05-16699. Medicare Program; Proposed Changes to the Hospital Outpatient Prospective Payment System and Calendar Year 2006 Payment Rates; Correction
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Start Preamble
Start Printed Page 50680
AGENCY:
Centers for Medicare & Medicaid Services (CMS), HHS.
ACTION:
Proposed rule; correction.
SUMMARY:
This document corrects technical errors that appeared in the proposed rule published in the Federal Register on July 25, 2005 entitled “Medicare Program; Proposed Changes to the Hospital Outpatient Prospective Payment System and Calendar Year 2006 Payment Rates; Proposed Rule.”
Start Further InfoFOR FURTHER INFORMATION CONTACT:
Rebecca Kane, (410) 786-0378.
End Further Info End Preamble Start Supplemental InformationSUPPLEMENTARY INFORMATION:
I. Background
FR Doc. 05-14448 contains our proposed rule to update the Medicare Outpatient Prospective Payment System for calendar year (CY) 2006. We have identified a number of technical errors in the “Summary of Errors” section and are correcting them in the “Correction of Errors” section below.
II. Summary of Errors
A. Corrections Related to the Rural Adjustment Calculation
The calendar year (CY) 2006 Outpatient Prospective Payment System (OPPS) proposed rule that we published in the Federal Register on July 25, 2005 included a proposed 6.6 percent adjustment for rural sole community hospitals. The calculations used to develop the conversion factor and budget neutrality scalar inadvertently incorporated this adjustment as 6.4 percent. The rural adjustment is used in calculations that determine the scalar and conversion factor, and therefore affects the payment rates and copayment amounts published in the proposed rule. The corrected scalar is 1.003753831, and the corrected conversion factor is $59.343. The various changes to the preamble are specified under section III. of this correction notice. In addition to preamble text changes, we are correcting specific tables and addenda which also reflected the inadvertent use of a 6.4 percent rural adjustment factor, which we have described below.
On page 42709, we published Table 11. We are correcting the last column of this table to present the corrected proposed CY 2006 payment amounts. In section III. of this notice, we republish Table 11 as corrected.
On pages 42761-42762, we published Table 33. In section III. of this notice, we republish Table 33 as corrected.
On pages 42764-42775, we published Addendum A, which provides the payment rates and copayment amounts for Ambulatory Payment Classification (APC) groups used for payment purposes under the OPPS. A corrected Addendum A is posted on the OPPS Web site at http://www.cms.hhs.gov/providers/hopps/2006p/1501p.asp.
On pages 42776-42965, we published Addendum B, which provides the payment rates and copayment amounts for services payable under OPPS. A corrected Addendum B, including additional technical errors affecting HCPCS codes 78814, 78815, 78816, 91035, and 95950 is posted on the OPPS Web site at http://www.cms.hhs.gov/providers/hopps/2006p/1501p.asp.
We are posting the corrected Addendum A and Addendum B on our Web site rather than publishing them in this notice because of the large volume of data included in these addenda. Hard copies of these tables are available by contacting the CMS staff member identified above.
We note that as soon as we discovered these inadvertent errors that affected the payment rates noted in the proposed rule, we posted the corrections on the CMS Web site at: http://www.cms.hhs.gov/providers/hopps/2006p/1501p.asp.
B. Other Corrections
We also noted other typographical, formatting, and other technical errors in the proposed rule.
On page 42714, we published Table 15. The proposed “unadjusted” and “adjusted” CY 2006 APC median cost for APC 0085 Level II Electrophysiologic Evaluation contained a typographical error and should read $2,123.38. We are correcting this under section III. of this notice.
On page 42761, column 2 includes a comparison that discusses the differences in copayments from CY 2005 to CY 2006. While the analysis of this example is correct, the example incorrectly identifies the comparison as being the “minimum unadjusted copayment” rather than the “national unadjusted copayment”. We are making this correction under section III. of this notice to refer to the “national unadjusted copayment”.
On page 42737, we published Table 26, which inadvertently excluded C2636 (Brachytherapy linear source, Palladium -103, per 1 mm) which was accurately described in the text of page 42736 as a proposed separately payable brachytherapy source. In section III. of the notice we append the excluded row to correct table 26 as published.
The other technical, typographical, formatting, and other errors that appeared on various other pages of the Federal Register are corrected as noted in section III. of this notice.
III. Correction of Errors
In FR Doc. 05-14448 of July 25, 2005 (70 FR 42674), make the following corrections:
1. On page 42690, in column 3, in the last paragraph, in line 20, the figure “0.999207669” is corrected to read “1.003753831”.
2. On page 42691, in column 1, in the second full paragraph, line 8, the year “2006” is corrected to read “2007”.
3. On page 42694,
a. In column 1, in the second full paragraph, in line 8, the figure “$240.51” is corrected to read “$241.57”.
b. In column 1, in the second full paragraph, in line 8, the figure “$48.10” is corrected to read “$48.31”.
c. In column 3, in the third full paragraph, in line 8, the figure “1.002015212” is corrected to read “1.002023412”.
d. In column 3, in the third full paragraph, in line 18, the figure “0.99652023” is corrected to read “0.99639633”.
e. In column 3, in the last partial paragraph, in line 5, the figure “1.002015212” is corrected to read “1.002023412”.
4. On page 42695,
a. In column 1, in the first partial paragraph, in line 5, the figure “0.99652023” is corrected to read “0.99639633”.
b. In column 1, in the first partial paragraph, in line 7, the figure “$59.350” is corrected to read “$59.343”.
5. On page 42703,
a. In column 1, in the second full paragraph, in line 5, the figure “$9.95” is corrected to read “$7.00”.
b. In column 1, in the second full paragraph, in line 5, the figure “40” is corrected to read “28”.
c. In column 1, in the second full paragraph, in line 6, the figure “$24.89” is corrected to read “$25.00”.
6. On page 42709,Start Printed Page 50681
a. In column 1, in the first full paragraph, in line 22, the figure “$1,297” is corrected to read “$1,274”.
b. In column 1, in the first full paragraph, in line 23, the figure “$1,366” is corrected to read “$1,244”.
c. In column 1, in the first full paragraph, in line 25, the figure “$1,100” is corrected to read “$1,025”.
d. Table 11 is corrected to read as follows:
Table 11.—Proposed APC Reassignment of New Technology Procedures Into Clinical APCs for CY 2006
HCPCS Descriptor CY 2005 APC CY 2005 status indicator Proposed CY 2006 APC Proposed CY 2006 status indicator CY 2005 payment amount Proposed CY 2006 payment amount 0027T Endoscopic epidural lysis 1547 T 0220 T $850 $1,030.11 33225 L ventric pacing lead add-on 1525 S 0418 T 3,750 6,486.45 61623 Endovasc tempory vessel occl 1555 T 0081 T 1,650 2,044.21 92974 Cath place, cardio brachytx 1559 T 0103 T 2,250 873.18 93580 Transcath closure of asd 1559 T 0434 T 2,250 5,387.61 93581 Transcath closure of vsd 1559 T 0434 T 2,250 5,387.61 95965 Meg, spontaneous 1528 S 0430 T 5,250 676.75 95966 Meg, evoked, single 1516 S 0430 T 1,450 676.75 95967 Meg, evoked, each add'l 1511 S 0430 T 950 676.75 C9713 Non-contact laser vap prosta 1525 S 0429 T 3,750 2,511.08 7. On page 42710, in column 2, in the first full paragraph, in line 19, the figure “$93.71” is corrected to read “$93.37”.
8. On page 42714, Table 15, APC 0085, in columns 5 and 7, in row 7, both occurrences of the figure “$2,123.46” are corrected to read “$2,123.38”.
9. On page 42737, Table 26, “Proposed Separately payable Brachytherapy Sources for CY 2006” is appended with the following row:
HCPCS Long descriptor APC APC title New status indicator C2636 Brachytherapy linear source, Palladium-103, per 1mm 2636 Brachytx linear source, P-103 H 10. On page 42756, in column 1, in the first partial paragraph, in line 5, the figure “1.8” is corrected to read “1.7”.
11. On page 42758, in column 2, in the third full paragraph, in line 13, the figure “$59.35” is corrected to read “$59.34”.
12. On page 42759,
a. In column 1, in the first partial paragraph, in line 21, the figure “5.8” is corrected to read “5.6”.
b. In column 1, in the first partial paragraph, in line 31, the figure “1.2” is corrected to read “1.3”.
c. In column 1, in the first partial paragraph, in line 31, the figure “1.8” is corrected to read “1.7”.
d. In column 1, in the first partial paragraph, in line 36, the figure “2.6” is corrected to read “2.5”.
e. In column 1, in the second partial paragraph, in line 22, the figure “2.9” is corrected to read “2.7”.
f. In column 1, in the second partial paragraph, in line 25, the figure “0.7” is corrected to read “0.6”.
g. In column 1, in the second partial paragraph, in line 30, the text “West South Central” is corrected to read “New England”.
h. In column 2, in the first partial paragraph, in line 2, the figure “1.9” is corrected to read “1.7”.
i. In column 2, in the first partial paragraph, in line 2, the figure “1.8” is corrected to read “1.6”.
j. In column 2, in the first full paragraph, in line 4, the figure “0.4” is corrected to read “0.3”.
k. In column 2, in the first full paragraph, in line 5, the figure “0.5” is corrected to read “0.3”.
l. In column 2, in the first full paragraph, in line 9, the figure “0.9” is corrected to read “1.6”.
m. In column 2, in the first full paragraph, in line 10, the figure “1.4” is corrected to read “2.2”.
n. In column 2, in the first full paragraph, in line 21, the sentence portion “1.3 percent and voluntary and government hospitals will gain at least 0.1 percent.” is corrected to read “1.1 percent, voluntary hospitals would gain 0.2 percent, and government hospitals will see no changes as a result of changes to APC structure.”
o. In column 3, in the second full paragraph, in line 7, the figure “0.997” is corrected to read “0.996”.
p. In column 3, in the second full paragraph, in line 10, the figure “0.3” is corrected to read “0.4”.
q. In column 3, in the second full paragraph, in line 13, the figure “5.2” is corrected to read “5.4”.
13. On page 42760,
a. In column 1, in the first partial paragraph, in line 6, the figure “0.3” is corrected to read “0.4”.
b. In column 1, in the first full paragraph, in line 19, the figure “5.8” is corrected to read “5.6”.
c. In column 1, in the first full paragraph, in line 24, the figure “-2.8” is corrected to read “-2.4”.
d. In column 1, in the first full paragraph, in line 32, the figure “1.2” is corrected to read “1.3”.
e. In column 1, in the first full paragraph, in line 35, the figure “0.3” is corrected to read “0.4”.
f. In column 1, in the first full paragraph, in line 37, the figure “1.5” is corrected to read “1.4”.
g. In column 1, in the last paragraph, in line 7, the figure “8.6” is corrected to read “8.7”.
h. In column 1, in the third partial paragraph, in line 12, the figure “5.0” is corrected to read “4.7”.
i. In column 3, in the first partial paragraph, in line 6, the figure “2.6” is corrected to read “2.5”.
j. In column 3, in the first partial paragraph, in line 12, the figure “2.1” is corrected to read “1.8”.
k. In column 3, in the first partial paragraph, in line 32, the figure “3.7” is corrected to read “3.6”.Start Printed Page 50682
l. In column 3, in the first full paragraph, in line 11, the figure “3.4” is corrected to read “3.5”.
m. In column 3, in the first full paragraph, in line 13, the figure “6.4” is corrected to read “6.5”.
n. In column 3, in the first full paragraph, in line 30, the text “greater than” is corrected to read “of at least”.
o. In column 3, in the first full paragraph, in lines 33 and 34, the figure “only 1.0” is corrected to read “1.4” and the text “and 0.8 percent, respectively.” is appended to the end of the sentence.
14. On page 42761
a. In column 1, in the first partial paragraph, in line 3, the figure “1.9” is corrected to read “2.6”.
b. In column 1, in the first partial paragraph, in line 6, the figure “2.6” is corrected to read “3.4”.
c. In column 1, in the first partial paragraph, in line 11, the figure “0.8” is corrected to read “0.6”.
d. In column 1, in line 12, the designation for the heading “Estimated Impacts of This Proposed Rule on Beneficiaries” is corrected from “G” to read “F”.
e. In column 1, in the second partial paragraph, in line 12, the figure “$11.86” is corrected to read “$11.91”.
f. In column 2, in the first partial paragraph, in lines 4 and 6, the term “minimum” is corrected to read “national”.
g. In column 2, in the first partial paragraph, in line 8, the figure “$223.91” is corrected to read “$224.91”.
