Wo/W Contrast............. 128 256 272
5107................ CT, Sinus Wo/W Contrast (Exam)...... 95 190 201
5108................ CT, Sinus Wo/W Contrast (Read)...... 33 66 70
5120................ CT, IAMS/IACS Wo/Contrast........... 93 186 196
5121................ CT, IAMS/IACS Wo/Contrast (Exam).... 63 126 134
5123................ CT, IAMS/IACS W/Contrast............ 108 216 230
5124................ CT, IAMS/IACS W/Contrast (Exam)..... 76 152 161
5125................ CT, IAMS/IACS W/Contrast (Read)..... 32 64 68
5126................ CT, IAMS/IACS Wo/W Contrast......... 129 257 274
5127................ CT, IAMS/IACS Wo/W Contrast (E)..... 95 190 202
5128................ CT, IAMS/IACS Wo/W Contrast (R)..... 34 68 72
5140................ CT, Facial Wo/Contrast.............. 90 179 190
5141................ CT, Facial Wo/Contrast (Exam)....... 63 126 134
5143................ CT, Facial W/Contrast............... 106 212 225
5144................ CT, Facial W/Contrast (Exam)........ 76 152 161
5146................ CT, Facial W/Wo Contrast............ 128 256 273
5147................ CT, Facial W/Wo Contrast (Exam)..... 95 190 202
5148................ CT, Facial W/Wo Contrast (Read)..... 33 66 70
5160................ CT, Coronals Wo/Contrast............ 83 166 176
5161................ CT, Coronals Wo/Contrast (Exam)..... 63 126 134
5163................ CT, Coronals W/Contrast............. 102 204 217
5164................ CT, Coronals W/Contrast (Exam)...... 76 152 160
5166................ CT, Coronals Wo/W Contrast.......... 125 249 264
5167................ CT, Coronals Wo/W Contrast (Ex)..... 95 190 201
5170................ CT, Temporals Wo/Contrast........... 93 186 197
5171................ CT, Temporals Wo/Contrast (Exam).... 63 126 135
5173................ CT, Temporals W/Contrast............ 106 212 225
5174................ CT, Temporals W/Contrast (Exam)..... 76 152 161
5175................ CT, Temporals W/Contrast (Read)..... 32 64 69
5176................ CT, Temporals Wo/W Contrast......... 129 257 273
5177................ CT, Temporals Wo/W Contrast (E)..... 95 190 202
5178................ CT, Temporals Wo/W Contrast (R)..... 34 68 72
5200................ CT, Brain Biopsy.................... 129 257 273
5201................ CT, Brain Biopsy (Exam)............. 95 190 202
5202................ CT, Brain Biopsy (Read)............. 34 68 72
5300................ CT, Chest........................... 151 301 321
5301................ CT, Chest (Exam).................... 119 237 252
5302................ CT, Chest (Read).................... 32 64 68
5303................ CT, Chest Biopsy.................... 151 301 320
5304................ CT, Chest Biopsy (Exam)............. 119 237 252
5305................ CT, Chest Biopsy (Read)............. 32 64 68
5400................ CT, C-Spine Wo/Contrast............. 106 212 224
5401................ CT, C-Spine Wo/Contrast (Exam)...... 79 158 168
5403................ CT, C-Spine W/Contrast.............. 165 329 348
5404................ CT, C-Spine W/Contrast (Exam)....... 95 190 202
5406................ CT, C-Spine Wo/W Contrast........... 148 296 315
5407................ CT, C-Spine Wo/W Contrast (Exam).... 119 237 252
5420................ CT, T-Spine Wo/Contrast............. 106 212 225
5421................ CT, T-Spine Wo/Contrast (Exam)...... 79 158 169
5423................ CT, T-Spine W/Contrast.............. 123 246 261
5424................ CT, T-Spine W/Contrast (Exam)....... 95 190 202
5426................ CT, T-Spine Wo/W Contrast........... 148 296 314
5427................ CT, T-Spine Wo/W Contrast (Exam).... 119 237 252
5440................ CT, L-Spine Wo/Contrast............. 106 212 225
5441................ CT, L-Spine Wo/Contrast (Exam)...... 79 158 168
5443................ CT, L-Spine W/Contrast.............. 123 246 262
5444................ CT, L-Spine W/Contrast (Exam)....... 95 190 202
5446................ CT, L-Spine Wo/W Contrast........... 148 296 314
5447................ CT, L-Spine Wo/W Cntrst (E)......... 119 237 252
5463................ CT, Spinal Stenosis................. 123 246 261
5464................ CT, Spinal Stenosis (Exam).......... 95 190 202
5500................ CT, Routine ABD Wo/Contrast......... 103 206 218
5501................ CT, Routine ABD Wo/Cntrst (E)....... 76 152 161
5503................ CT, Routine ABD W/Contrast.......... 121 242 256
5504................ CT, Routine ABD W/Cntrst (E)........ 92 183 194
5506................ CT, Routine ABD Wo/W Contrast....... 147 293 312
5507................ CT, Routine ABD Wo/W Cntrst (E)..... 114 227 241
5508................ CT, Routine ABD Wo/W Cntrst (R)..... 33 66 70
5523................ CT, Invasive Procedure.............. 187 373 397
5524................ CT, Invasive Procedure (Exam)....... 111 221 235
5525................ CT, Invasive Procedure (Read)....... 77 153 162
5540................ CT, Liver W/O Contrast.............. 103 206 219
5541................ CT, Liver W/O Contrast (Exam)....... 76 152 161
5543................ CT, Liver W Contrast................ 121 242 257
5544................ CT, Liver W Contrast (Exam)......... 92 183 194
5546................ CT, Liver Wo/W Contrast............. 147 293 312
5547................ CT, Liver Wo/W Contrast (Exam)...... 114 227 241