h. Table 33 is corrected to read as follows:
Table 33.—Impact of Proposed Changes for CY 2006 Hospital Outpatient Prospective Payment System
Hospital category Number of hospitals APC changes New wage index New adj for rural sole community hospitals Cumulative (Cols 2,3,4) with market basket update All changes (1) (2) (3) (4) (5) (6) ALL HOSPITALS 4212 0.0 0.0 0.0 3.2 1.9 URBAN HOSPITALS 2949 0.0 0.0 −0.4 2.8 1.6 LARGE URBAN 1624 −0.8 0.0 −0.4 2.0 0.8 OTHER URBAN 1325 1.0 0.0 −0.4 3.8 2.5 RURAL HOSPITALS 1263 −0.1 0.1 1.8 5.0 3.5 SOLE COMMUNITY 478 −0.1 0.0 5.4 8.7 6.5 OTHER RURAL 785 −0.1 0.1 −0.4 2.8 1.6 BEDS (URBAN): 0-99 BEDS 917 0.0 0.2 −0.4 3.0 2.1 100-199 BEDS 964 −0.4 0.0 −0.4 2.5 1.5 200-299 BEDS 503 0.2 0.1 −0.4 3.2 2.4 300-499 BEDS 402 −0.1 −0.1 −0.4 2.6 1.5 500 + BEDS 163 0.3 0.0 −0.4 3.1 1.0 BEDS (RURAL): 0-49 BEDS 551 −0.9 0.2 2.1 4.6 3.1 50-100 BEDS 419 −0.8 0.2 2.3 4.8 3.0 101-149 BEDS 180 1.4 0.0 1.1 5.8 4.7 150-199 BEDS 62 −0.2 −0.2 1.8 4.7 3.7 200 + BEDS 51 0.1 0.0 1.7 5.1 3.1 VOLUME (URBAN): LT 5,000 claim lines 600 −5.6 0.5 −0.4 −2.4 −1.8 5,000-10,999 180 −2.4 0.2 −0.4 0.5 0.6 11,000-20,999 299 −0.6 0.2 −0.4 2.4 2.5 21,000-42,999 575 −0.6 0.1 −0.4 2.3 1.9 GT 42,999 1295 0.2 0.0 −0.4 3.0 1.6 VOLUME (RURAL): LT 5,000 claim lines 119 −2.7 0.0 1.4 1.7 1.4 5,000-10,999 195 −1.9 0.0 2.1 3.4 2.4 11,000-20,999 325 −0.9 −0.1 2.0 4.3 3.4 21,000-42,999 364 −0.9 0.2 1.9 4.5 3.0 GT 42,999 260 0.6 0.0 1.7 5.7 3.8 REGION (URBAN): NEW ENGLAND 166 −1.3 −0.1 −0.4 1.4 −0.2 MIDDLE ATLANTIC 393 0.6 −0.1 −0.4 3.4 2.1 SOUTH ATLANTIC 453 −0.4 −0.4 −0.4 2.0 1.0 EAST NORTH CENT 466 0.4 −0.1 −0.4 3.2 1.7 EAST SOUTH CENT 197 1.5 0.0 −0.4 4.4 3.4 WEST NORTH CENT 184 2.5 −0.3 −0.4 5.1 3.6 WEST SOUTH CENT 445 −0.3 −0.1 −0.4 2.5 1.3 MOUNTAIN 163 −0.1 −0.2 −0.4 2.5 1.3 PACIFIC 431 −1.7 1.1 −0.4 2.2 1.4 PUERTO RICO 51 0.4 −0.3 −0.4 2.9 2.2 REGION (RURAL): NEW ENGLAND 37 −1.1 0.9 1.2 4.2 0.8 MIDDLE ATLANTIC 78 1.7 −0.4 1.4 6.0 4.1 SOUTH ATLANTIC 189 −0.4 −0.2 1.7 4.4 3.3 EAST NORTH CENT 171 −0.6 0.1 1.4 4.1 2.2 EAST SOUTH CENT 202 −0.7 0.5 0.5 3.5 3.0 WEST NORTH CENT 188 1.6 −0.3 2.6 7.2 4.7 Start Printed Page 50683 WEST SOUTH CENT 242 −0.9 −0.2 2.2 4.4 3.7 MOUNTAIN 95 −1.0 0.1 4.6 7.0 5.2 PACIFIC 61 −0.7 1.8 2.7 7.2 5.3 TEACHING STATUS: NON-TEACHING 3115 −0.3 0.1 0.3 3.2 2.3 MINOR 769 0.3 0.0 −0.2 3.3 2.3 MAJOR 328 0.3 −0.2 −0.3 3.0 0.6 DSH PATIENT PERCENT: 0 16 0.3 0.0 −0.4 3.1 3.1 GT 0-0.10 386 0.1 −0.2 −0.3 2.8 1.7 0.10-0.16 555 0.0 0.1 0.2 3.5 2.4 0.16-0.23 802 0.1 0.0 0.1 3.5 2.3 0.23-0.35 977 0.1 −0.1 0.0 3.2 1.9 GE 0.35 792 −0.3 0.1 −0.1 3.0 1.8 TEFRA: DSH NOT AVAIL 1 684 −1.6 0.0 −0.4 1.2 −2.6 URBAN TEACHING/DSH: TEACHING & DSH 944 0.4 −0.1 −0.4 3.1 1.7 NO TEACHING/DSH 1401 −0.3 0.1 −0.4 2.5 1.8 NO TEACHING/NO DSH 16 0.3 0.0 −0.4 3.1 3.1 TEFRA: DSH NOT AVAIL 1 588 −2.2 0.1 −0.4 0.7 −3.4 TYPE OF OWNERSHIP: VOLUNTARY 2397 0.2 0.0 0.0 3.3 2.0 PROPRIETARY 1091 −1.1 0.0 0.0 2.1 1.6 GOVERNMENT 724 0.0 0.1 0.2 3.6 1.7 Col (1) Total Hospitals in 2006. Col (2) This column shows the impact of changes resulting from the reclassification of HCPCS codes among APC groups and from the addition of multiple procedure discounting for radiology procedures (budget neutral overall). Col (3) This column shows the adjustment for updating the wage index (budget neutral overall). Col (4) This column shows the adjustment for rural sole community hospitals (budget neutral overall). Col (5) This column shows the cumulative impact of cols 2 through 4 and the addition of the market basket update. Col (6) The column shows the impact of the change in MMA dollars in 2006 (drugs and 508) and outlier changes. 1 Complete DSH numbers are not available for hospitals that are not paid under IPPS. 15. On pages 42764-42775, Addendum A is corrected to read as follows:
Start Printed Page 50684Start Printed Page 50696Addendum A.—List of Ambulatory Payment Classifications (APCs) with Status Indicators, Relative Weights, Payment Rates, and Copayment Amounts Calendar Year 2006
APC Group title SI Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment 0001 Level I Photochemotherapy S 0.4213 $25.00 $7.00 $5.00 0002 Level I Fine Needle Biopsy/Aspiration T 0.9559 $56.73 $11.35 0003 Bone Marrow Biopsy/Aspiration T 2.6530 $157.44 $31.49 0004 Level I Needle Biopsy/ Aspiration Except Bone Marrow T 1.7646 $104.72 $22.36 $20.94 0005 Level II Needle Biopsy/Aspiration Except Bone Marrow T 3.5994 $213.60 $71.59 $42.72 0006 Level I Incision & Drainage T 1.5500 $91.98 $22.28 $18.40 0007 Level II Incision & Drainage T 11.4501 $679.48 $135.90 0008 Level III Incision and Drainage T 16.4989 $979.09 $195.82 0009 Nail Procedures T 0.6680 $39.64 $8.34 $7.93 0010 Level I Destruction of Lesion T 0.5719 $33.94 $9.65 $6.79 0011 Level II Destruction of Lesion T 2.0839 $123.66 $25.17 $24.73 0012 Level I Debridement & Destruction T 0.8497 $50.42 $11.18 $10.08 0013 Level II Debridement & Destruction T 1.1078 $65.74 $14.20 $13.15 0015 Level III Debridement & Destruction T 1.6514 $98.00 $20.29 $19.60 0016 Level IV Debridement & Destruction T 2.5834 $153.31 $33.57 $30.66 0017 Level VI Debridement & Destruction T 18.4211 $1,093.16 $227.84 $218.63 0018 Biopsy of Skin/Puncture of Lesion T 1.1726 $69.59 $16.04 $13.92 0019 Level I Excision/ Biopsy T 4.0547 $240.62 $71.87 $48.12 0020 Level II Excision/ Biopsy T 6.9433 $412.04 $107.40 $82.41 0021 Level III Excision/ Biopsy T 14.9776 $888.82 $219.48 $177.76 0022 Level IV Excision/ Biopsy T 19.6472 $1,165.92 $354.45 $233.18 0023 Exploration Penetrating Wound T 4.7775 $283.51 $56.70 0024 Level I Skin Repair T 1.6084 $95.45 $31.25 $19.09 0025 Level II Skin Repair T 5.4938 $326.02 $101.85 $65.20 0027 Level IV Skin Repair T 18.4182 $1,092.99 $329.72 $218.60 0028 Level I Breast Surgery T 19.5801 $1,161.94 $303.74 $232.39 0029 Level II Breast Surgery T 32.0476 $1,901.80 $632.64 $380.36 0030 Level III Breast Surgery T 40.0825 $2,378.62 $763.55 $475.72 0033 Partial Hospitalization P 4.0708 $241.57 $48.31 0035 Venous Cutdown T 0.7158 $42.48 $8.50 0036 Level II Fine Needle Biopsy/Aspiration T 2.1773 $129.21 $25.84 0037 Level IV Needle Biopsy/Aspiration Except Bone Marrow T 9.4751 $562.28 $224.91 $112.46 0039 Level I Implantation of Neurostimulator S 181.4000 $10,764.82 $2,152.96 0040 Level I Implantation of Neurostimulator Electrodes S 55.3297 $3,283.43 $656.69 0041 Level I Arthroscopy T 28.1318 $1,669.43 $333.89 0042 Level II Arthroscopy T 43.9753 $2,609.63 $804.74 $521.93 0043 Closed Treatment Fracture Finger/Toe/Trunk T 1.7694 $105.00 $21.00 0045 Bone/Joint Manipulation Under Anesthesia T 14.4945 $860.15 $268.47 $172.03 0046 Open/Percutaneous Treatment Fracture or Dislocation T 37.7023 $2,237.37 $535.76 $447.47 0047 Arthroplasty without Prosthesis T 31.6107 $1,875.87 $537.03 $375.17 0048 Level I Arthroplasty with Prosthesis T 43.1288 $2,559.39 $570.30 $511.88 0049 Level I Musculoskeletal Procedures Except Hand and Foot T 20.3707 $1,208.86 $241.77 0050 Level II Musculoskeletal Procedures Except Hand and Foot T 23.9081 $1,418.78 $283.76 0051 Level III Musculoskeletal Procedures Except Hand and Foot T 36.5271 $2,167.63 $433.53 0052 Level IV Musculoskeletal Procedures Except Hand and Foot T 43.9378 $2,607.40 $521.48 0053 Level I Hand Musculoskeletal Procedures T 15.6795 $930.47 $253.49 $186.09 0054 Level II Hand Musculoskeletal Procedures T 25.3711 $1,505.60 $301.12 0055 Level I Foot Musculoskeletal Procedures T 20.0692 $1,190.97 $355.34 $238.19 0056 Level II Foot Musculoskeletal Procedures T 40.2957 $2,391.27 $478.25 0057 Bunion Procedures T 27.5493 $1,634.86 $475.91 $326.97 0058 Level I Strapping and Cast Application S 1.0934 $64.89 $12.98 0060 Manipulation Therapy S 0.4935 $29.29 $5.86 0068 CPAP Initiation S 1.2293 $72.95 $29.18 $14.59 0069 Thoracoscopy T 30.6775 $1,820.49 $591.64 $364.10 0070 Thoracentesis/Lavage Procedures T 3.2101 $190.50 $38.10 0071 Level I Endoscopy Upper Airway T 0.7915 $46.97 $11.31 $9.39 0072 Level II Endoscopy Upper Airway T 1.4361 $85.22 $21.27 $17.04 0074 Level IV Endoscopy Upper Airway T 15.7757 $936.18 $295.70 $187.24 0075 Level V Endoscopy Upper Airway T 21.3426 $1,266.53 $445.92 $253.31 0076 Level I Endoscopy Lower Airway T 9.4592 $561.34 $189.82 $112.27 0077 Level I Pulmonary Treatment S 0.3444 $20.44 $7.74 $4.09 0078 Level II Pulmonary Treatment S 1.0236 $60.74 $14.55 $12.15 0079 Ventilation Initiation and Management S 2.3482 $139.35 $27.87 0080 Diagnostic Cardiac Catheterization T 37.1361 $2,203.77 $838.92 $440.75 0081 Non-Coronary Angioplasty or Atherectomy T 34.4473 $2,044.21 $408.84 0082 Coronary Atherectomy T 85.0126 $5,044.90 $1,085.20 $1,008.98 0083 Coronary Angioplasty and Percutaneous Valvuloplasty T 50.8925 $3,020.11 $604.02 0084 Level I Electrophysiologic Evaluation S 10.0205 $594.65 $118.93 0085 Level II Electrophysiologic Evaluation T 35.1882 $2,088.17 $426.25 $417.63 Start Printed Page 50685 0086 Ablate Heart Dysrhythm Focus T 44.2596 $2,626.50 $833.33 $525.30 0087 Cardiac Electrophysiologic Recording/Mapping T 30.7101 $1,822.43 $364.49 0088 Thrombectomy T 36.5617 $2,169.68 $655.22 $433.94 0089 Insertion/Replacement of Permanent Pacemaker and Electrodes T 105.6143 $6,267.47 $1,682.28 $1,253.49 0090 Insertion/Replacement of Pacemaker Pulse Generator T 89.1574 $5,290.87 $1,612.80 $1,058.17 0091 Level II Vascular Ligation T 28.9999 $1,720.94 $348.23 $344.19 0092 Level I Vascular Ligation T 23.4516 $1,391.69 $278.34 0093 Vascular Reconstruction/Fistula Repair without Device 0094 Level I Resuscitation and Cardioversion S 2.5363 $150.51 $47.62 $30.10 0095 Cardiac Rehabilitation S 0.5885 $34.92 $13.96 $6.98 0096 Non-Invasive Vascular Studies S 1.6307 $96.77 $38.70 $19.35 0097 Cardiac and Ambulatory Blood Pressure Monitoring X 1.0223 $60.67 $23.79 $12.13 0098 Injection of Sclerosing Solution T 1.1346 $67.33 $13.47 0099 Electrocardiograms S 0.3821 $22.67 $4.53 0100 Cardiac Stress Tests X 2.4968 $148.17 $41.44 $29.63 0101 Tilt Table Evaluation S 4.2787 $253.91 $101.56 $50.78 0103 Miscellaneous Vascular Procedures T 14.7142 $873.18 $223.63 $174.64 0104 Transcatheter Placement of Intracoronary Stents T 79.0094 $4,688.65 $937.73 0105 Revision/Removal of Pacemakers, AICD, or Vascular T 22.3685 $1,327.41 $370.40 $265.48 0106 Insertion/Replacement/Repair of Pacemaker and/or Electrodes T 45.4851 $2,699.22 $539.84 0107 Insertion of Cardioverter-Defibrillator T 260.0295 $15,430.93 $3,103.22 $3,086.19 0108 Insertion/Replacement/Repair of Cardioverter-Defibrillator Leads T 349.1681 $20,720.68 $4,144.14 0109 Removal of Implanted Devices T 11.0433 $655.34 $131.49 $131.07 0110 Transfusion S 3.6594 $217.16 $43.43 0111 Blood Product Exchange S 12.3956 $735.59 $200.18 $147.12 0112 Apheresis, Photopheresis, and Plasmapheresis S 26.7948 $1,590.08 $438.94 $318.02 0113 Excision Lymphatic System T 21.4653 $1,273.82 $254.76 0114 Thyroid/Lymphadenectomy Procedures T 40.7652 $2,419.13 $485.91 $483.83 0115 Cannula/Access Device Procedures T 31.4727 $1,867.68 $459.35 $373.54 0116 Chemotherapy Administration by Other Technique Except Infusion S 1.1453 $67.97 $13.59 0117 Chemotherapy Administration by Infusion Only S 3.2378 $192.14 $42.54 $38.43 0120 Infusion Therapy Except Chemotherapy S 2.0193 $119.83 $28.21 $23.97 0121 Level I Tube changes and Repositioning T 2.2766 $135.10 $43.80 $27.02 0122 Level II Tube changes and Repositioning T 6.9721 $413.75 $84.85 $82.75 0123 Bone Marrow Harvesting and Bone Marrow/Stem Cell Transplant S 22.9902 $1,364.31 $272.86 0125 Refilling of Infusion Pump T 1.9331 $114.72 $22.94 0130 Level I Laparoscopy T 31.9271 $1,894.65 $659.53 $378.93 0131 Level II Laparoscopy T 43.3389 $2,571.86 $1,001.89 $514.37 0132 Level III Laparoscopy T 62.9914 $3,738.10 $1,239.22 $747.62 0140 Esophageal Dilation without Endoscopy T 5.4737 $324.83 $94.18 $64.97 0141 Level I Upper GI Procedures T 8.1835 $485.63 $143.38 $97.13 0142 Small Intestine Endoscopy T 9.3487 $554.78 $152.78 $110.96 0143 Lower GI Endoscopy T 8.6869 $515.51 $186.06 $103.10 0146 Level I Sigmoidoscopy and Anoscopy T 4.6374 $275.20 $64.40 $55.04 0147 Level II Sigmoidoscopy and Anoscopy T 7.9679 $472.84 $94.57 0148 Level I Anal/Rectal Procedures T 3.7383 $221.84 $57.21 $44.37 0149 Level III Anal/Rectal Procedures T 18.0726 $1,072.48 $293.06 $214.50 0150 Level IV Anal/Rectal Procedures T 23.8654 $1,416.24 $437.12 $283.25 0151 Endoscopic Retrograde Cholangio-Pancreatography (ERCP) T 18.7338 $1,111.72 $245.46 $222.34 0152 Level I Percutaneous Abdominal and Biliary Procedures T 12.2833 $728.93 $145.79 0153 Peritoneal and Abdominal Procedures T 21.6961 $1,287.51 $382.75 $257.50 0154 Hernia/Hydrocele Procedures T 28.7847 $1,708.17 $464.85 $341.63 0155 Level II Anal/Rectal Procedures T 16.2546 $964.60 $192.92 0156 Level II Urinary and Anal Procedures T 2.5751 $152.81 $40.52 $30.56 0157 Colorectal Cancer Screening: Barium Enema S 2.2904 $135.92 $27.18 0158 Colorectal Cancer Screening: Colonoscopy T 7.6588 $454.50 $113.63 0159 Colorectal Cancer Screening: Flexible Sigmoidoscopy S 3.1455 $186.66 $46.67 0160 Level I Cystourethroscopy and other Genitourinary Procedures T 6.6753 $396.13 $105.06 $79.23 0161 Level II Cystourethroscopy and other Genitourinary Procedures T 18.5576 $1,101.26 $249.36 $220.25 0162 Level III Cystourethroscopy and other Genitourinary Procedures T 23.3918 $1,388.14 $277.63 0163 Level IV Cystourethroscopy and other Genitourinary Procedures T 33.7354 $2,001.96 $400.39 0164 Level I Urinary and Anal Procedures T 1.1855 $70.35 $17.29 $14.07 Start Printed Page 50686 0165 Level III Urinary and Anal Procedures T 16.6689 $989.18 $197.84 0166 Level I Urethral Procedures T 17.6743 $1,048.85 $218.73 $209.77 0168 Level II Urethral Procedures T 28.2685 $1,677.54 $388.03 $335.51 0169 Lithotripsy T 43.0133 $2,552.54 $1,021.01 $510.51 0170 Dialysis S 5.8994 $350.09 $70.02 0180 Circumcision T 19.8827 $1,179.90 $304.87 $235.98 0181 Penile Procedures T 30.8663 $1,831.70 $621.82 $366.34 0183 Testes/Epididymis Procedures T 23.6415 $1,402.96 $280.59 0184 Prostate Biopsy T 4.3566 $258.53 $96.27 $51.71 0188 Level II Female Reproductive Proc T 1.1400 $67.65 $13.53 0189 Level III Female Reproductive Proc T 2.3710 $140.70 $28.14 0190 Level I Hysteroscopy T 21.0653 $1,250.08 $424.28 $250.02 0191 Level I Female Reproductive Proc T 0.1670 $9.91 $2.78 $1.98 0192 Level IV Female Reproductive Proc T 4.3082 $255.66 $51.13 0193 Level V Female Reproductive Proc T 14.5843 $865.48 $173.10 0194 Level VIII Female Reproductive Proc T 20.7525 $1,231.52 $397.84 $246.30 0195 Level IX Female Reproductive Proc T 26.6791 $1,583.22 $483.80 $316.64 0196 Dilation and Curettage T 17.0974 $1,014.61 $338.23 $202.92 0197 Infertility Procedures T 2.3572 $139.88 $27.98 0198 Pregnancy and Neonatal Care Procedures T 1.3683 $81.20 $32.19 $16.24 0200 Level VII Female Reproductive Proc T 17.8728 $1,060.63 $263.69 $212.13 0201 Level VI Female Reproductive Proc T 17.6047 $1,044.72 $329.65 $208.94 0202 Level X Female Reproductive Proc T 40.3866 $2,396.66 $958.66 $479.33 0203 Level IV Nerve Injections T 10.4015 $617.26 $246.90 $123.45 0204 Level I Nerve Injections T 2.1910 $130.02 $40.13 $26.00 0206 Level II Nerve Injections T 5.4920 $325.91 $75.55 $65.18 0207 Level III Nerve Injections T 6.0109 $356.70 $86.92 $71.34 0208 Laminotomies and Laminectomies T 42.3409 $2,512.64 $502.53 0209 Extended EEG Studies and Sleep Studies, Level II S 11.5713 $686.68 $274.67 $137.34 0212 Nervous System Injections T 2.9740 $176.49 $70.59 $35.30 0213 Extended EEG Studies and Sleep Studies, Level I S 2.2932 $136.09 $54.43 $27.22 0214 Electroencephalogram S 1.1353 $67.37 $26.94 $13.47 0215 Level I Nerve and Muscle Tests S 0.6115 $36.29 $14.51 $7.26 0216 Level III Nerve and Muscle Tests S 2.6720 $158.56 $31.71 0218 Level II Nerve and Muscle Tests S 1.1408 $67.70 $13.54 0220 Level I Nerve Procedures T 17.3586 $1,030.11 $206.02 0221 Level II Nerve Procedures T 29.9209 $1,775.60 $463.62 $355.12 0222 Implantation of Neurological Device T 179.0982 $10,628.22 $2,125.64 0223 Implantation or Revision of Pain Management Catheter T 28.1230 $1,668.90 $333.78 0224 Implantation of Reservoir/Pump/Shunt T 40.6455 $2,412.03 $482.41 0225 Level II Implantation of Neurostimulator Electrodes S 234.6925 $13,927.36 $2,785.47 0226 Implantation of Drug Infusion Reservoir T 138.8695 $8,240.93 $1,648.19 0227 Implantation of Drug Infusion Device T 136.4922 $8,099.86 $1,619.97 0228 Creation of Lumbar Subarachnoid Shunt T 51.7258 $3,069.56 $613.91 0229 Transcatherter Placement of Intravascular Shunts T 64.4545 $3,824.92 $771.23 $764.98 0230 Level I Eye Tests & Treatments S 0.7858 $46.63 $14.97 $9.33 0231 Level III Eye Tests & Treatments S 1.9278 $114.40 $44.61 $22.88 0232 Level I Anterior Segment Eye Procedures T 6.6732 $396.01 $103.17 $79.20 0233 Level II Anterior Segment Eye Procedures T 14.9673 $888.20 $266.33 $177.64 0234 Level III Anterior Segment Eye Procedures T 21.9741 $1,304.01 $511.31 $260.80 0235 Level I Posterior Segment Eye Procedures T 4.6593 $276.50 $67.40 $55.30 0236 Level II Posterior Segment Eye Procedures T 17.0229 $1,010.19 $202.04 0237 Level III Posterior Segment Eye Procedures T 28.9401 $1,717.39 $343.48 0238 Level I Repair and Plastic Eye Procedures T 2.5933 $153.89 $30.78 0239 Level II Repair and Plastic Eye Procedures T 6.9097 $410.04 $82.01 0240 Level III Repair and Plastic Eye Procedures T 18.1508 $1,077.12 $315.31 $215.42 0241 Level IV Repair and Plastic Eye Procedures T 23.3036 $1,382.91 $384.47 $276.58 0242 Level V Repair and Plastic Eye Procedures T 30.5464 $1,812.72 $597.36 $362.54 0243 Strabismus/Muscle Procedures T 22.1671 $1,315.46 $431.39 $263.09 0244 Corneal Transplant T 38.3723 $2,277.13 $803.26 $455.43 0245 Level I Cataract Procedures without IOL Insert T 13.3625 $792.97 $221.89 $158.59 0246 Cataract Procedures with IOL Insert T 23.4597 $1,392.17 $495.96 $278.43 0247 Laser Eye Procedures Except Retinal T 5.0330 $298.67 $104.31 $59.73 0248 Laser Retinal Procedures T 4.6769 $277.54 $93.98 $55.51 0249 Level II Cataract Procedures without IOL Insert T 27.9369 $1,657.86 $524.67 $331.57 0250 Nasal Cauterization/Packing T 1.2896 $76.53 $26.79 $15.31 0251 Level I ENT Procedures T 2.0101 $119.29 $23.86 0252 Level II ENT Procedures T 7.8673 $466.87 $113.41 $93.37 0253 Level III ENT Procedures T 16.1357 $957.54 $282.29 $191.51 Start Printed Page 50687 0254 Level IV ENT Procedures T 23.4040 $1,388.86 $321.35 $277.77 0256 Level V ENT Procedures T 37.3204 $2,214.70 $442.94 0258 Tonsil and Adenoid Procedures T 22.2466 $1,320.18 $437.25 $264.04 0259 Level VI ENT Procedures T 366.3317 $21,739.22 $8,070.21 $4,347.84 0260 Level I Plain Film Except Teeth X 0.7555 $44.83 $17.93 $8.97 0261 Level II Plain Film Except Teeth Including Bone Density Measurement X 1.2901 $76.56 $15.31 0262 Plain Film of Teeth X 0.9228 $54.76 $10.95 0263 Level I Miscellaneous Radiology Procedures X 1.7476 $103.71 $24.40 $20.74 0264 Level II Miscellaneous Radiology Procedures X 3.5240 $209.12 $79.41 $41.82 0265 Level I Diagnostic Ultrasound S 1.0213 $60.61 $24.24 $12.12 0266 Level II Diagnostic Ultrasound S 1.6393 $97.28 $38.91 $19.46 0267 Level III Diagnostic Ultrasound S 2.6327 $156.23 $62.18 $31.25 0268 Ultrasound Guidance Procedures S 1.0610 $62.96 $12.59 0269 Level III Echocardiogram Except Transesophageal S 3.2437 $192.49 $76.99 $38.50 0270 Transesophageal Echocardiogram S 6.0192 $357.20 $142.88 $71.44 0272 Level I Fluoroscopy X 1.3801 $81.90 $32.76 $16.38 0274 Myelography S 3.0413 $180.48 $72.19 $36.10 0275 Arthrography S 3.5779 $212.32 $69.09 $42.46 0276 Level I Digestive Radiology S 1.5319 $90.91 $36.36 $18.18 0277 Level II Digestive Radiology S 2.3852 $141.54 $56.61 $28.31 0278 Diagnostic Urography S 2.6434 $156.87 $62.74 $31.37 0279 Level II Angiography and Venography except Extremity S 8.9319 $530.05 $150.03 $106.01 0280 Level III Angiography and Venography except Extremity S 20.7902 $1,233.75 $353.85 $246.75 0282 Miscellaneous Computerized Axial Tomography S 1.6542 $98.17 $39.26 $19.63 0283 Computerized Axial Tomography with Contrast Material S 4.4253 $262.61 $105.04 $52.52 0284 Magnetic Resonance Imaging and Magnetic Resonance Angiography with Contras S 6.4201 $380.99 $152.39 $76.20 0285 Myocardial Positron Emission Tomography (PET) S 17.1798 $1,019.50 $318.72 $203.90 0288 Bone Density: Axial Skeleton S 1.2568 $74.58 $14.92 0296 Level I Therapeutic Radiologic Procedures S 2.2452 $133.24 $53.29 $26.65 0297 Level II Therapeutic Radiologic Procedures S 5.2530 $311.73 $122.13 $62.35 0299 Miscellaneous Radiation Treatment S 5.8482 $347.05 $69.41 0300 Level I Radiation Therapy S 1.5198 $90.19 $18.04 0301 Level II Radiation Therapy S 2.2195 $131.71 $26.34 0302 Level III Radiation Therapy S 4.6145 $273.84 $103.74 $54.77 0303 Treatment Device Construction X 2.8356 $168.27 $66.95 $33.65 0304 Level I Therapeutic Radiation Treatment Preparation X 1.7738 $105.26 $41.52 $21.05 0305 Level II Therapeutic Radiation Treatment Preparation X 4.0036 $237.59 $91.38 $47.52 0310 Level III Therapeutic Radiation Treatment Preparation X 13.9490 $827.78 $325.27 $165.56 0312 Radioelement Applications S 5.0032 $296.90 $59.38 0313 Brachytherapy S 12.8655 $763.48 $152.70 0314 Hyperthermic Therapies S 5.9945 $355.73 $98.36 $71.15 0315 Level II Implantation of Neurostimulator T 290.6470 $17,247.86 $3,449.57 0320 Electroconvulsive Therapy S 5.3765 $319.06 $80.06 $63.81 0321 Biofeedback and Other Training S 1.3579 $80.58 $21.71 $16.12 0322 Brief Individual Psychotherapy S 1.2319 $73.10 $14.62 0323 Extended Individual Psychotherapy S 1.6227 $96.30 $20.08 $19.26 0324 Family Psychotherapy S 2.0997 $124.60 $24.92 0325 Group Psychotherapy S 1.3189 $78.27 $17.10 $15.65 0330 Dental Procedures S 7.1756 $425.82 $85.16 0332 Computerized Axial Tomography and Computerized Angiography without Contras S 3.2694 $194.02 $77.60 $38.80 0333 Computerized Axial Tomography and Computerized Angio w/o Contrast Material S 5.2836 $313.54 $125.41 $62.71 0335 Magnetic Resonance Imaging, Miscellaneous S 5.1581 $306.10 $122.43 $61.22 0336 Magnetic Resonance Imaging and Magnetic Resonance Angiography without Cont S 6.0742 $360.46 $144.18 $72.09 0337 MRI and Magnetic Resonance Angiography without Contrast Material followed S 8.7945 $521.89 $208.75 $104.38 0339 Observation S 7.1403 $423.73 $84.75 0340 Minor Ancillary Procedures X 0.6384 $37.88 $7.58 0341 Skin Tests X 0.1112 $6.60 $2.62 $1.32 0342 Level I Pathology X 0.1560 $9.26 $3.70 $1.85 0343 Level III Pathology X 0.4786 $28.40 $11.10 $5.68 0344 Level IV Pathology X 0.7996 $47.45 $15.66 $9.49 0345 Level I Transfusion Laboratory Procedures X 0.2277 $13.51 $3.01 $2.70 0346 Level II Transfusion Laboratory Procedures X 0.3434 $20.38 $4.54 $4.08 0347 Level III Transfusion Laboratory Procedures X 0.8434 $50.05 $12.35 $10.01 Start Printed Page 50688 0348 Fertility Laboratory Procedures X 0.7927 $47.04 $9.41 0350 Administration of flu and PPV vaccines X 0.3954 $23.46 $0.00 $0.00 0352 Level I Injections X 0.1413 $8.39 $1.68 0353 Level II Injections X 0.3954 $23.46 $4.69 0359 Level III Injections X 0.8312 $49.33 $9.87 0360 Level I Alimentary Tests X 1.4739 $87.47 $34.98 $17.49 0361 Level II Alimentary Tests X 3.6216 $214.92 $83.23 $42.98 0362 Contact Lens and Spectacle Services X 2.6607 $157.89 $31.58 0363 Level I Otorhinolaryngologic Function Tests X 0.9128 $54.17 $17.44 $10.83 0364 Level I Audiometry X 0.4708 $27.94 $9.06 $5.59 0365 Level II Audiometry X 1.2356 $73.32 $18.95 $14.66 0366 Level III Audiometry X 1.7743 $105.29 $30.04 $21.06 0367 Level I Pulmonary Test X 0.6659 $39.52 $14.80 $7.90 0368 Level II Pulmonary Tests X 0.9761 $57.92 $23.16 $11.58 0369 Level III Pulmonary Tests X 2.7519 $163.31 $44.18 $32.66 0370 Allergy Tests X 1.1232 $66.65 $13.33 0372 Therapeutic Phlebotomy X 0.5700 $33.83 $10.09 $6.77 0373 Neuropsychological Testing X 2.1926 $130.12 $26.02 0374 Monitoring Psychiatric Drugs X 1.0414 $61.80 $12.36 0375 Ancillary Outpatient Services When Patient Expires T 42.5900 $2,527.42 $505.48 0376 Level II Cardiac Imaging S 5.1975 $308.44 $121.42 $61.69 0377 Level III Cardiac Imaging S 6.8344 $405.57 $162.22 $81.11 0378 Level II Pulmonary Imaging S 5.4997 $326.37 $130.54 $65.27 0379 Injection adenosine K $33.45 $6.69 0381 Single Allergy Tests X 0.1884 $11.18 $2.35 $2.24 0384 GI Procedures with Stents T 22.3392 $1,325.68 $287.93 $265.14 0385 Level I Prosthetic Urological Procedures S 75.6446 $4,488.98 $897.80 0386 Level II Prosthetic Urological Procedures S 120.1694 $7,131.21 $1,426.24 0387 Level II Hysteroscopy T 32.5445 $1,931.29 $655.55 $386.26 0388 Discography S 12.3294 $731.66 $292.66 $146.33 0389 Non-imaging Nuclear Medicine S 1.4976 $88.87 $35.54 $17.77 0390 Level I Endocrine Imaging S 2.5562 $151.69 $60.67 $30.34 0391 Level II Endocrine Imaging S 2.8774 $170.75 $68.30 $34.15 0393 Red Cell/Plasma Studies S 3.4438 $204.37 $81.74 $40.87 0394 Hepatobiliary Imaging S 4.4630 $264.85 $105.93 $52.97 0395 GI Tract Imaging S 3.8699 $229.65 $91.86 $45.93 0396 Bone Imaging S 4.1426 $245.83 $98.33 $49.17 0397 Vascular Imaging S 2.2646 $134.39 $53.75 $26.88 0398 Level I Cardiac Imaging S 4.3093 $255.73 $102.29 $51.15 0399 Nuclear Medicine Add-on Imaging S 1.5192 $90.15 $36.06 $18.03 0400 Hematopoietic Imaging S 4.1335 $245.29 $98.11 $49.06 0401 Level I Pulmonary Imaging S 3.4150 $202.66 $81.06 $40.53 0402 Brain Imaging S 5.1847 $307.68 $123.07 $61.54 0403 CSF Imaging S 3.6138 $214.45 $85.78 $42.89 0404 Renal and Genitourinary Studies Level I S 3.8559 $228.82 $91.52 $45.76 0405 Renal and Genitourinary Studies Level II S 4.2674 $253.24 $101.29 $50.65 0406 Tumor/Infection Imaging S 4.3035 $255.38 $102.15 $51.08 0407 Radionuclide Therapy S 3.9839 $236.42 $94.56 $47.28 0409 Red Blood Cell Tests X 0.1258 $7.47 $2.22 $1.49 0411 Respiratory Procedures S 0.3869 $22.96 $4.59 0412 IMRT Treatment Delivery S 5.3643 $318.33 $63.67 0415 Level II Endoscopy Lower Airway T 22.0955 $1,311.21 $459.92 $262.24 0416 Level I Intravascular and Intracardiac Ultrasound and Flow Reserve S 19.5542 $1,160.40 $232.08 0417 Computerized Reconstruction S 4.0750 $241.82 $48.36 0418 Insertion of Left Ventricular Pacing Elect T 109.3043 $6,486.45 $1,297.29 0421 Prolonged Physiologic Monitoring X 1.6600 $98.51 $19.70 0422 Level II Upper GI Procedures T 22.9647 $1,362.79 $448.81 $272.56 0423 Level II Percutaneous Abdominal and Biliary Procedures T 40.2866 $2,390.73 $478.15 0425 Level II Arthroplasty with Prosthesis T 100.2058 $5,946.51 $1,378.01 $1,189.30 0426 Level II Strapping and Cast Application S 2.1243 $126.06 $25.21 0427 Level III Tube Changes and Repositioning T 10.1977 $605.16 $124.11 $121.03 0428 Level III Sigmoidoscopy and Anoscopy T 19.9022 $1,181.06 $236.21 0429 Level V Cystourethroscopy and other Genitourinary Procedures T 42.3147 $2,511.08 $502.22 0430 Level IV Nerve and Muscle Tests T 11.4040 $676.75 $135.35 0432 Health and Behavior Services S 0.6949 $41.24 $8.25 0433 Level II Pathology X 0.2581 $15.32 $6.12 $3.06 0434 Cardiac Defect Repair T 90.7877 $5,387.61 $1,077.52 Start Printed Page 50689 0600 Low Level Clinic Visits V 0.8688 $51.56 $10.31 0601 Mid Level Clinic Visits V 1.0038 $59.57 $11.91 0602 High Level Clinic Visits V 1.4284 $84.77 $16.95 0610 Low Level Emergency Visits V 1.2947 $76.83 $19.48 $15.37 0611 Mid Level Emergency Visits V 2.2718 $134.82 $35.76 $26.96 0612 High Level Emergency Visits V 3.9853 $236.50 $54.12 $47.30 0620 Critical Care S 8.2996 $492.52 $135.68 $98.50 0621 Level I Vascular Access Procedures T 8.2986 $492.46 $98.49 0622 Level II Vascular Access Procedures T 21.2671 $1,262.05 $252.41 0623 Level III Vascular Access Procedures T 27.1105 $1,608.82 $321.76 0648 Breast Reconstruction with Prosthesis T 50.4459 $2,993.61 $598.72 0651 Complex Interstitial Radiation Source Application S 12.1448 $720.71 $144.14 0652 Insertion of Intraperitoneal Catheters T 28.8948 $1,714.70 $342.94 0653 Vascular Reconstruction/Fistula Repair with Device T 30.5339 $1,811.97 $362.39 0654 Insertion/Replacement of a permanent dual chamber pacemaker T 100.9294 $5,989.45 $1,197.89 0655 Insertion/Replacement/Conversion of a permanent dual chamber pacemaker T 133.7768 $7,938.72 $1,587.74 0656 Transcatheter Placement of Intracoronary Drug-Eluting Stents T 109.9237 $6,523.20 $1,304.64 0657 Placement of Tissue Clips S 1.7092 $101.43 $20.29 0658 Percutaneous Breast Biopsies T 6.1049 $362.28 $72.46 0659 Hyperbaric Oxygen S 1.5473 $91.82 $18.36 0660 Level II Otorhinolaryngologic Function Tests X 1.6419 $97.44 $30.66 $19.49 0661 Level V Pathology X 3.3775 $200.43 $80.17 $40.09 0662 CT Angiography S 5.1621 $306.33 $122.53 $61.27 0664 Level I Proton Beam Radiation Therapy S 12.9439 $768.13 $153.63 0665 Bone Density: AppendicularSkeleton S 0.6464 $38.36 $7.67 0667 Level II Proton Beam Radiation Therapy S 15.4857 $918.97 $183.79 0668 Level I Angiography and Venography except Extremity S 6.5024 $385.87 $114.67 $77.17 0670 Level II Intravascular and Intracardiac Ultrasound and Flow Reserve S 25.4131 $1,508.09 $472.46 $301.62 0671 Level II Echocardiogram Except Transesophageal S 1.7028 $101.05 $40.42 $20.21 0672 Level IV Posterior Segment Eye Procedures T 36.9284 $2,191.44 $438.29 0673 Level IV Anterior Segment Eye Procedures T 29.2582 $1,736.27 $649.56 $347.25 0674 Prostate Cryoablation T 95.7856 $5,684.20 $1,136.84 0675 Prostatic Thermotherapy T 43.7329 $2,595.24 $519.05 0676 Thrombolysis and Thrombectomy T 2.4105 $143.05 $28.61 0678 External Counterpulsation T 1.7276 $102.52 $20.50 0679 Level II Resuscitation and Cardioversion S 5.5774 $330.98 $95.30 $66.20 0680 Insertion of Patient Activated Event Recorders S 62.9082 $3,733.16 $746.63 0681 Knee Arthroplasty T 137.1630 $8,139.66 $2,081.48 $1,627.93 0682 Level V Debridement & Destruction T 6.9107 $410.10 $162.42 $82.02 0683 Level II Photochemotherapy S 1.9006 $112.79 $25.34 $22.56 0685 Level III Needle Biopsy/Aspiration Except Bone Marrow T 6.0174 $357.09 $115.47 $71.42 0686 Level III Skin Repair T 13.8287 $820.64 $164.13 0687 Revision/Removal of Neurostimulator Electrodes T 19.2347 $1,141.44 $456.57 $228.29 0688 Revision/Removal of Neurostimulator Pulse Generator Receiver T 43.0444 $2,554.38 $1,021.75 $510.88 0689 Electronic Analysis of Cardioverter-defibrillators S 0.5735 $34.03 $6.81 0690 Electronic Analysis of Pacemakers and other Cardiac Devices S 0.3755 $22.28 $8.91 $4.46 0691 Electronic Analysis of Programmable Shunts/Pumps S 2.5252 $149.85 $59.94 $29.97 0692 Electronic Analysis of Neurostimulator Pulse Generators S 2.0111 $119.34 $30.16 $23.87 0693 Level II Breast Reconstruction T 42.2254 $2,505.78 $798.17 $501.16 0694 Mohs Surgery T 3.8452 $228.19 $61.86 $45.64 0695 Level VII Debridement & Destruction T 20.3164 $1,205.64 $266.59 $241.13 0697 Level I Echocardiogram Except Transesophageal S 1.5357 $91.13 $36.45 $18.23 0698 Level II Eye Tests & Treatments S 1.2438 $73.81 $16.55 $14.76 0699 Level IV Eye Tests & Treatments T 10.0177 $594.48 $118.90 0700 Antepartum Manipulation T 5.3614 $318.16 $63.63 0701 SR 89 chloride, per mCi H 0702 SM 153 lexidronam H 0704 IN 111 Satumomab pendetide per dose H 0705 Technetium TC99M tetrofosmin H 0726 Dexrazoxane hcl injection K $216.39 $43.28 0728 Filgrastim injection K $178.39 $35.68 0730 Pamidronate disodium K $58.42 $11.68 0731 Sargramostim injection K $21.11 $4.22 0732 Mesna injection K $13.68 $2.74 0733 Non esrd epoetin alpha inj K $9.99 $2.00 Start Printed Page 50690 0734 Injection, darbepoetin alfa (for non-ESRD) K $3.28 $0.66 0735 Ampho b cholesteryl sulfate K $12.24 $2.45 0736 Amphotericin b liposome inj K $21.91 $4.38 0737 Ammonia N-13, per dose H 0738 Rasburicase G $109.18 $21.84 0750 Dolasetron mesylate K $6.55 $1.31 0763 Dolasetron mesylate oral K $48.54 $9.71 0764 Granisetron HCl injection K $7.24 $1.45 0765 Granisetron HCl oral K $33.51 $6.70 0768 Ondansetron hcl injection K $3.80 $0.76 0769 Ondansetron hcl oral K $32.02 $6.40 0800 Leuprolide acetate K $441.78 $88.36 0802 Etoposide oral K $41.12 $8.22 0807 Aldesleukin/single use vial K $701.76 $140.35 0809 Bcg live intravesical vac K $121.74 $24.35 0810 Goserelin acetate implant K $196.25 $39.25 0811 Carboplatin injection K $77.16 $15.43 0812 Carmus bischl nitro inj K $141.29 $28.26 0814 Asparaginase injection K $55.42 $11.08 0819 Dacarbazine inj K $6.20 $1.24 0820 Daunorubicin K $35.28 $7.06 0821 Daunorubicin citrate liposom K $57.56 $11.51 0823 Docetaxel K $301.17 $60.23 0827 Floxuridine injection K $60.17 $12.03 0828 Gemcitabine HCL K $117.45 $23.49 0830 Irinotecan injection K $129.08 $25.82 0831 Ifosfomide injection K $53.54 $10.71 0832 Idarubicin hcl injection K $314.00 $62.80 0834 Interferon alfa-2a inj K $31.75 $6.35 0835 Inj cosyntropin K $69.27 $13.85 0836 Interferon alfa-2b inj recombinant, 1 million K $13.22 $2.64 0838 Interferon gamma 1-b inj K $277.79 $55.56 0840 Melphalan hydrochl K $523.22 $104.64 0842 Fludarabine phosphate inj K $262.41 $52.48 0843 Pegaspargase K $1,528.80 $305.76 0844 Pentostatin injection K $1,868.91 $373.78 0849 Rituximab K $447.97 $89.59 0850 Streptozocin injection K $153.33 $30.67 0851 Thiotepa injection K $44.55 $8.91 0852 Topotecan K $755.51 $151.10 0855 Vinorelbine tartrate K $62.85 $12.57 0856 Porfimer sodium K $2,457.97 $491.59 0857 Bleomycin sulfate injection K $54.18 $10.84 0858 Cladribine K $39.37 $7.87 0860 Plicamycin (mithramycin) inj K $80.54 $16.11 0861 Leuprolide acetate injection K $10.96 $2.19 0862 Mitomycin K $26.36 $5.27 0863 Paclitaxel injection K $19.11 $3.82 0864 Mitoxantrone hcl K $329.69 $65.94 0865 Interferon alfa-n3 inj, human leukocyte derived, 2 K $8.77 $1.75 0868 Oral aprepitant G $4.75 $0.95 0869 IVIG lyophil 1g K $39.46 $7.89 0870 IVIG lyophil 10 mg K $0.40 $0.08 0871 IVIG non-lyophil 1g K $57.26 $11.45 0872 IVIG non-lyophil 10 mg K $0.57 $0.11 0876 Caffeine citrate injection K $3.34 $0.67 0880 Penicillin g benzathine inj K $72.26 $14.45 0884 Rho d immune globulin inj K $113.91 $22.78 0887 Azathioprine parenteral K $47.40 $9.48 0888 Cyclosporine oral K $3.94 $0.79 0890 Lymphocyte immune globulin K $290.30 $58.06 0891 Tacrolimus oral K $3.37 $0.67 0892 Edetate calcium disodium inj K $40.34 $8.07 0893 Calcitonin salmon injection K $35.68 $7.14 0895 Deferoxamine mesylate inj K $14.91 $2.98 0900 Alglucerase injection K $39.94 $7.99 0901 Alpha 1 proteinase inhibitor K $3.30 $0.66 0902 Botulinum toxin a, per unit K $4.80 $0.96 0903 Cytomegalovirus imm IV/vial K $683.07 $136.61 Start Printed Page 50691 0906 RSV-ivig K $15.56 $3.11 0910 Interferon beta-1b K $81.95 $16.39 0911 Streptokinase K $83.36 $16.67 0912 Interferon alfacon-1 K $3.91 $0.78 0913 Ganciclovir long act implant K $4,318.68 $863.74 0916 Injection imiglucerase /unit K $3.98 $0.80 0917 Adenosine injection K $71.53 $14.31 0925 Factor viii K $0.51 $0.10 0926 Factor VIII (porcine) K $1.75 $0.35 0927 Factor viii recombinant K $0.94 $0.19 0928 Factor ix complex K $0.52 $0.10 0929 Anti-inhibitor per iu K $1.12 $0.22 0931 Factor IX non-recombinant K $0.75 $0.15 0932 Factor IX recombinant K $0.86 $0.17 0935 Clonidine hydrochloride K $57.47 $11.49 0949 Plasma, Pooled Multiple