5548................ CT, Liver Wo/W Contrast (Read)...... 33 66 70
5560................ CT, Pancreas Wo/Contrast............ 103 206 219
5561................ CT, Pancreas Wo/Contrast (Exam)..... 76 152 161
5563................ CT, Pancreas Wo/Contrast............ 121 242 257
5564................ CT, Pancreas Wo/Contrast (Exam)..... 92 183 193
5566................ CT, Pancreas Wo/Contrast............ 147 293 311
5567................ CT, Pancreas Wo/Contrast (Ex)....... 114 227 240
5568................ CT, Pancreas Wo/Contrast (RE)....... 33 66 70
5580................ CT, Kidney Wo/Contrast.............. 103 206 220
5581................ CT, Kidney Wo/Contrast (Exam)....... 76 152 161
5583................ CT, Kidney W/Contrast............... 121 242 257
5584................ CT, Kidney W/Contrast (Exam)........ 92 183 195
5586................ CT, Kidney Wo/W Contrast............ 147 293 311
5587................ CT, Kidney Wo/W Contrast (Exam)..... 114 227 241
5588................ CT, Kidney Wo/W Contrast (Read)..... 33 66 70
5600................ CT, Pelvis Wo/Contrast.............. 103 206 219
5601................ CT, Pelvis Wo/Contrast (Exam)....... 76 152 161
5603................ CT, Pelvis W/Contrast............... 121 242 257
5604................ CT, Pelvis W/Contrast (Exam)........ 92 183 195
5606................ CT, Pelvis Wo/W Contrast............ 147 293 311
5607................ CT, Pelvis Wo/W Contrast (Exam)..... 114 227 241
5608................ CT, Pelvis Wo/W Contrast (Read)..... 33 66 70
5700................ CT, Extremity Wo/Contrast........... 92 183 194
5701................ CT, Extremity Wo/Contrast (Exam).... 66 132 140
5703................ CT, Extremity W/Contrast............ 106 212 224
5704................ CT, Extremity W/Contrast (Exam)..... 79 158 168
5706................ CT, Extremity Wo/W Contrast......... 128 255 270
5707................ CT, Extremity Wo/W Contrast (E)..... 100 199 211
5720................ CT, Ortho Bone Study................ 45 90 97
5721................ CT, Ortho Bone Study (Exam)......... 40 79 84
5800................ CT, Reconstruction.................. 142 283 300
5820................ CT, Review.......................... 71 142 152
5840................ CT, Therapy Planning................ 142 283 300
5996................ CT, Other........................... 154 308 327
5997................ CT, Other (Exam).................... 83 166 176
5998................ CT, Other (Read).................... 71 142 151
6009................ Thyroid Scn/Upt, Single Det......... 40 80 85
6012................ Thy Scn/Upt, Mult Det............... 43 86 91
6018................ Thyroid Image W/Flow................ 40 80 86
6021................ Thy Metascan: Ltd Area.............. 47 93 99
6024................ Parathyroid......................... 43 86 91
6027................ Thy Metascan: Mult Areas............ 65 130 138
6028................ Thy Metascan: Mult Areas (E)........ 45 90 96
6030................ Thy Metascan: Whole Body............ 88 175 186
6031................ Thy Metascan: Whole Body (E)........ 65 130 137
6033................ Adrenal Image: Cortical............. 83 166 176
6034................ Adrenal Image: Cortical (E)......... 65 130 137
6036................ Bone Marrow Image: Ltd Area......... 38 75 80
6039................ Bone Marrow Image: Multi Area....... 56 112 120
6040................ Bone Marrow Image: Multi Area (E)... 38 76 81
6042................ Bone Marrow Image: Whole Body....... 68 135 143
6043................ Bone Marrow Image: Whole Body (E)... 49 98 105
6048................ Plasma Volume Mult Sample........... 36 72 76
6054................ Red Cell Vol Mult Sample............ 43 85 90
6055................ Red Cell Vol Mult Sample (E)........ 35 70 74
6057................ WB Vol: W/Plasma & RBC Vol.......... 66 132 140
6058................ WB Vol: W/Plasma & RBC Vol (E)...... 56 112 119
6060................ Red Cell Survival Study............. 49 98 104
6061................ Red Cell Survival Study (E)......... 35 69 74
6063................ RBC Surv: W/Spleen & Hep Sequest.... 74 147 156
6064................ RBC Surv: W/Spleen & Hep Seq (E).... 59 118 125
6066................ RBC Spleen & Hepatic Sequest........ 62 123 131
6067................ RBC Spleen & Pepatic Seq (E)........ 48 95 101
6069................ Plasma Iron Disappearance........... 52 103 109
6070................ Plasma Iron Disapp (E).............. 44 88 92
6072................ Iron Oral Absorption................ 49 98 104
6073................ Iron Oral Absorption (E)............ 39 78 82
6075................ Iron Red Cell Utilization........... 74 147 156
6076................ Iron Red Cell Util (E).............. 64 128 137
6078................ Spleen Imaging Only................. 38 75 80
6081................ Spleen Imaging Only: W/Flow......... 46 92 98
6082................ Spleen Imaging Only: W/Flow (E)..... 35 70 75
6084................ Platelet Survival................... 103 206 219
6085................ Platelet Survival (E)............... 89 177 188
6087................ WBC Localization: LTD............... 60 119 126
6088................ WBC Localization: LTD (E)........... 41 82 87