Donor, Solvent/Detergent T K 1.1956 $70.95 $14.19 0950 Blood (Whole) For Transfusion K 2.0123 $119.42 $23.88 0952 Cryoprecipitate K 0.7395 $43.88 $8.78 0954 RBC leukocytes reduced K 2.7370 $162.42 $32.48 0955 Plasma, Fresh Frozen K 1.2934 $76.75 $15.35 0956 Plasma Protein Fraction K 1.1226 $66.62 $13.32 0957 Platelet Concentrate K 0.8317 $49.36 $9.87 0958 Platelet Rich Plasma K 5.1815 $307.49 $61.50 0959 Red Blood Cells K 2.0301 $120.47 $24.09 0960 Washed Red Blood Cells K 2.9707 $176.29 $35.26 0961 Infusion, Albumin (Human) 5%, 50 ml K 0.5119 $30.38 $6.08 0963 Albumin (human), 5% K 1.3869 $82.30 $16.46 0964 Albumin (human), 25% K 0.4878 $28.95 $5.79 0965 Albumin (human), 25% K 1.1117 $65.97 $13.19 0966 Plasmaprotein fract, 5% K 4.9564 $294.13 $58.83 0967 Split unit of blood K 1.2698 $75.35 $15.07 0968 Platelets leukocyte reduced irradiated K 2.3639 $140.28 $28.06 0969 Red blood cell leukocyte reduced irradiated K 3.6451 $216.31 $43.26 1009 Cryoprecip reduced plasma K 1.3062 $77.51 $15.50 1010 Blood, L/R, CMV-neg K 2.9692 $176.20 $35.24 1011 Platelets, HLA-m, L/R, unit K 10.9690 $650.93 $130.19 1013 Platelet concentrate, L/R, unit K 1.6023 $95.09 $19.02 1016 Blood, L/R, froz/deglycerol/washed K 5.2631 $312.33 $62.47 1017 Platelets, aph/pher, L/R, CMV-neg, unit K 8.5998 $510.34 $102.07 1018 Blood, L/R, irradiated K 2.8004 $166.18 $33.24 1019 Platelets, aph/pher, L/R, irradiated, unit K 9.5131 $564.54 $112.91 1020 Pit, pher, L/R, CMV, irrad K 10.1551 $602.63 $120.53 1021 RBC, frz/deg/wsh, L/R, irrad K 4.8787 $289.52 $57.90 1022 RBC, L/R, CMV neg, irrad K 4.2901 $254.59 $50.92 1045 Iobenguane sulfate I-131 H 1052 Injection, Voriconazole K $4.63 $0.93 1064 I-131 sodium iodide capsule H 1065 I-131 sodium iodide solution H 1080 I-131 tositumomab, dx H 1081 I-131 tositumomab, tx H 1082 Treprostinil K $55.02 $11.00 1083 Injection, Adalimumab K $300.10 $60.02 1084 Denileukin diftitox K $1,235.33 $247.07 1085 Injection, Gallium Nitrate K $1.30 $0.26 1086 Temozolomide,oral K $7.28 $1.46 1088 Dx I131 so iodide cap millic H 1091 IN 111 Oxyquinoline H 1092 IN 111 Pentetate H 1093 TC99M fanolesomab H 1096 TC 99M Exametazime, per dose H 1150 Th I131 so iodide sol millic H 1166 Cytarabine liposome K $366.43 $73.29 1167 Epirubicin hcl K $25.15 $5.03 1178 Busulfan IV K 0.2851 $16.92 $3.38 1201 TC 99M SUCCIMER, PER Vial H 1203 Verteporfin for injection K $9.16 $1.83 1207 Octreotide injection, depot K $87.40 $17.48 1210 Inj dihydroergotamine mesylt K $27.82 $5.56 1280 Corticotropin injection K $95.44 $19.09 Start Printed Page 50692 1305 Apligraf K 12.9222 $766.84 $153.37 1330 Ergonovine maleate injection K 0.5263 $31.23 $6.25 1409 Factor viia recombinant K $1,080.11 $216.02 1436 Etidronate disodium inj K $68.69 $13.74 1491 New Technology—Level I ($0-$10) S $5.00 $1.00 1492 New Technology—Level I ($10-$20) S $15.00 $3.00 1493 New Technology—Level I ($20-$30) S $25.00 $5.00 1494 New Technology—Level I ($30-$40) S $35.00 $7.00 1495 New Technology—Level I ($40-$50) S $45.00 $9.00 1496 New Technology—Level I ($0-$10) T $5.00 $1.00 1497 New Technology—Level I ($10-$20) T $15.00 $3.00 1498 New Technology—Level I ($20-$30) T $25.00 $5.00 1499 New Technology—Level I ($30-$40) T $35.00 $7.00 1500 New Technology—Level I ($40-$50) T $45.00 $9.00 1502 New Technology—Level II ($50-$100) S $75.00 $15.00 1503 New Technology—Level III ($100-$200) S $150.00 $30.00 1504 New Technology—Level IV ($200-$300) S $250.00 $50.00 1505 New Technology—Level V ($300-$400) S $350.00 $70.00 1506 New Technology—Level VI ($400-$500) S $450.00 $90.00 1507 New Technology—Level VII ($500-$600) S $550.00 $110.00 1508 New Technology—Level VIII ($600-$700) S $650.00 $130.00 1509 New Technology—Level IX ($700-$800) S $750.00 $150.00 1510 New Technology—Level X ($800-$900) S $850.00 $170.00 1511 New Technology—Level XI ($900-$1000) S $950.00 $190.00 1512 New Technology—Level XII ($1000-$1100) S $1,050.00 $210.00 1513 New Technology—Level XIII ($1100-$1200) S $1,150.00 $230.00 1514 New Technology—Level XIV ($1200-$1300) S $1,250.00 $250.00 1515 New Technology—Level XV ($1300-$1400) S $1,350.00 $270.00 1516 New Technology—Level XVI ($1400-$1500) S $1,450.00 $290.00 1517 New Technology—Level XVII ($1500-$1600) S $1,550.00 $310.00 1518 New Technology—Level XVIII ($1600-$1700) S $1,650.00 $330.00 1519 New Technology—Level IXX ($1700-$1800) S $1,750.00 $350.00 1520 New Technology—Level XX ($1800-$1900) S $1,850.00 $370.00 1521 New Technology—Level XXI ($1900-$2000) S $1,950.00 $390.00 1522 New Technology—Level XXII ($2000-$2500) S $2,250.00 $450.00 1523 New Technology—Level XXIII ($2500-$3000) S $2,750.00 $550.00 1524 New Technology—Level XIV ($3000-$3500) S $3,250.00 $650.00 1525 New Technology—Level XXV ($3500-$4000) S $3,750.00 $750.00 1526 New Technology—Level XXVI ($4000-$4500) S $4,250.00 $850.00 1527 New Technology—Level XXVII ($4500-$5000) S $4,750.00 $950.00 1528 New Technology—Level XXVIII ($5000-$5500) S $5,250.00 $1,050.00 1529 New Technology—Level XXIX ($5500-$6000) S $5,750.00 $1,150.00 1530 New Technology—Level XXX ($6000-$6500) S $6,250.00 $1,250.00 1531 New Technology—Level XXXI ($6500-$7000) S $6,750.00 $1,350.00 1532 New Technology—Level XXXII ($7000-$7500) S $7,250.00 $1,450.00 1533 New Technology—Level XXXIII ($7500-$8000) S $7,750.00 $1,550.00 1534 New Technology—Level XXXIV ($8000-$8500) S $8,250.00 $1,650.00 1535 New Technology—Level XXXV ($8500-$9000) S $8,750.00 $1,750.00 1536 New Technology—Level XXXVI ($9000-$9500) S $9,250.00 $1,850.00 1537 New Technology—Level XXXVII ($9500-$10000) S $9,750.00 $1,950.00 1539 New Technology—Level II ($50-$100) T $75.00 $15.00 1540 New Technology—Level III ($100-$200) T $150.00 $30.00 1541 New Technology—Level IV ($200-$300) T $250.00 $50.00 1542 New Technology—Level V ($300-$400) T $350.00 $70.00 1543 New Technology—Level VI ($400-$500) T $450.00 $90.00 1544 New Technology—Level VII ($500-$600) T $550.00 $110.00 1545 New Technology—Level VIII ($600-$700) T $650.00 $130.00 1546 New Technology—Level IX ($700-$800) T $750.00 $150.00 1547 New Technology—Level X ($800-$900) T $850.00 $170.00 1548 New Technology—Level XI ($900-$1000) T $950.00 $190.00 1549 New Technology—Level XII ($1000-$1100) T $1,050.00 $210.00 1550 New Technology—Level XIII ($1100-$1200) T $1,150.00 $230.00 1551 New Technology—Level XIV ($1200- $1300) T $1,250.00 $250.00 1552 New Technology—Level XV ($1300-$1400) T $1,350.00 $270.00 1553 New Technology—Level XVI ($1400-$1500) T $1,450.00 $290.00 1554 New Technology—Level XVII ($1500-$1600) T $1,550.00 $310.00 1555 New Technology—Level XVIII ($1600-$1700) T $1,650.00 $330.00 1556 New Technology—Level XIX ($1700-$1800) T $1,750.00 $350.00 1557 New Technology—Level XX ($1800-$1900) T $1,850.00 $370.00 Start Printed Page 50693 1558 New Technology—Level XXI ($1900-$2000) T $1,950.00 $390.00 1559 New Technology—Level XXII ($2000-$2500) T $2,250.00 $450.00 1560 New Technology—Level XXIII ($2500-$3000) T $2,750.00 $550.00 1561 New Technology—Level XXIV ($3000-$3500) T $3,250.00 $650.00 1562 New Technology—Level XXV ($3500-$4000) T $3,750.00 $750.00 1563 New Technology—Level XXVI ($4000-$4500) T $4,250.00 $850.00 1564 New Technology—Level XXVII ($4500-$5000) T $4,750.00 $950.00 1565 New Technology—Level XXVIII ($5000-$5500) T $5,250.00 $1,050.00 1566 New Technology—Level XXIX ($5500-$6000) T $5,750.00 $1,150.00 1567 New Technology—Level XXX ($6000-$6500) T $6,250.00 $1,250.00 1568 New Technology—Level XXXI ($6500-$7000) T $6,750.00 $1,350.00 1569 New Technology—Level XXXII ($7000-$7500) T $7,250.00 $1,450.00 1570 New Technology—Level XXXIII ($7500-$8000) T $7,750.00 $1,550.00 1571 New Technology—Level XXXIV ($8000-$8500) T $8,250.00 $1,650.00 1572 New Technology—Level XXXV ($8500-$9000) T $8,750.00 $1,750.00 1573 New Technology—Level XXXVI ($9000-$9500) T $9,250.00 $1,850.00 1574 New Technology—Level XXXVII ($9500-$10000) T $9,750.00 $1,950.00 1600 Technetium TC 99m sestamibi H 1603 Thallous chloride TL 201 H 1604 IN 111 capromab pendetide, per dose H 1605 Abciximab injection K $450.60 $90.12 1607 Eptifibatide injection K $12.73 $2.55 1608 Etanercept injection K $152.11 $30.42 1609 Rho(D) immune globulin h, sd K $12.04 $2.41 1611 Hylan G-F 20 injection K $203.15 $40.63 1612 Daclizumab, parenteral K $381.48 $76.30 1613 Trastuzumab K $53.98 $10.80 1615 Basiliximab K $1,473.57 $294.71 1618 Vonwillebrandfactrcmplx, per iu K $0.74 $0.15 1619 Gallium ga 67 H 1620 Technetium tc99m bicisate H 1622 Technetium tc99m mertiatide H 1624 Sodium phosphate p32 H 1625 Indium 111-in pentetreotide H 1628 Chromic phosphate p32 H 1655 Tinzaparin sodium injection K $2.53 $0.51 1670 Tetanus immune globulin inj K $76.90 $15.38 1716 Brachytx source, Gold 198 H 1717 Brachytx source, HDR Ir-192 H 1718 Brachytx source, Iodine 125 H 1719 Brachytx sour, Non-HDR Ir-192 H 1720 Brachytx sour, Palladium 103 H 1740 Diazoxide injection K $113.86 $22.77 1775 FDG, per dose (4-40 mCi/ml) H 2210 Methyldopate hcl injection K $9.58 $1.92 2616 Brachytx source, Yttrium-90 H 2632 Brachytx sol, I-125, per mCi H 2633 Brachytx source, Cesium-131 H 2634 Brachytx source, HA, I-125 H 2635 Brachytx source, HA, P-103 H 2636 Brachytx linear source, P-103 H 2730 Pralidoxime chloride inj K $76.68 $15.34 2770 Quinupristin/dalfopristin K $105.48 $21.10 2940 Somatrem injection K $43.14 $8.63 3030 Sumatriptan succinate K $51.03 $10.21 7000 Amifostine K $436.01 $87.20 7005 Gonadorelin hydroch K $173.44 $34.69 7011 Oprelvekin injection K $249.06 $49.81 7015 Busulfan, oral K $1.98 $0.40 7019 Aprotinin K $2.20 $0.44 7024 Corticorelin ovine triflutat K $386.53 $77.31 7025 Digoxin immune FAB (ovine) K $552.18 $110.44 7026 Ethanolamine oleate K $64.53 $12.91 7027 Fomepizole K $12.31 $2.46 7028 Fosphenytoin K $5.19 $1.04 7030 Hemin K $6.51 $1.30 7034 Somatropin injection K $42.93 $8.59 7035 Teniposide K $266.23 $53.25 7036 Urokinase inj K $415.69 $83.14 Start Printed Page 50694 7037 Urofollitropin K $44.74 $8.95 7038 Monoclonal antibodies K $885.36 $177.07 7040 Pentastarch 10% solution K $12.45 $2.49 7041 Tirofiban hcl K $7.89 $1.58 7042 Capecitabine, oral K $3.30 $0.66 7043 Infliximab injection K $54.20 $10.84 7045 Trimetrexate glucoronate K $139.85 $27.97 7046 Doxorubicin hcl liposome inj K $365.64 $73.13 7048 Alteplase recombinant K $30.65 $6.13 7049 Filgrastim injection K $282.29 $56.46 7051 Leuprolide acetate implant K $2,262.19 $452.44 7308 Aminolevulinic acid hcl top K $96.79 $19.36 7316 Sodium hyaluronate injection K $110.65 $22.13 7515 Cyclosporine oral K $1.00 $0.20 9001 Linezolid injection K $24.15 $4.83 9002 Tenecteplase K $2,052.77 $410.55 9003 Palivizumab K 4.1491 $246.22 $49.24 9004 Gemtuzumab ozogamicin K $2,245.04 $449.01 9005 Reteplase injection K $898.81 $179.76 9006 Tacrolimus injection K $126.61 $25.32 9008 Baclofen Refill Kit-500mcg K 0.2447 $14.52 $2.90 9009 Baclofen refill kit—per 2000 mcg K 0.7209 $42.78 $8.56 9012 Arsenic Trioxide K $33.76 $6.75 9015 Mycophenolate mofetil oral K $2.50 $0.50 9018 Botulinum toxin B K $7.89 $1.58 9019 Caspofungin acetate K $32.35 $6.47 9020 Sirolimus tablet K $6.85 $1.37 9022 IM inj interferon beta 1-a K $89.10 $17.82 9023 Rho d immune globulin K $25.08 $5.02 9024 Amphotericin b lipid complex K $11.95 $2.39 9025 Rubidium-Rb-82 H 9030 Amphotericin B K $30.70 $6.14 9031 Arbutamine HCl injection K $163.15 $32.63 9032 Baclofen 10 MG injection K $188.01 $37.60 9033 Cidofovir injection K $782.98 $156.60 9038 Inj estrogen conjugate K $57.77 $11.55 9040 Intraocular Fomivirsen na K $203.93 $40.79 9042 Glucagon hydrochloride K $62.16 $12.43 9044 Ibutilide fumarate injection K $243.34 $48.67 9045 Iron dextran K $11.43 $2.29 9046 Iron sucrose injection K $0.38 $0.08 9047 Itraconazole injection K $36.93 $7.39 9051 Urea injection K 1.0454 $62.04 $12.41 9054 Metabolically active tissue K $15.69 $3.14 9055 Injectable human tissue K $3.54 $0.71 9057 Lepirudin K $128.17 $25.63 9100 Iodinated I-131 serumalbumin, per 5uci H 9104 Anti-thymocycte globulin rabbit K $299.47 $59.89 9105 Hep B imm glob K 1.8813 $111.64 $22.33 9108 Thyrotropin alfa K $712.58 $142.52 9110 Alemtuzumab injection K $516.87 $103.37 9112 Inj Perflutren lipid micros, ml K $63.51 $12.70 9114 Nesiritide K $75.19 $15.04 9115 Inj, zoledronic acid K $202.41 $40.48 9117 Yttrium 90 ibritumomab tiuxetan H 9118 In-111 ibritumomab tiuxetan H 9119 Pegfilgrastim K $2,178.28 $435.66 9120 Inj, Fulvestrant K $82.90 $16.58 9121 Inj, Argatroban K 0.1897 $11.26 $2.25 9122 Triptorelin pamoate K $369.98 $74.00 9123 Transcyte K $719.41 $143.88 9124 Injection, daptomycin G $0.30 $0.06 9125 Risperidone, long acting G $4.71 $0.94 9126 Injection, natalizumab G $6.51 $1.30 9127 Paclitaxel protein pr K $8.59 $1.72 9128 Inj pegaptanib sodium K $1,074.27 $214.85 9130 Na chromateCr51, per 0.25mCi H 9132 51 Na Chromate, 50mCi H 9133 Rabies ig, im/sc K $64.56 $12.91 Start Printed Page 50695 9134 Rabies ig, heat treated K $69.79 $13.96 9135 Varicella-zoster ig, im K $96.58 $19.32 9136 Adenovirus vaccine, type 4 K 0.9499 $56.37 $11.27 9137 Bcg vaccine, percut K $124.54 $24.91 9138 Hep a/hep b vacc, adult im K 0.9674 $57.41 $11.48 9139 Rabies vaccine, im K $128.04 $25.61 9140 Rabies vaccine, id K 1.4959 $88.77 $17.75 9141 Measles-rubella vaccine, sc K 0.9467 $56.18 $11.24 9142 Chicken pox vaccine, sc K $64.29 $12.86 9143 Meningococcal vaccine, sc K $56.75 $11.35 9144 Encephalitis vaccine, sc K $67.73 $13.55 9145 Meningococcal vaccine, im K 0.8948 $53.10 $10.62 9146 Technetium TC99m Disofenin H 9147 Technetium TC 99M Depreotide H 9148 I-123 sodium iodide capsule H 9149 Dx I131 so iodide microcurie H 9150 I-125 serum albumin micro H 9151 Tc 99M ARCITUMOMAB PER VIAL H 9152 Baclofen Intrathecal kit-1am K 0.8562 $50.81 $10.16 9153 Na Iothalamate I-125, 10 uCi H 9154 Technetium tc99m glucepatate H 9155 Technetium tc99mlabeledrbcs H 9156 Nonmetabolic active tissue K $53.76 $10.75 9157 LOCM <=149 mg/ml iodine K $0.51 $0.10 9158 LOCM 150-199mg/ml iodine K $2.00 $0.40 9159 LOCM 200-249mg/ml iodine K $0.78 $0.16 9160 LOCM 250-299mg/ml iodine K $0.66 $0.13 9161 LOCM 300-349mg/ml iodine K $0.41 $0.08 9162 LOCM 350-399mg/ml iodine K $0.27 $0.05 9163 LOCM >= 400 mg/ml iodine K $0.20 $0.04 9164 Inj Gad-base MR contrast K $3.01 $0.60 9165 Oral MR contrast K $9.01 $1.80 9166 Dyphylline injection K $7.74 $1.55 9167 Valrubicin K $376.87 $75.37 9168 Pegademase bovine K $161.16 $32.23 9169 Anthrax vaccine, sc K $128.95 $25.79 9200 Orcel K 2.6893 $159.59 $31.92 9201 Dermagraft K 6.2066 $368.32 $73.66 9202 Inj Octafluoropropane mic,ml K $41.42 $8.28 9203 Inj Perflexane lipid micros, ml K $13.49 $2.70 9205 Oxaliplatin K $84.06 $16.81 9206 Integra K $9.23 $1.85 9207 Injection, bortezomib K $28.90 $5.78 9208 Injection, agalsidase beta K $123.35 $24.67 9209 Injection, laronidase K $23.16 $4.63 9210 Injection, palonosetron HCL K 18.42 $3.68 9211 Inj, alefacept, IV K $571.01 $114.20 9212 Inj, alefacept, IM K $402.00 $80.40 9213 Injection, Pemetrexed G $41.29 $8.26 9214 Injection, Bevacizumab G $58.17 $11.63 9215 Injection, Cetuximab G $50.59 $10.12 9216 Abarelix Injection G $66.96 $13.39 9217 Leuprolide acetate suspnsion K $230.87 $46.17 9218 Injection, Azacitidine K $4.03 $0.81 9219 Mycophenolic Acid G $2.47 $0.49 9220 Sodium hyaluronate G $203.84 $40.77 9221 Graftjacket Reg Matrix G $1,234.36 $246.87 9222 Graftjacket SftTis G $890.74 $178.15 9300 Injection, Omalizumab G $15.98 $3.20 9500 Platelets, irradiated K 1.3589 $80.64 $16.13 9501 Platelets, pheresis, leukocytes reduced K 8.1495 $483.62 $96.72 9502 Platelet pheresis irradiated K 5.1895 $307.96 $61.59 9503 Fresh frozen plasma, ea unit K 1.6241 $96.38 $19.28 9504 RBC deglycerolized K 6.4314 $381.66 $76.33 9505 RBC irradiated K 2.3876 $141.69 $28.34 9506 Granulocytes, pheresis K 15.6155 $926.67 $185.33 9507 Platelets, pheresis K 6.8988 $409.40 $81.88 9508 Plasma, frozen w/in 8 hours K 1.2038 $71.44 $14.29 6. On pages 42776-42965, Addendum B is corrected to read as follows:
Start Printed Page 50886Addendum B.—Payment Status by HCPCS Code and Related Information Calendar Year 2006
CPT/HCPCS SI CI Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment 0003T S Cervicography 1492 $15.00 $3.00 0008T T Upper gi endoscopy w/suture 0422 22.9647 $1,362.79 $448.81 $272.56 00100 N Anesth, salivary gland 00102 N Anesth, repair of cleft lip 00103 N Anesth, blepharoplasty 00104 N Anesth, electroshock 0010T A Tb test, gamma interferon 00120 N Anesth, ear surgery 00124 N Anesth, ear exam 00126 N Anesth, tympanotomy 00140 N Anesth, procedures on eye 00142 N Anesth, lens surgery 00144 N Anesth, corneal transplant 00145 N Anesth, vitreoretinal surg 00147 N Anesth, iridectomy 00148 N Anesth, eye exam 00160 N Anesth, nose/sinus surgery 00162 N Anesth, nose/sinus surgery 00164 N Anesth, biopsy of nose 0016T T Thermotx choroid vasc lesion 0235 4.6593 $276.50 $67.40 $55.30 00170 N Anesth, procedure on mouth 00172 N Anesth, cleft palate repair 00174 N Anesth, pharyngeal surgery 00176 C Anesth, pharyngeal surgery 0017T E Photocoagulat macular drusen 0018T S Transcranial magnetic stimul 0215 0.6115 $36.29 $14.51 $7.26 00190 N Anesth, face/skull bone surg 00192 C Anesth, facial bone surgery 0019T E Extracorp shock wave tx, ms 0020T B Extracorp shock wave tx, ft 00210 N Anesth, open head surgery 00212 N Anesth, skull drainage 00214 C Anesth, skull drainage 00215 C Anesth, skull repair/fract 00216 N Anesth, head vessel surgery 00218 N Anesth, special head surgery 0021T C Fetal oximetry, trnsvag/cerv 00220 N Anesth, intrcrn nerve 00222 N Anesth, head nerve surgery 0023T A Phenotype drug test, hiv 1 0024T C Transcath cardiac reduction 0026T A Measure remnant lipoproteins 0027T T Endoscopic epidural lysis 0220 17.3586 $1,030.11 $206.02 0028T N Dexa body composition study 0029T A Magnetic tx for incontinence 00300 N Anesth, head/neck/ptrunk 0030T A Antiprothrombin antibody 0031T N Speculoscopy 00320 N Anesth, neck organ, 1 & over 00322 N Anesth, biopsy of thyroid 00326 N Anesth, larynx/trach, < 1 yr 0032T N Speculoscopy w/direct sample 0033T C Endovasc taa repr incl subcl 0034T C Endovasc taa repr w/o subcl 00350 N Anesth, neck vessel surgery 00352 N Anesth, neck vessel surgery 0035T C Insert endovasc prosth, taa 0036T C Endovasc prosth, taa, add-on 0037T C Artery transpose/endovas taa 0038T C Rad endovasc taa rpr w/cover 0039T C Rad s/i, endovasc taa repair 00400 N Anesth, skin, ext/per/atrunk Start Printed Page 50697 00402 N Anesth, surgery of breast 00404 C Anesth, surgery of breast 00406 C Anesth, surgery of breast 0040T C Rad s/i, endovasc taa prosth 00410 N Anesth, correct heart rhythm 0041T A Detect ur infect agnt w/cpas 0042T N Ct perfusion w/contrast, cbf 0043T A Co expired gas analysis 0044T N Whole body photography 00450 N Anesth, surgery of shoulder 00452 C Anesth, surgery of shoulder 00454 N Anesth, collar bone biopsy 0045T N Whole body photography 0046T T Cath lavage, mammary duct(s) 0021 14.9776 $888.82 $219.48 $177.76 00470 N Anesth, removal of rib 00472 N Anesth, chest wall repair 00474 C Anesth, surgery of rib(s) 0047T T Cath lavage, mammary duct(s) 0021 14.9776 $888.82 $219.48 $177.76 0048T C Implant ventricular device 0049T C External circulation assist 00500 N Anesth, esophageal surgery 0050T C Removal circulation assist 0051T C Implant total heart system 00520 N Anesth, chest procedure 00522 N Anesth, chest lining biopsy 00524 C Anesth, chest drainage 00528 N Anesth, chest partition view 00529 N Anesth, chest partition view 0052T C Replace component heart syst 00530 N Anesth, pacemaker insertion 00532 N Anesth, vascular access 00534 N Anesth, cardioverter/defib 00537 N Anesth, cardiac electrophys 00539 N Anesth, trach-bronch reconst 0053T C Replace component heart syst 00540 C Anesth, chest surgery 00541 N Anesth, one lung ventilation 00542 C Anesth, release of lung 00546 C Anesth, lung,chest wall surg 00548 N Anesth, trachea,bronchi surg 0054T B Bone surgery using computer 00550 N Anesth, sternal debridement 0055T B Bone surgery using computer 00560 C Anesth, open heart surgery 00561 C Anesth, heart surg < age 1 00562 C Anesth, open heart surgery 00563 N Anesth, heart proc w/pump 00566 N Anesth, cabg w/o pump 0056T B Bone surgery using computer 00580 C Anesth, heart/lung transplnt 0058T X Cryopreservation, ovary tiss 0348 0.7927 $47.04 $9.41 0059T X Cryopreservation, oocyte 0348 0.7927 $47.04 $9.41 00600 N Anesth, spine, cord surgery 00604 C Anesth, sitting procedure 0060T B Electrical impedance scan 0061T B Destruction of tumor, breast 00620 N Anesth, spine, cord surgery 00622 C Anesth, removal of nerves 0062T T Rep intradisc annulus1 lev 0203 10.4015 $617.26 $246.90 $123.45 00630 N Anesth, spine, cord surgery 00632 C Anesth, removal of nerves 00634 N Anesth for chemonucleolysis 00635 N Anesth, lumbar puncture 0063T T Rep intradisc annulus>1lev 0203 10.4015 $617.26 $246.90 $123.45 00640 N Anesth, spine manipulation 0064T A Spectroscop eval expired gas Start Printed Page 50698 0065T A Ocular photoscreen bilat 0066T E Ct colonography screen 00670 C Anesth, spine, cord surgery 0067T* S Ct colonography dx 0333 5.2836 $313.54 $125.41 $62.71 0068T B Interp/rept heart sound 0069T N Analysis only heart sound 00700 N Anesth, abdominal wall surg 00702 N Anesth, for liver biopsy 0070T N Interp only heart sound 0071T T U/s leiomyomata ablate <200 0193 14.5843 $865.48 $173.10 0072T T U/s leiomyomata ablate >200 0193 14.5843 $865.48 $173.10 00730 N Anesth, abdominal wall surg 0073T S Delivery, comp imrt 0412 5.3643 $318.33 $63.67 00740 N Anesth, upper gi visualize 0074T E Online physician e/m 00750 N Anesth, repair of hernia 00752 N Anesth, repair of hernia 00754 N Anesth, repair of hernia 00756 N Anesth, repair of hernia 0075T C Perq stent/chest vert art 0076T C S&i stent/chest vert art 00770 N Anesth, blood vessel repair 0077T C Cereb therm perfusion probe 0078T C Endovasc aort repr w/device 00790 N Anesth, surg upper abdomen 00792 C Anesth, hemorr/excise liver 00794 C Anesth, pancreas removal 00796 C Anesth, for liver transplant 00797 N Anesth, surgery for obesity 0079T C Endovasc visc extnsn repr 00800 N Anesth, abdominal wall surg 00802 C Anesth, fat layer removal 0080T C Endovasc aort repr rad s&i 00810 N Anesth, low intestine scope 0081T C Endovasc visc extnsn s&i 00820 N Anesth, abdominal wall surg 0082T B Stereotactic rad delivery 00830 N Anesth, repair of hernia 00832 N Anesth, repair of hernia 00834 N Anesth, hernia repair< 1 yr 00836 N Anesth hernia repair preemie 0083T N Stereotactic rad tx mngmt 00840 N Anesth, surg lower abdomen 00842 N Anesth, amniocentesis 00844 C Anesth, pelvis surgery 00846 C Anesth, hysterectomy 00848 C Anesth, pelvic organ surg 0084T T Temp prostate urethral stent 0164 1.1855 $70.35 $17.29 $14.07 00851 N Anesth, tubal ligation 0085T X Breath test heart reject 0340 0.6384 $37.88 $7.58 00860 N Anesth, surgery of abdomen 00862 N Anesth, kidney/ureter surg 00864 C Anesth, removal of bladder 00865 C Anesth, removal of prostate 00866 C Anesth, removal of adrenal 00868 C Anesth, kidney transplant 0086T N L ventricle fill pressure 00870 N Anesth, bladder stone surg 00872 N Anesth kidney stone destruct 00873 N Anesth kidney stone destruct 0087T X Sperm eval hyaluronan 0348 0.7927 $47.04 $9.41 00880 N Anesth, abdomen vessel surg 00882 C Anesth, major vein ligation 0088T T Rf tongue base vol reduxn 