6090................ WBC Localization: Whole Body........ 138 276 293
6091................ WBC Localization: Whole Body (E).... 118 235 249
6093................ Rad Nuclide Lymphangiogram.......... 65 130 139
6094................ Rad Nuclide Lymphangiogram (E)...... 49 98 104
6096................ Liver Imaging: Static............... 39 78 83
6099................ Liver Imaging: W/Flow............... 47 94 100
6100................ Liver Imaging: W/Flow (E)........... 35 70 74
6102................ Liver Imaging: Spect................ 88 176 186
6103................ Liver Imaging: Spect (E)............ 71 142 151
6105................ Liver/Spleen Imaging: Static........ 47 94 100
6106................ Liver/Spleen Imag: Static (E)....... 35 70 75
6108................ Liver/Spleen Imaging: Flow.......... 55 110 117
6109................ Liver/Spleen Imaging: Flow (E)...... 42 84 89
6111................ Liver FXN: W/Hepbil Agent/Dyn....... 57 113 120
6112................ Liver FXN: W/Hepbil Agnt/Dyn (E).... 45 90 95
6114................ Hepatobiliary: Duct & GB............ 64 128 135
6115................ Hepatobiliary: Duct & GB (E)........ 44 88 94
6117................ Liver-Lung Imaging.................. 60 120 128
6118................ Liver-Lung Imaging (E).............. 48 96 102
6120................ Salivary Gland: Static Only......... 37 74 79
6123................ Salivary Gland: Dynamic............. 50 100 107
6124................ Salivary Gland: Dynamic (E)......... 38 76 81
6126................ Salivary Gland: Function............ 54 108 114
6127................ Salivary Gland: Function (E)........ 43 85 90
6129................ Esophageal Motility................. 52 104 110
6130................ Esophageal Motility (E)............. 35 70 74
6132................ Gastric Mucosa Imaging.............. 65 130 139
6133................ Gastric Mucosa Imaging (E).......... 49 98 104
6135................ Gastroesophageal Study.............. 67 134 142
6136................ Gastroesophageal Study (E).......... 51 102 109
6138................ Gastric Emptying Study.............. 68 136 144
6139................ Gastric Emptying Study (E).......... 50 99 105
6147................ Schillings Stage 1 & 2 (Dicopac).... 34 68 72
6150................ GI ASP Blood Loss Loc............... 55 110 117
6151................ GI ASP Blood Loss Loc (E)........... 39 78 82
6153................ Acute GI Blood Loss Imaging......... 82 163 173
6154................ Acute GI Blood Loss Imaging (E)..... 59 118 125
6156................ GI Blood Loss: Stool Count.......... 48 96 102
6157................ GI Blood Loss: Stool Count (E)...... 39 78 83
6159................ Bowel Imag (ECT Meckels)............ 53 106 112
6160................ Bowel Imag (ECT Meckels) (E)........ 37 74 78
6162................ Perit-Venous Shunt (Leveen)......... 58 115 122
6163................ Perit-Venous Shunt (Leveen) (E)..... 33 66 71
6165................ Bone Imaging: LTD Area.............. 45 89 95
6168................ Bone Imaging: Multi Area............ 63 126 134
6169................ Bone Imaging: Multi Area (E)........ 44 88 94
6171................ Bone Imaging: Whole Body............ 70 140 149
6172................ Bone Imaging: Whole Body (E)........ 52 103 110
6177................ Bone, 3 Phase....................... 78 156 166
6178................ Bone, 3 Phase (E)................... 58 115 122
6180................ Bone Spect.......................... 95 190 202
6181................ Bone Spect (E)...................... 71 142 151
6189................ Joint Imaging, Ltd Area............. 46 92 98
6190................ Joint Imaging, Ltd Area (E)......... 34 68 72
6192................ Joint Imaging, Multi Area........... 61 122 129
6193................ Joint Imaging, Multi Area (E)....... 43 86 92
6195................ Card Blood Pool, FXN Imag........... 43 86 92
6196................ Card Blood Pool, FXN Imag (E)....... 33 65 69
6201................ Cardiac Shunt Detection............. 45 90 96
6204................ Cardiac Flow (Angiocard)............ 55 110 117
6205................ Cardiac Flow (Angiocard) (E)........ 44 88 93
6207................ Vascular Flow (Venography).......... 34 68 72
6210................ VEN Thrombosis (Fibrinogen)......... 65 130 138
6211................ VEN Thrombosis (Fibrinogen) (E)..... 48 96 102
6213................ Rad Nuc Venogram: Unilat............ 50 100 106
6214................ Rad Nuc Venogram: Unilat (E)........ 32 64 68
6216................ Rad Nuc Venogram: Bilat............. 69 138 147
6217................ Rad Nuc Venogram: Bilat (E)......... 48 96 102
6219................ Myocard Perf/Qual Rest.............. 49 98 103
6222................ Myoc Perf/Qual, RE&EX/Pharm......... 86 172 182
6223................ Myoc Perf/Qual, RE&EX/Pharm (E)..... 57 114 121
6225................ Myocard Perf/Quant Rest............. 62 123 131
6226................ Myocard Perf/Quant Rest (E)......... 40 80 86
6228................ Yoc Perf/Quant RE&EX/Pharm.......... 101 202 215
6229................ Myoc Perf/Quant RE&EX/Pharm (E)..... 71 142 151
6231................ Myocard Perf/Spect Rest............. 111 221 235
6232................ Myocard Perf/Spect Rest (E)......... 85 170 181
6234................ Myoc Perf/Spect RE&EX/Pharm......... 176 352 374