0253 16.1357 $957.54 $282.29 $191.51 00902 N Anesth, anorectal surgery 00904 C Anesth, perineal surgery Start Printed Page 50699 00906 N Anesth, removal of vulva 00908 C Anesth, removal of prostate 00910 N Anesth, bladder surgery 00912 N Anesth, bladder tumor surg 00914 N Anesth, removal of prostate 00916 N Anesth, bleeding control 00918 N Anesth, stone removal 00920 N Anesth, genitalia surgery 00921 N Anesth, vasectomy 00922 N Anesth, sperm duct surgery 00924 N Anesth, testis exploration 00926 N Anesth, removal of testis 00928 N Anesth, removal of testis 00930 N Anesth, testis suspension 00932 C Anesth, amputation of penis 00934 C Anesth, penis, nodes removal 00936 C Anesth, penis, nodes removal 00938 N Anesth, insert penis device 00940 N Anesth, vaginal procedures 00942 N Anesth, surg on vag/urethral 00944 C Anesth, vaginal hysterectomy 00948 N Anesth, repair of cervix 00950 N Anesth, vaginal endoscopy 00952 N Anesth, hysteroscope/graph 01112 N Anesth, bone aspirate/bx 01120 N Anesth, pelvis surgery 01130 N Anesth, body cast procedure 01140 C Anesth, amputation at pelvis 01150 C Anesth, pelvic tumor surgery 01160 N Anesth, pelvis procedure 01170 N Anesth, pelvis surgery 01173 N Anesth, fx repair, pelvis 01180 N Anesth, pelvis nerve removal 01190 N Anesth, pelvis nerve removal 01200 N Anesth, hip joint procedure 01202 N Anesth, arthroscopy of hip 01210 N Anesth, hip joint surgery 01212 C Anesth, hip disarticulation 01214 C Anesth, hip arthroplasty 01215 N Anesth, revise hip repair 01220 N Anesth, procedure on femur 01230 N Anesth, surgery of femur 01232 C Anesth, amputation of femur 01234 C Anesth, radical femur surg 01250 N Anesth, upper leg surgery 01260 N Anesth, upper leg veins surg 01270 N Anesth, thigh arteries surg 01272 C Anesth, femoral artery surg 01274 C Anesth, femoral embolectomy 01320 N Anesth, knee area surgery 01340 N Anesth, knee area procedure 01360 N Anesth, knee area surgery 01380 N Anesth, knee joint procedure 01382 N Anesth, dx knee arthroscopy 01390 N Anesth, knee area procedure 01392 N Anesth, knee area surgery 01400 N Anesth, knee joint surgery 01402 C Anesth, knee arthroplasty 01404 C Anesth, amputation at knee 01420 N Anesth, knee joint casting 01430 N Anesth, knee veins surgery 01432 N Anesth, knee vessel surg 01440 N Anesth, knee arteries surg 01442 C Anesth, knee artery surg 01444 C Anesth, knee artery repair 01462 N Anesth, lower leg procedure Start Printed Page 50700 01464 N Anesth, ankle/ft arthroscopy 01470 N Anesth, lower leg surgery 01472 N Anesth, achilles tendon surg 01474 N Anesth, lower leg surgery 01480 N Anesth, lower leg bone surg 01482 N Anesth, radical leg surgery 01484 N Anesth, lower leg revision 01486 C Anesth, ankle replacement 01490 N Anesth, lower leg casting 01500 N Anesth, leg arteries surg 01502 C Anesth, lwr leg embolectomy 01520 N Anesth, lower leg vein surg 01522 N Anesth, lower leg vein surg 01610 N Anesth, surgery of shoulder 01620 N Anesth, shoulder procedure 01622 N Anes dx shoulder arthroscopy 01630 N Anesth, surgery of shoulder 01632 C Anesth, surgery of shoulder 01634 C Anesth, shoulder joint amput 01636 C Anesth, forequarter amput 01638 C Anesth, shoulder replacement 01650 N Anesth, shoulder artery surg 01652 C Anesth, shoulder vessel surg 01654 C Anesth, shoulder vessel surg 01656 C Anesth, arm-leg vessel surg 01670 N Anesth, shoulder vein surg 01680 N Anesth, shoulder casting 01682 N Anesth, airplane cast 01710 N Anesth, elbow area surgery 01712 N Anesth, uppr arm tendon surg 01714 N Anesth, uppr arm tendon surg 01716 N Anesth, biceps tendon repair 01730 N Anesth, uppr arm procedure 01732 N Anesth, dx elbow arthroscopy 01740 N Anesth, upper arm surgery 01742 N Anesth, humerus surgery 01744 N Anesth, humerus repair 01756 C Anesth, radical humerus surg 01758 N Anesth, humeral lesion surg 01760 N Anesth, elbow replacement 01770 N Anesth, uppr arm artery surg 01772 N Anesth, uppr arm embolectomy 01780 N Anesth, upper arm vein surg 01782 N Anesth, uppr arm vein repair 01810 N Anesth, lower arm surgery 01820 N Anesth, lower arm procedure 01829 N Anesth, dx wrist arthroscopy 01830 N Anesth, lower arm surgery 01832 N Anesth, wrist replacement 01840 N Anesth, lwr arm artery surg 01842 N Anesth, lwr arm embolectomy 01844 N Anesth, vascular shunt surg 01850 N Anesth, lower arm vein surg 01852 N Anesth, lwr arm vein repair 01860 N Anesth, lower arm casting 01905 N Anes, spine inject, x-ray/re 01916 N Anesth, dx arteriography 01920 N Anesth, catheterize heart 01922 N Anesth, cat or MRI scan 01924 N Anes, ther interven rad, art 01925 N Anes, ther interven rad, car 01926 N Anes, tx interv rad hrt/cran 01930 N Anes, ther interven rad, vei 01931 N Anes, ther interven rad, tip 01932 N Anes, tx interv rad, th vein 01933 N Anes, tx interv rad, cran v Start Printed Page 50701 01951 N Anesth, burn, less 4 percent 01952 N Anesth, burn, 4-9 percent 01953 N Anesth, burn, each 9 percent 01958 N Anesth, antepartum manipul 01960 N Anesth, vaginal delivery 01961 N Anesth, cs delivery 01962 N Anesth, emer hysterectomy 01963 N Anesth, cs hysterectomy 01964 N Anesth, abortion procedures 01967 N Anesth/analg, vag delivery 01968 N Anes/analg cs deliver add-on 01969 N Anesth/analg cs hyst add-on 01990 C Support for organ donor 01991 N Anesth, nerve block/inj 01992 N Anesth, n block/inj, prone 01995 N Regional anesthesia limb 01996 N Hosp manage cont drug admin 01999 N Unlisted anesth procedure 0500F E Initial prenatal care visit 0501F E Prenatal flow sheet 0502F E Subsequent prenatal care 0503F E Postpartum care visit 1000F E Tobacco use, smoking, assess 1001F E Tobacco use, non-smoking 10021 T Fna w/o image 0002 0.9559 $56.73 $11.35 10022 T Fna w/image 0036 2.1773 $129.21 $25.84 1002F E Assess anginal symptom/level 10040 T Acne surgery 0010 0.5719 $33.94 $9.65 $6.79 10060 T Drainage of skin abscess 0006 1.55 $91.98 $22.28 $18.40 10061 T Drainage of skin abscess 0006 1.55 $91.98 $22.28 $18.40 10080 T Drainage of pilonidal cyst 0006 1.55 $91.98 $22.28 $18.40 10081 T Drainage of pilonidal cyst 0007 11.4501 $679.48 $135.90 10120 T Remove foreign body 0006 1.55 $91.98 $22.28 $18.40 10121 T Remove foreign body 0021 14.9776 $888.82 $219.48 $177.76 10140 T Drainage of hematoma/fluid 0007 11.4501 $679.48 $135.90 10160 T Puncture drainage of lesion 0018 1.1726 $69.59 $16.04 $13.92 10180 T Complex drainage, wound 0008 16.4989 $979.09 $195.82 11000 T Debride infected skin 0015 1.6514 $98.00 $20.29 $19.60 11001 T Debride infected skin add-on 0012 0.8497 $50.42 $11.18 $10.08 11004 C Debride genitalia & perineum 11005 C Debride abdom wall 11006 C Debride genit/per/abdom wall 11008 C Remove mesh from abd wall 11010 T Debride skin, fx 0019 4.0547 $240.62 $71.87 $48.12 11011 T Debride skin/muscle, fx 0019 4.0547 $240.62 $71.87 $48.12 11012 T Debride skin/muscle/bone, fx 0019 4.0547 $240.62 $71.87 $48.12 11040 T Debride skin, partial 0015 1.6514 $98.00 $20.29 $19.60 11041 T Debride skin, full 0015 1.6514 $98.00 $20.29 $19.60 11042 T Debride skin/tissue 0016 2.5834 $153.31 $33.57 $30.66 11043 T Debride tissue/muscle 0016 2.5834 $153.31 $33.57 $30.66 11044 T Debride tissue/muscle/bone 0682 6.9107 $410.10 $162.42 $82.02 11055 T Trim skin lesion 0012 0.8497 $50.42 $11.18 $10.08 11056 T Trim skin lesions, 2 to 4 0012 0.8497 $50.42 $11.18 $10.08 11057 T Trim skin lesions, over 4 0013 1.1078 $65.74 $14.20 $13.15 11100 T Biopsy, skin lesion 0018 1.1726 $69.59 $16.04 $13.92 11101 T Biopsy, skin add-on 0018 1.1726 $69.59 $16.04 $13.92 11200 T Removal of skin tags 0013 1.1078 $65.74 $14.20 $13.15 11201 T Remove skin tags add-on 0015 1.6514 $98.00 $20.29 $19.60 11300 T Shave skin lesion 0012 0.8497 $50.42 $11.18 $10.08 11301 T Shave skin lesion 0012 0.8497 $50.42 $11.18 $10.08 11302 T Shave skin lesion 0013 1.1078 $65.74 $14.20 $13.15 11303 T Shave skin lesion 0015 1.6514 $98.00 $20.29 $19.60 11305 T Shave skin lesion 0013 1.1078 $65.74 $14.20 $13.15 11306 T Shave skin lesion 0013 1.1078 $65.74 $14.20 $13.15 11307 T Shave skin lesion 0013 1.1078 $65.74 $14.20 $13.15 11308 T Shave skin lesion 0013 1.1078 $65.74 $14.20 $13.15 Start Printed Page 50702 11310 T Shave skin lesion 0013 1.1078 $65.74 $14.20 $13.15 11311 T Shave skin lesion 0013 1.1078 $65.74 $14.20 $13.15 11312 T Shave skin lesion 0013 1.1078 $65.74 $14.20 $13.15 11313 T Shave skin lesion 0016 2.5834 $153.31 $33.57 $30.66 11400 T Removal of skin lesion 0019 4.0547 $240.62 $71.87 $48.12 11401 T Removal of skin lesion 0019 4.0547 $240.62 $71.87 $48.12 11402 T Removal of skin lesion 0019 4.0547 $240.62 $71.87 $48.12 11403 T Removal of skin lesion 0020 6.9433 $412.04 $107.40 $82.41 11404 T Removal of skin lesion 0021 14.9776 $888.82 $219.48 $177.76 11406 T Removal of skin lesion 0021 14.9776 $888.82 $219.48 $177.76 11420 T Removal of skin lesion 0020 6.9433 $412.04 $107.40 $82.41 11421 T Removal of skin lesion 0020 6.9433 $412.04 $107.40 $82.41 11422 T Removal of skin lesion 0020 6.9433 $412.04 $107.40 $82.41 11423 T Removal of skin lesion 0021 14.9776 $888.82 $219.48 $177.76 11424 T Removal of skin lesion 0021 14.9776 $888.82 $219.48 $177.76 11426 T Removal of skin lesion 0022 19.6472 $1,165.92 $354.45 $233.18 11440 T Removal of skin lesion 0019 4.0547 $240.62 $71.87 $48.12 11441 T Removal of skin lesion 0019 4.0547 $240.62 $71.87 $48.12 11442 T Removal of skin lesion 0020 6.9433 $412.04 $107.40 $82.41 11443 T Removal of skin lesion 0020 6.9433 $412.04 $107.40 $82.41 11444 T Removal of skin lesion 0020 6.9433 $412.04 $107.40 $82.41 11446 T Removal of skin lesion 0022 19.6472 $1,165.92 $354.45 $233.18 11450 T Removal, sweat gland lesion 0022 19.6472 $1,165.92 $354.45 $233.18 11451 T Removal, sweat gland lesion 0022 19.6472 $1,165.92 $354.45 $233.18 11462 T Removal, sweat gland lesion 0022 19.6472 $1,165.92 $354.45 $233.18 11463 T Removal, sweat gland lesion 0022 19.6472 $1,165.92 $354.45 $233.18 11470 T Removal, sweat gland lesion 0022 19.6472 $1,165.92 $354.45 $233.18 11471 T Removal, sweat gland lesion 0022 19.6472 $1,165.92 $354.45 $233.18 11600 T Removal of skin lesion 0019 4.0547 $240.62 $71.87 $48.12 11601 T Removal of skin lesion 0019 4.0547 $240.62 $71.87 $48.12 11602 T Removal of skin lesion 0019 4.0547 $240.62 $71.87 $48.12 11603 T Removal of skin lesion 0020 6.9433 $412.04 $107.40 $82.41 11604 T Removal of skin lesion 0020 6.9433 $412.04 $107.40 $82.41 11606 T Removal of skin lesion 0021 14.9776 $888.82 $219.48 $177.76 11620 T Removal of skin lesion 0020 6.9433 $412.04 $107.40 $82.41 11621 T Removal of skin lesion 0019 4.0547 $240.62 $71.87 $48.12 11622 T Removal of skin lesion 0020 6.9433 $412.04 $107.40 $82.41 11623 T Removal of skin lesion 0021 14.9776 $888.82 $219.48 $177.76 11624 T Removal of skin lesion 0021 14.9776 $888.82 $219.48 $177.76 11626 T Removal of skin lesion 0022 19.6472 $1,165.92 $354.45 $233.18 11640 T Removal of skin lesion 0020 6.9433 $412.04 $107.40 $82.41 11641 T Removal of skin lesion 0020 6.9433 $412.04 $107.40 $82.41 11642 T Removal of skin lesion 0020 6.9433 $412.04 $107.40 $82.41 11643 T Removal of skin lesion 0020 6.9433 $412.04 $107.40 $82.41 11644 T Removal of skin lesion 0021 14.9776 $888.82 $219.48 $177.76 11646 T Removal of skin lesion 0022 19.6472 $1,165.92 $354.45 $233.18 11719 T Trim nail(s) 0009 0.668 $39.64 $8.34 $7.93 11720 T Debride nail, 1-5 0009 0.668 $39.64 $8.34 $7.93 11721 T Debride nail, 6 or more 0009 0.668 $39.64 $8.34 $7.93 11730 T Removal of nail plate 0013 1.1078 $65.74 $14.20 $13.15 11732 T Remove nail plate, add-on 0012 0.8497 $50.42 $11.18 $10.08 11740 T Drain blood from under nail 0009 0.668 $39.64 $8.34 $7.93 11750 T Removal of nail bed 0019 4.0547 $240.62 $71.87 $48.12 11752 T Remove