6235................ Myoc Perf/Spect RE&EX/Pharm (E)..... 143 285 302
6236................ Myoc Perf/Spect RE&EX/Pharm (R)..... 34 68 72
6237................ Myocard Imfarct IMG: Qual........... 48 96 102
6238................ Myocard Imfarct IMG: Qual (E)....... 32 64 67
6240................ Myocard Imfarct IMG: Quant.......... 55 110 117
6241................ Myocard Imfarct IMG: Quant (E)...... 38 76 80
6243................ Myoc Infarct IMG: W/1St Pass........ 63 126 133
6244................ Myoc Infarct IMG: W/1St Pass (E).... 44 88 94
6246................ Myoc Infarct Img: Spect............. 85 169 179
6247................ Myco Infarct Img: Spect (E)......... 63 126 134
6249................ Cardiac Output...................... 55 110 117
6250................ Cardiac Output (E).................. 45 89 95
6252................ Gated Rest: Wall MTN&EF............. 85 170 180
6253................ Gated Rest: Wall MTN&EF (E)......... 63 126 134
6255................ Gated Rest: Wall MTN® EF......... 89 178 189
6256................ Gated Rest: Wall MTN® EF (E)..... 66 132 140
6258................ Gtd Rest: Wall MTN, REG EF, VV...... 97 193 205
6259................ Gtd Rest: Wall MTN, REG EF, VV (E).. 73 146 155
6261................ Gated Ex/Phrm: Quan, Wall MTN....... 142 283 300
6262................ Gated Ex/Phrm: Quan, Wall MTN (E)... 114 227 241
6264................ Gtd Rst, Ex/Phrm: Wall MTN, EF...... 147 294 312
6265................ Gtd Rst, Ex/Phrm: Wall MTN EF (E)... 120 239 254
6267................ Gtd Rst, Ex/Phrm: Wm, EF, VV........ 160 319 338
6268................ Gtd Rst, Ex/Phrm: Wm, EF, VV (E).... 131 261 277
6273................ 1st Pass, Wall MTN&EF............... 86 172 183
6274................ 1st Pass, Wall MTN&EF (E)........... 63 126 134
6276................ 1st Pass, Wall MTN, EF, VVD......... 97 193 205
6277................ 1st Pass, Wall MTN, EF, VVD (E)..... 73 146 155
6279................ 1st Pass, Ex/Pharm, Wl MTN.......... 142 283 300
6280................ 1st Pass, Ex/Pharm, Wl MTN (E)...... 114 227 241
6282................ 1st Pass, Ex/Ph, Wl MTN, VV......... 147 294 312
6283................ 1st Pass, Ex/Ph, Wl MTN, VV (E)..... 120 239 254
6285................ 1st Pass, Ex/Ph, Wl MTN, EF, VV..... 160 319 338
6286................ 1st Pass, Ex/Ph, Wl MTN, EF, VV (E). 131 261 277
6288................ 1st Pass, Rest, Ser, Any Comb....... 63 125 132
6289................ 1st Pass, Rest Ser, Any Comb (E).... 42 84 88
6291................ Lung Perf, Particulate.............. 59 118 125
6292................ Lung Perf, Particulate (E).......... 41 82 87
6294................ Lung Perf, Gaseous.................. 45 90 95
6297................ Lung Perf: Gas W/VNT, EQ, W/O....... 67 133 141
6298................ Lung Perf: Gas W/VNT, EQ, W/O (E)... 45 90 96
6300................ Lung Perf: Part, VNT, 1br........... 62 123 131
6301................ Lung Perf: Part, VNT, 1br (E)....... 39 78 82
6303................ V/Q Part, Full Study................ 93 186 198
6304................ V/Q Part, Full Study (E)............ 68 136 144
6306................ Pulm Aerosol, 1view................. 40 80 86
6309................ Pulm Aerosol, Mult View............. 45 90 96
6310................ Pulm Aerosol, Mult View (E)......... 34 68 72
6312................ Pulm Vent, 1br, 1view............... 44 88 93
6313................ Pulm Vent, 1br, 1view (E)........... 35 69 73
6315................ Pulm Vent, W/1br, EQ, W/O, 1view.... 53 106 113
6316................ Pulm Vent, W/1br, EQ, W/O, 1v (E)... 42 84 88
6318................ Pul Ven, W/1br, EQ, W/O, Mult V..... 71 142 150
6319................ Pul Ven, W/1br, Eq, W/O, Mult V (E). 60 120 127
6321................ Brain, Ltd, Static Only............. 45 90 95
6322................ Brain, Ltd, Static Only (E)......... 35 70 74
6324................ Brain, Flow & Scan, Ltd............. 53 106 113
6325................ Brain Flow & Scan, Ltd (E).......... 41 82 87
6327................ Brain Complete, Static Only......... 54 108 114
6328................ Brain Complete, Static Only (E)..... 41 82 87
6330................ Brain Flow & Scan, Complete......... 62 123 131
6331................ Brain Flow & Scan, Complete (E)..... 47 93 99
6333................ Brain Spect Complete................ 108 216 229
6334................ Brain Spect Complete (E)............ 79 158 168
6339................ Cerebral Blood Flow................. 56 112 119
6340................ Cerebral Blood Flow (E)............. 47 93 99
6342................ CSF Flow, W/O Intro, Cisterno....... 77 153 163
6343................ CST Flow, W/O Intro, Cisterno (E)... 61 122 129
6345................ CSF Flow Ventriculography........... 45 90 95
6348................ CSF Flow Shunt Eval................. 55 110 117
6349................ CSF Flow Shunt Eval (E)............. 41 82 87
6351................ CSF leak Detection & Localize....... 70 140 149
6352................ CSF Leak Detection & Localize (E)... 56 112 118
6354................ CSF Flow Spect...................... 92 184 195
6355................ CSF Flow Spect (E).................. 71 142 151
6357................ Radionucl ID of Eye Tumor........... 73 146 155
6358................ Radionucl ID of Eye Tumor (E)....... 60 120 127
6360................ Dacrocystography.................... 38 76 81
6363................ Renal Static Only................... 47 94 100
6364................ Renal Static Only (E)............... 37 74 78
6366................ Renal W/Flow........................ 55 109 116
6367................ Renal W/Flow (E).................... 43 86 91
6369................ Renal W/Funct (EG IM Reno).......... 65 130 138
6370................ Renal W/Funct (EG IM Reno) (E)...... 48 96 102
6372................ Renal W/Flow & Funct................ 76 152 161
6373................ Renal W/Flow & Funct (E)............ 54 108 115
6375................ Renal Spect......................... 87 173 184
6376................ Renal Spect (E)..................... 71 142 151
6384................ Renal Funct W/Pharm Interv.......... 56 112 119
6385................ Renal Funct W/Pharm Interv (E)...... 36 72 76
6387................ Renal Transplant Eval............... 71 142 151
6388................ Renal Transplant Eval (E)........... 48 96 102
6396................ Testicular Imaging.................. 48 95 101
6397................ Testicular Imaging (E).............. 32 64 68
6400................ Testicular Imaging W/Flow (E)....... 39 78 82
6402................ Tumor Localization, Ltd............. 56 112 119
6403................ Tumor Localization, Ltd (E)......... 41 82 87
6405................ Tumor Locatization Mult Area........ 69 138 147
6406................ Tumor Locatization Mult Area (E).... 51 102 108
6408................ Tumor Local Whole Body.............. 87 174 185
6409................ Tumor Local Whole Body (E).......... 68 136 145
6411................ Tumor Localization Spect............ 84 167 178
6412................ Tumor Localization Spect (E)........ 83 165 175
6414................ Gallium Study, Ltd.................. 57 114 121
6415................ Gallium Study, Ltd (Exam)........... 41 82 87
6417................ Gallium Study Whole Body............ 87 173 184
6418................ Gallium Study Whole Body (E)........ 67 133 141
6423................ Auto Data Interdisc>30Min........... 34 68 72
6424................ Auto Data Interdisc>30Min (E)....... 32 64 67
6226................ TX Hyperthy, Init W/Eval............ 73 146 155
6427................ TX Hyperthy, Init W/Eval (E)........ 32 64 67
6428................ TX Hyperthy, Init W/Eval (R)........ 42 84 88
6429................ TX Hyperthy, Subseq, Ea Visit....... 40 80 85
6432................ Thy Suppress, Euthy (Card D)........ 74 147 156
6433................ Thy Suppress, Euthy (Card D) (E).... 32 64 67
6434................ Thy Suppress, Euthy (Card D) (R).... 42 84 89
6435................ Thyroid CA Ablation................. 80 160 170
6436................ Thyroid CA Ablation (Exam).......... 32 64 67
6437................ Thyroid CA Ablation (Read).......... 48 96 102
6438................ RN Metastases of Thy CA............. 90 180 191
6439................ RN Metastases of Thy CA (E)......... 32 64 67
6440................ RN Metastases of Thy CA (R)......... 59 118 125
6441................ TX For Polycy Vera, Q/TX............ 63 125 132
6442................ TX For Polycy Vera, Q/TX (E)........ 32 64 67
6444................ TX Intracavitary Colloid............ 78 156 165
6445................ TX Intracavitary Colloid (E)........ 32 64 67
6446................ TX Intracavitary Colloid (R)........ 46 92 98
6447................ Non Thy, Non Hemat (Bone Met)....... 78 155 164
6448................ Non Thy, Non Hemat (Bone Met) (E)... 32 64 67
6449................ Non Thy, Non Hemat (Bone Met) (R)... 46 92 97
7000................ Th Rad TX Planning; Simple.......... 33 65 69
7003................ Th Rad TX Planning; Intermed........ 49 98 104
7006................ Th Rad TX Planning; Complex......... 73 146 155
7020................ Th Rad Simul-Aid Fld Set Smpl....... 53 106 112
7021................ Th Rad Simul-Aid Fld Set Smple...... 37 74 78
7023................ Th Rad Simul-Aid Fld Set Med........ 83 166 177
7024................ Th Rad Simul-Aid Fld Set Med (E).... 59 118 125
7026................ Th Rad Simul-Aid Fld Set Complx..... 105 210 223
7027................ Th Rad Simul-Aid Fld Set Cplxe...... 69 138 146
7028................ Th Rad Simul-Aid Fld Set Cplxr...... 36 72 76
7043................ Teletx, Isodose Plan; Simple........ 36 72 76
7046................ Teletx, Isodose Plan; Intermed...... 49 98 103
7060................ Teletx, Isodose Plan; Complx........ 65 129 137
7062................ Teletx, Isodose Plan; Complx (Rea).. 37 74 78
7063................ Spec Teletx Port PL, Hemi/Tot....... 65 129 137
7064................ Spec Teletx Port PL, Hemi/Tot (E)... 43 85 90
7080................ Brachyth Isodose Calcul, Smple...... 47 93 99
7083................ Brachyth Isodose Calcul, Interm..... 69 138 147
7084................ Brachyth Isodose Calcul, Intere..... 37 74 78
7085................ Brachyth Isodose Calcul, Interr..... 33 65 69
7086................ Brachyth Isodose Calcul, Comple..... 101 202 215
7087................ Brachyth Isodose Calcul, Cmplxe..... 53 105 111
7088................ Brachyth Isodose Calcul, Complxr.... 49 98 103
7103................ TX Devices, Design & Constr, Inter.. 40 79 84
7106................ TX Devices, Design & Constr, Coml... 63 126 134
7107................ TX Devices, Design & Constr, Cmpex.. 34 68 72
7120................ Cont Rad Phys Cons Sup W/OA......... 32 64 67
7123................ Special Med Rad Physic Consul....... 37 74 79
7130................ Weekly Megavolt TX Manage Simp...... 131 261 277
7131................ Wkly Megavolt TX Manage Smpl (E).... 93 186 198
7132................ Wkly Megavolt TX Manage Smpl (R).... 38 75 79
7133................ Weekly Megavolt TX Manage Inte...... 168 335 355
7134................ Wkly Megavolt TX Manage Inte (E).... 111 221 234
7135................ Wkly Megavolt TX Manage Inte (R).... 57 114 121
7136................ Wkeely Megavolt TX Manage Comp...... 207 413 438
7137................ Wkly Megavolt TX Manage Cplx (E).... 123 245 260
7138................ Wkly Megavolt TX Manage Cplx (R).... 84 168 178
7146................ Spec TC Proc (Tot/Hemibod/P-OS)..... 166 332 352
7147................ Spec TC Proc (Tot/Hemibod/P-OS) (E). 49 98 103
7148................ Spec TC Proc (Tot/Hemibod/P-OS) (R). 249 235 118
7160................ Hyperthermia, Ext Gen, Superf....... 155 146 73
7161................ Hyperthermia, Ext Gen, Superf (E)... 78 74 37
7162................ Hyperthermia, Ext Gen, Superf (R)... 77 74 37
7163................ Hyperthermia, Ext Gen, Deep......... 207 195 98
7164................ Hyperthermia, Ext Gen, Deep (Ex).... 105 98 49
7165................ Hyperthermia, Ext Gen, Deep (Re).... 103 98 49
7166................ Hyperthermia, Interstit Probe....... 156 146 73
7167................ Hyperthermia, Interstit Probe (Ex).. 79 74 37
7168................ Hyperthermia, Interstit Probe (Re).. 79 74 37
7170................ Hyperthermia, Interstit Pro>5....... 207 195 98
7171................ Hyperthermia, Interstit Pro>5E...... 207 195 98
7172................ Hyperthermia, Interstit Pro>5R...... 104 98 49
7173................ Hypertherm Gen By Intracav Pro...... 156 146 73
7174................ Hypertherm Gen By Intracav Pre...... 78 74 37
7175................ Hypertherm Gen By Intracav Prr...... 77 74 37
7176................ Infusion/Instill Radioelem Sol...... 261 245 123
7178................ Infusion/Instill Radioele Solr...... 226 214 107
7200................ Intracav Radioele Appl Simple....... 232 219 110
7202................ Intracav Radioele Appl Simp (R)..... 175 166 83
7203................ Intracav Radioelem Appl Interm...... 163 326 346
7204................ Intracav Radioele Appl Inte (Ex).... 38 76 81
7205................ Intracav Radioele Appl Inte (Re).... 125 250 265
7206................ Intracav Radioelem Applic Comp...... 235 469 497
7207................ Intracav Radioele Appl Cmpl (Ex).... 48 95 101
7208................ Intracav Radioele Appl Cmpl (Re).... 187 373 397
7220................ Interstit Radioelem Appl Simpl...... 135 270 286
7222................ Interstit Radioel Appl Smple (R).... 109 217 231
7223................ Interstit Radioelem Applic Int...... 214 427 454
7224................ Interstit Radioele Appl; Inte (E)... 51 102 109
7225................ Interstit Radioele Appl; Inte (R)... 163 325 345
7226................ Interstit Radioelem Appl Compl...... 306 611 649
7227................ Interstit Radioele Appl Cmp (Ex).... 62 123 131
7228................ Interstit Radioele Appl Cmp (Re).... 244 487 518
8000................ MrI, Brain (W/O Contrast)........... 125 250 265
8001................ MRI, Brain (W/O Contrast) (Exam).... 95 190 201
8003................ MRI, Brain (W/Contrast)............. 221 441 469
8004................ MRI, Brain (W/Contrast) (Exam)...... 181 361 382
8005................ MRI, Brain (W/Contrast) (Read)...... 41 82 87
8006................ MRI, Brain (W W/O Contrast)......... 356 710 753
8007................ MRI, Brain (W W/O Contrast) (Ex).... 301 600 637
8008................ MRI, Brain (W W/O Contrast) (Re).... 55 110 117
8010................ MRI, Angiogram...................... 356 710 753
8011................ MRI, Angiogram (Exam)............... 301 600 637
8012................ MRI, Angiogram (Read)............... 55 110 117
8020................ MRI, Orbit Wo/Contrast.............. 93 186 198
8021................ MRI, Orbit Wo/Contrast (Exam)....... 63 126 134
8023................ MRI, Orbit W/Contrast............... 93 186 198
8024................ MRI, Orbit W/Contrast (Exam)........ 63 126 134
8026................ MRI, Orbit Wo/W Contrast............ 129 257 273
8027................ MRI, Orbit Wo/W Contrast (Exam)..... 95 190 201
8028................ MRI, Orbit Wo/W Contrast (Read)..... 34 68 72
8040................ MRI, Sinus Wo/Contrast.............. 90 179 190
8041................ MRI, Sinus Wo/Contrast (Exam)....... 63 126 134
8043................ MRI, Sinus W/Contrast............... 106 212 225
8044................ MRI, Sinus W/Contrast (Exam)........ 76 152 161
8046................ MRI, Sinus W/Wo Contrast............ 128 256 272
8047................ MRI, Sinus W/Wo Contr (Exam)........ 95 190 201
8048................ MRI, Sinus W/Wo Contr (Read)........ 33 66 71
8060................ MRI, Neck (W/O Contrast)............ 83 166 177
8061................ MRI, Neck (W/O Contrast) (Exam)..... 63 126 134
8063................ MRI, Neck (W/Contrast).............. 102 204 216
8064................ MRI, Neck (W/Contrast) (Exam)....... 76 152 161
8066................ MRI, Neck (W W/O Contrast).......... 166 332 352
8067................ MRI, Neck (W W/O Contrst) (Exam).... 95 190 201
8080................ MRI, Chest Wo/Contrast.............. 93 186 198
8081................ MRI, Chest Wo/Contrast (Exam)....... 63 126 134
8083................ MRI, Chest W/Contrast............... 93 186 198
8084................ MRI, Chest W/Contrast (Exam)........ 63 126 134
8086................ MRI, Chest Wo/W Contrast............ 129 257 273
8087................ MRI, Chest Wo/W Contrast (Exam)..... 95 190 201
8088................ MRI, Chest Wo/W Contrast (Read)..... 34 68 72
8100................ MRI, C-Spine Wo/Contrast............ 106 212 225
8101................ MRI, C-Spine Wo/Contrast (Exam)..... 79 158 168
8103................ MRI, C-Spine W/Contrast............. 225 449 477
8104................ MRI, C-Spine W/Contrast (Exam)...... 180 359 382
8105................ MRI, C-Spine W/Contrast (Read)...... 45 90 95
8106................ MRI, C-Spine Wo/W Contrast.......... 361 720 764
8107................ MRI, C-Spine Wo/W Contrast (Exam)... 301 600 637
8108................ MRI, C-Spine Wo/W Contrast (Read)... 60 120 127
8120................ MRI, T-Spine Wo/Contrast............ 106 212 225
8121................ MRI, T-Spine Wo/Contrast (Exam)..... 79 158 168
8123................ MRI, T-Spine W/Contrast............. 225 449 477
8124................ MRI, T-Spine W/Contrast (Exam)...... 180 359 382
8125................ MRI, T-Spine W/Contrast (Read)...... 45 90 95
8126................ MRI, T-Spine Wo/W Contrast.......... 361 720 764
8127................ MRI, T-Spine Wo/W Contrast (Exam)... 301 600 637
8128................ MRI, T-Spine Wo/W Contrast (Read)... 60 120 127
8140................ MRI, L-Spine Wo/Contrast............ 106 212 225
8141................ MRI, L-Spine Wo/Contrast (Exam)..... 79 158 168
8143................ MRI, L-Spine W/Contrast............. 222 443 470
8144................ MRI, L-Spine W/Contrast (Exam)...... 181 361 382
8145................ MRI, L-Spine W/Contrast (Read)...... 41 82 87
8146................ MRI, L-Spine Wo/Contrast............ 148 296 314
8147................ MRI, L-Spine Wo/Contrast (Exam)..... 356 710 753
8148................ MRI, L-Spine Wo/W Contrast (Read)... 301 600 637
8160................ MRI, Pelvis Wo/Contrast............. 103 206 219
8161................ MRI, Pelvis Wo/Contrast (Exam)...... 76 152 161
8163................ MRI, Pelvis W/Contrast.............. 121 242 257
8164................ MRI, Pelvis W/Contrast (Exam)....... 92 183 194
8166................ MRI, Pelvis Wo/Contrast............. 147 293 311
8167................ MRI, Pelvis Wo/Contrast (Exam)...... 114 227 241
8168................ MRI, Pelvis Wo/Contrast (Read)...... 33 66 70
8180................ MRI, Upper Ext Wo/Contrast.......... 173 345 366
8181................ MRI, Upper Ext Wo/Contrast (Exam)... 150 299 318
8183................ MRI, Upper Ext W/Contrast........... 106 212 225
8184................ MRI, Upper Ext W/Contrast (Exam).... 79 158 168
8186................ MRI, Upper Ext Wo/W Contrast........ 128 255 271
8187................ MRI, Upper Ext Wo/W Contrast (E).... 100 199 211
8200................ MRI, Lower Ext Wo/Contrast.......... 173 345 366
8201................ MRI, Lower Ext Wo/Contrast (Exam)... 150 299 318
8203................ MRI, Lower Ext W/Contrast........... 106 212 225
8204................ MRI, Lower Ext W/Contrast (Exam).... 79 158 168
8206................ MRI, Lower Ext Wo/W Contrast........ 128 255 271
8207................ MRI, Lower Ext Wo/W Contrast (E).... 100 199 211
8220................ MRI, Abdomen Wo/Contrast............ 106 212 225
8221................ MRI, Abdomen Wo/Contrast (Exam)..... 79 158 168
8223................ MRI, Abdomen W/Contrast............. 123 246 261
8224................ MRI, Abdomen W/Contrast (Exam)...... 95 190 201
8226................ MRI, Abdomen Wo/W Contrast.......... 148 296 314
8227................ MRI, Abdomen Wo/W Contrast (Exam)... 119 237 252
8240................ MRI, Heart Wo/Contrast.............. 106 212 225
8241................ MRI, Heart Wo/Contrast (Exam)....... 79 158 168
8243................ MRI, Heart W/Contrast............... 123 246 261
8244................ MRI, Heart W/Contrast (Exam)........ 95 190 201
8246................ MRI, Heart Wo/W Contrast............ 148 296 314
8247................ MRI, Heart Wo/W Contrast (Exam)..... 119 237 252
8260................ MRI, TMJ Wo/Contrast................ 172 343 365
8261................ MRI, TMJ Wo/Contrast (Exam)......... 150 299 318
8263................ MRI, TMJ W/Contrast................. 106 212 225
8264................ MRI, TMJ W/Contrast (Exam).......... 79 158 168
8996................ MRI, Other.......................... 125 250 265
8997................ MRI, Other (Exam)................... 95 190 201
8266................ MRI, TMJ Wo/W Contrast.............. 128 255 271
8267................ MRI, TMJ Wo/W Contrast (Exam)....... 100 199 211
----------------------------------------------------------------------------------------------------------------
Explanations at end of docket.
F. Elective Cosmetic Surgery Procedures and Rates
----------------------------------------------------------------------------------------------------------------
International Common
classification procedure Amount of
Cosmetic surgery procedure diseases (ICD- terminology FY 95 charge\7\ charge
9) (CPT)\6\
----------------------------------------------------------------------------------------------------------------
Mammaplasty........................ 85.50 19325 Surgical care services or same day (a)
85.32 19324 surgery. (b)
85.31 19318
Mastopexy.......................... 85.60 19316 Surgical care services or same day (a)
surgery. (b)
Facial Rhytidectomy................ 86.82 15824 Surgical care services or same day (a)
86.22 surgery. (b)
Blepharoplasty..................... 08.70 15820 Surgical care services or same day (a)
08.44 15821 surgery. (b)
15822
15823
Mentoplasty (Augmentation 76.68 21208 Surgical care services or same day (a)
Reduction). 76.67 21209 surgery. (b)
Abdominoplasty..................... 86.83 15831 Surgical care services or same day (a)
surgery. (b)
Lipectomy, suction per region\8\... 86.83 15876 Surgical care services or same day (a)
15877 surgery. (b)
15878
15879
Rhinoplasty........................ 21.87 30400 Surgical care services or same day (a)
21.86 30410 surgery. (b)
Scar revisions beyond CHAMPUS...... 86.84 1578__ Surgical care services or same day (a)
surgery. (b)
Mandibular or maxillary 76.41 21194 Surgical care services or same day (a)
repositioning. surgery. (b)
Minor skin lesions\9\.............. 86.30 1578__ Surgical care services or same day (a)
surgery. (b)
Dermabrasion....................... 86.25 15780 Surgical care services or same day (a)
surgery. (b)
Hair Restoration................... 86.64 15775 Surgical care services or same day (a)
surgery. (b)
Removing Tatoos.................... 86.25 15780 Surgical care services or same day (a)
surgery. (b)
Chemical Peel...................... 86.24 15790 Surgical care services or same day (a)
surgery. (b)
Arm/Thigh Dermolipectomy........... 86.83 1583__ Surgical care services or same day (a)
surgery. (b)
Brow Lift.......................... 86.3 15839 Surgical care services or same day (a)
surgery. (b)
----------------------------------------------------------------------------------------------------------------
Notes on Cosmetic Surgery Charges
aCharges for surgical care are contained in Section I.B. (See
notes 7 through 9 on reimbursable rates for further details.)
bCharges for same day surgery are contained in Section II.L.
(See notes 7 through 9 on reimbursable rates for further details.)
Notes on Reimbursable Rates
\1\Percentages are applied to both inpatient and outpatient
services provided when billing third party payers (e.g., insurance
companies). Pursuant to the provisions of 10 U.S.C. 1095, the inpatient
Diagnosis Related Groups are 95 percent hospital and 5 percent
professional fee. The outpatient per visit percentages are 57 percent
hospital, 33 percent ancillary and 10 percent professional.
\2\DoD civilian employees located in overseas areas shall be
rendered a bill when services are performed. Payment is due 60 days
from the date of the bill.
\3\The cost of DRG (Diagnosis Related Groups) is based on the
inpatient full reimbursement rate per hospital discharge, weighted to
reflect the intensity of the principal diagnosis involved. The adjusted
standardized amounts (ASA) per Relative Weighted Product (RWP) for use
in the Direct Care System will be comparable to procedures utilized by
Health Care Financing Administration (HFCA) and the Civilian Health and
Medical Program for the Uniformed Services (CHAMPUS). These expenses
include all direct care expenses associated with direct patient care.
The average cost per relative weight product for large urban, other
urban, rural and overseas will be published annually as an inpatient
standardized amount and will include the cost of inpatient professional
services. The DRG rates will apply to reimbursement from all sources,
not just third party payers.
\4\A third party payer may be billed if the total prescription
costs exceed $60. The prescription cost is calculated by multiplying
the number of units (tablets, capsules, etc.) times the unit cost and
adding a $3.95 dispensing fee per prescription.
\5\Charges for high cost medications/services requested by external
providers (Physicians, Dentists, etc.) are only relevant to the Third
Party Collection Program. Third party payers (such as insurance
companies) shall be billed for high cost services in those instances in
which dependents who have medical insurance, seen by providers external
to a Military Medical Treatment Facility (MTF), obtain the prescribed
service or medication from an MTF. Eligible beneficiaries (family
members or retirees with medical insurance) are not personally liable
for this cost and shall not be billed by the MTF. The standard cost of
high cost medications includes the cost of the drugs plus a dispensing
fee, per prescription.
\6\The attending physician is to complete the common procedure
terminology code to indicate the appropriate procedure followed during
cosmetic surgery. The appropriate rate will be applied depending on the
admission type of the patient, e.g., outpatient surgical, same day/
ambulatory surgery, or surgical care services.
\7\Family members of active duty personnel, retirees and their
family members, and survivors will be charged cosmetic surgery rates.
The patient shall be charged the rate as specified in the FY 1995
reimbursable rates for an episode of care. The charges for elective
cosmetic surgery are at the full reimbursement rate (designated as the
Other rate) in Section I.B., general surgery (designated as the Other
rate) in Section II.B., or same day surgery as contained in Section
II.L. of this attachment. The patient will be responsible for both the
cost of the implant(s) in addition to the prescribed cosmetic surgery
rates.
Note: The implants and procedures used for the augmentation
mammaplasty are in compliance with Federal Drug Administration
guidelines.
\8\Each regional lipectomy will carry a separate charge. Regions
include head and neck, abdomen, flanks, and hips.
\9\These procedures are inclusive in the minor skin lesions.
However, CHAMPUS separates them as noted here. All charges are for the
entire treatment regardless of the number of visits required.
Dated: October 17, 1994.
L.M. Bynum,
Alternate OSD Federal Register Liaison Officer, Department of Defense.
[FR Doc. 94-26081 Filed 10-21-94; 8:45 am]
BILLING CODE 5000-04-M