nail bed/finger tip 0022 19.6472 $1,165.92 $354.45 $233.18 11755 T Biopsy, nail unit 0019 4.0547 $240.62 $71.87 $48.12 11760 T Repair of nail bed 0024 1.6084 $95.45 $31.25 $19.09 11762 T Reconstruction of nail bed 0024 1.6084 $95.45 $31.25 $19.09 11765 T Excision of nail fold, toe 0015 1.6514 $98.00 $20.29 $19.60 11770 T Removal of pilonidal lesion 0022 19.6472 $1,165.92 $354.45 $233.18 11771 T Removal of pilonidal lesion 0022 19.6472 $1,165.92 $354.45 $233.18 11772 T Removal of pilonidal lesion 0022 19.6472 $1,165.92 $354.45 $233.18 11900 T Injection into skin lesions 0012 0.8497 $50.42 $11.18 $10.08 11901 T Added skin lesions injection 0012 0.8497 $50.42 $11.18 $10.08 11920 T Correct skin color defects 0024 1.6084 $95.45 $31.25 $19.09 11921 T Correct skin color defects 0024 1.6084 $95.45 $31.25 $19.09 11922 T Correct skin color defects 0024 1.6084 $95.45 $31.25 $19.09 Start Printed Page 50703 11950 T Therapy for contour defects 0024 1.6084 $95.45 $31.25 $19.09 11951 T Therapy for contour defects 0024 1.6084 $95.45 $31.25 $19.09 11952 T Therapy for contour defects 0024 1.6084 $95.45 $31.25 $19.09 11954 T Therapy for contour defects 0024 1.6084 $95.45 $31.25 $19.09 11960 T Insert tissue expander(s) 0027 18.4182 $1,092.99 $329.72 $218.60 11970 T Replace tissue expander 0027 18.4182 $1,092.99 $329.72 $218.60 11971 T Remove tissue expander(s) 0022 19.6472 $1,165.92 $354.45 $233.18 11975 E Insert contraceptive cap 11976 T Removal of contraceptive cap 0019 4.0547 $240.62 $71.87 $48.12 11977 E Removal/reinsert contra cap 11980 X Implant hormone pellet(s) 0340 0.6384 $37.88 $7.58 11981 X Insert drug implant device 0340 0.6384 $37.88 $7.58 11982 X Remove drug implant device 0340 0.6384 $37.88 $7.58 11983 X Remove/insert drug implant 0340 0.6384 $37.88 $7.58 12001 T Repair superficial wound(s) 0024 1.6084 $95.45 $31.25 $19.09 12002 T Repair superficial wound(s) 0024 1.6084 $95.45 $31.25 $19.09 12004 T Repair superficial wound(s) 0024 1.6084 $95.45 $31.25 $19.09 12005 T Repair superficial wound(s) 0024 1.6084 $95.45 $31.25 $19.09 12006 T Repair superficial wound(s) 0024 1.6084 $95.45 $31.25 $19.09 12007 T Repair superficial wound(s) 0024 1.6084 $95.45 $31.25 $19.09 12011 T Repair superficial wound(s) 0024 1.6084 $95.45 $31.25 $19.09 12013 T Repair superficial wound(s) 0024 1.6084 $95.45 $31.25 $19.09 12014 T Repair superficial wound(s) 0024 1.6084 $95.45 $31.25 $19.09 12015 T Repair superficial wound(s) 0024 1.6084 $95.45 $31.25 $19.09 12016 T Repair superficial wound(s) 0024 1.6084 $95.45 $31.25 $19.09 12017 T Repair superficial wound(s) 0024 1.6084 $95.45 $31.25 $19.09 12018 T Repair superficial wound(s) 0024 1.6084 $95.45 $31.25 $19.09 12020 T Closure of split wound 0024 1.6084 $95.45 $31.25 $19.09 12021 T Closure of split wound 0024 1.6084 $95.45 $31.25 $19.09 12031 T Layer closure of wound(s) 0024 1.6084 $95.45 $31.25 $19.09 12032 T Layer closure of wound(s) 0024 1.6084 $95.45 $31.25 $19.09 12034 T Layer closure of wound(s) 0024 1.6084 $95.45 $31.25 $19.09 12035 T Layer closure of wound(s) 0024 1.6084 $95.45 $31.25 $19.09 12036 T Layer closure of wound(s) 0024 1.6084 $95.45 $31.25 $19.09 12037 T Layer closure of wound(s) 0025 5.4938 $326.02 $101.85 $65.20 12041 T Layer closure of wound(s) 0024 1.6084 $95.45 $31.25 $19.09 12042 T Layer closure of wound(s) 0024 1.6084 $95.45 $31.25 $19.09 12044 T Layer closure of wound(s) 0024 1.6084 $95.45 $31.25 $19.09 12045 T Layer closure of wound(s) 0024 1.6084 $95.45 $31.25 $19.09 12046 T Layer closure of wound(s) 0024 1.6084 $95.45 $31.25 $19.09 12047 T Layer closure of wound(s) 0025 5.4938 $326.02 $101.85 $65.20 12051 T Layer closure of wound(s) 0024 1.6084 $95.45 $31.25 $19.09 12052 T Layer closure of wound(s) 0024 1.6084 $95.45 $31.25 $19.09 12053 T Layer closure of wound(s) 0024 1.6084 $95.45 $31.25 $19.09 12054 T Layer closure of wound(s) 0024 1.6084 $95.45 $31.25 $19.09 12055 T Layer closure of wound(s) 0024 1.6084 $95.45 $31.25 $19.09 12056 T Layer closure of wound(s) 0024 1.6084 $95.45 $31.25 $19.09 12057 T Layer closure of wound(s) 0025 5.4938 $326.02 $101.85 $65.20 13100 T Repair of wound or lesion 0025 5.4938 $326.02 $101.85 $65.20 13101 T Repair of wound or lesion 0025 5.4938 $326.02 $101.85 $65.20 13102 T Repair wound/lesion add-on 0024 1.6084 $95.45 $31.25 $19.09 13120 T Repair of wound or lesion 0024 1.6084 $95.45 $31.25 $19.09 13121 T Repair of wound or lesion 0024 1.6084 $95.45 $31.25 $19.09 13122 T Repair wound/lesion add-on 0024 1.6084 $95.45 $31.25 $19.09 13131 T Repair of wound or lesion 0024 1.6084 $95.45 $31.25 $19.09 13132 T Repair of wound or lesion 0024 1.6084 $95.45 $31.25 $19.09 13133 T Repair wound/lesion add-on 0024 1.6084 $95.45 $31.25 $19.09 13150 T Repair of wound or lesion 0025 5.4938 $326.02 $101.85 $65.20 13151 T Repair of wound or lesion 0024 1.6084 $95.45 $31.25 $19.09 13152 T Repair of wound or lesion 0025 5.4938 $326.02 $101.85 $65.20 13153 T Repair wound/lesion add-on 0024 1.6084 $95.45 $31.25 $19.09 13160 T Late closure of wound 0027 18.4182 $1,092.99 $329.72 $218.60 14000 T Skin tissue rearrangement 0686 13.8287 $820.64 $164.13 14001 T Skin tissue rearrangement 0027 18.4182 $1,092.99 $329.72 $218.60 14020 T Skin tissue rearrangement 0686 13.8287 $820.64 $164.13 14021 T Skin tissue rearrangement 0027 18.4182 $1,092.99 $329.72 $218.60 Start Printed Page 50704 14040 T Skin tissue rearrangement 0686 13.8287 $820.64 $164.13 14041 T Skin tissue rearrangement 0027 18.4182 $1,092.99 $329.72 $218.60 14060 T Skin tissue rearrangement 0027 18.4182 $1,092.99 $329.72 $218.60 14061 T Skin tissue rearrangement 0686 13.8287 $820.64 $164.13 14300 T Skin tissue rearrangement 0027 18.4182 $1,092.99 $329.72 $218.60 14350 T Skin tissue rearrangement 0027 18.4182 $1,092.99 $329.72 $218.60 15000 T Skin graft 0025 5.4938 $326.02 $101.85 $65.20 15001 T Skin graft add-on 0025 5.4938 $326.02 $101.85 $65.20 15050 T Skin pinch graft 0025 5.4938 $326.02 $101.85 $65.20 15100 T Skin split graft 0027 18.4182 $1,092.99 $329.72 $218.60 15101 T Skin split graft add-on 0027 18.4182 $1,092.99 $329.72 $218.60 15120 T Skin split graft 0027 18.4182 $1,092.99 $329.72 $218.60 15121 T Skin split graft add-on 0027 18.4182 $1,092.99 $329.72 $218.60 15200 T Skin full graft 0027 18.4182 $1,092.99 $329.72 $218.60 15201 T Skin full graft add-on 0025 5.4938 $326.02 $101.85 $65.20 15220 T Skin full graft 0027 18.4182 $1,092.99 $329.72 $218.60 15221 T Skin full graft add-on 0025 5.4938 $326.02 $101.85 $65.20 15240 T Skin full graft 0686 13.8287 $820.64 $164.13 15241 T Skin full graft add-on 0025 5.4938 $326.02 $101.85 $65.20 15260 T Skin full graft 0686 13.8287 $820.64 $164.13 15261 T Skin full graft add-on 0025 5.4938 $326.02 $101.85 $65.20 15342 T Cultured skin graft, 25 cm 0024 1.6084 $95.45 $31.25 $19.09 15343 T Culture skn graft addl 25 cm 0024 1.6084 $95.45 $31.25 $19.09 15350 T Skin homograft 0686 13.8287 $820.64 $164.13 15351 T Skin homograft add-on 0686 13.8287 $820.64 $164.13 15400 T Skin heterograft 0025 5.4938 $326.02 $101.85 $65.20 15401 T Skin heterograft add-on 0025 5.4938 $326.02 $101.85 $65.20 15570 T Form skin pedicle flap 0027 18.4182 $1,092.99 $329.72 $218.60 15572 T Form skin pedicle flap 0027 18.4182 $1,092.99 $329.72 $218.60 15574 T Form skin pedicle flap 0027 18.4182 $1,092.99 $329.72 $218.60 15576 T Form skin pedicle flap 0686 13.8287 $820.64 $164.13 15600 T Skin graft 0027 18.4182 $1,092.99 $329.72 $218.60 15610 T Skin graft 0027 18.4182 $1,092.99 $329.72 $218.60 15620 T Skin graft 0027 18.4182 $1,092.99 $329.72 $218.60 15630 T Skin graft 0027 18.4182 $1,092.99 $329.72 $218.60 15650 T Transfer skin pedicle flap 0027 18.4182 $1,092.99 $329.72 $218.60 15732 T Muscle-skin graft, head/neck 0027 18.4182 $1,092.99 $329.72 $218.60 15734 T Muscle-skin graft, trunk 0027 18.4182 $1,092.99 $329.72 $218.60 15736 T Muscle-skin graft, arm 0027 18.4182 $1,092.99 $329.72 $218.60 15738 T Muscle-skin graft, leg 0027 18.4182 $1,092.99 $329.72 $218.60 15740 T Island pedicle flap graft 0686 13.8287 $820.64 $164.13 15750 T Neurovascular pedicle graft 0027 18.4182 $1,092.99 $329.72 $218.60 15756 C Free muscle flap, microvasc 15757 C Free skin flap, microvasc 15758 C Free fascial flap, microvasc 15760 T Composite skin graft 0027 18.4182 $1,092.99 $329.72 $218.60 15770 T Derma-fat-fascia graft 0027 18.4182 $1,092.99 $329.72 $218.60 15775 T Hair transplant punch grafts 0025 5.4938 $326.02 $101.85 $65.20 15776 T Hair transplant punch grafts 0025 5.4938 $326.02 $101.85 $65.20 15780 T Abrasion treatment of skin 0022 19.6472 $1,165.92 $354.45 $233.18 15781 T Abrasion treatment of skin 0019 4.0547 $240.62 $71.87 $48.12 15782 T Dressing change not for burn 0019 4.0547 $240.62 $71.87 $48.12 15783 T Abrasion treatment of skin 0016 2.5834 $153.31 $33.57 $30.66 15786 T Abrasion, lesion, single 0013 1.1078 $65.74 $14.20 $13.15 15787 T Abrasion, lesions, add-on 0013 1.1078 $65.74 $14.20 $13.15 15788 T Chemical peel, face, epiderm 0012 0.8497 $50.42 $11.18 $10.08 15789 T Chemical peel, face, dermal 0015 1.6514 $98.00 $20.29 $19.60 15792 T Chemical peel, nonfacial 0013 1.1078 $65.74 $14.20 $13.15 15793 T Chemical peel, nonfacial 0012 0.8497 $50.42 $11.18 $10.08 15810 T Salabrasion 0016 2.5834 $153.31 $33.57 $30.66 15811 T Salabrasion 0016 2.5834 $153.31 $33.57 $30.66 15819 T Plastic surgery, neck 0025 5.4938 $326.02 $101.85 $65.20 15820 T Revision of lower eyelid 0027 18.4182 $1,092.99 $329.72 $218.60 15821 T Revision of lower eyelid 0027 18.4182 $1,092.99 $329.72 $218.60 15822 T Revision of upper eyelid 0027 18.4182 $1,092.99 $329.72 $218.60 15823 T Revision of upper eyelid 0027 18.4182 $1,092.99 $329.72 $218.60 Start Printed Page 50705 15824 T Removal of forehead wrinkles 0027 18.4182 $1,092.99 $329.72 $218.60 15825 T Removal of neck wrinkles 0027 18.4182 $1,092.99 $329.72 $218.60 15826 T Removal of brow wrinkles 0027 18.4182 $1,092.99 $329.72 $218.60 15828 T Removal of face wrinkles 0027 18.4182 $1,092.99 $329.72 $218.60 15829 T Removal of skin wrinkles 0027 18.4182 $1,092.99 $329.72 $218.60 15831 T Excise excessive skin tissue 0022 19.6472 $1,165.92 $354.45 $233.18 15832 T Excise excessive skin tissue 0022 19.6472 $1,165.92 $354.45 $233.18 15833 T Excise excessive skin tissue 0022 19.6472 $1,165.92 $354.45 $233.18 15834 T Excise excessive skin tissue 0022 19.6472 $1,165.92 $354.45 $233.18 15835 T Excise excessive skin tissue 0025 5.4938 $326.02 $101.85 $65.20 15836 T Excise excessive skin tissue 0021 14.9776 $888.82 $219.48 $177.76 15837 T Excise excessive skin tissue 0021 14.9776 $888.82 $219.48 $177.76 15838 T Excise excessive skin tissue 0021 14.9776 $888.82 $219.48 $177.76 15839 T Excise excessive skin tissue 0021 14.9776 $888.82 $219.48 $177.76 15840 T Graft for face nerve palsy 0027 18.4182 $1,092.99 $329.72 $218.60 15841 T Graft for face nerve palsy 0027 18.4182 $1,092.99 $329.72 $218.60 15842 T Flap for face nerve palsy 0027 18.4182 $1,092.99 $329.72 $218.60 15845 T Skin and muscle repair, face 0027 18.4182 $1,092.99 $329.72 $218.60 15850 T Removal of sutures 0016 2.5834 $153.31 $33.57 $30.66 15851 T Removal of sutures 0016 2.5834 $153.31 $33.57 $30.66 15852 X Dressing change not for burn 0340 0.6384 $37.88 $7.58 15860 X Test for blood flow in graft 0359 0.8312 $49.33 $9.87 15876 T Suction assisted lipectomy 0027 18.4182 $1,092.99 $329.72 $218.60 15877 T Suction assisted lipectomy 0027 18.4182 $1,092.99 $329.72 $218.60 15878 T Suction assisted lipectomy 0686 13.8287 $820.64 $164.13 15879 T Suction assisted lipectomy 0027 18.4182 $1,092.99 $329.72 $218.60 15920 T Removal of tail bone ulcer 0019 4.0547 $240.62 $71.87 $48.12 15922 T Removal of tail bone ulcer 0027 18.4182 $1,092.99 $329.72 $218.60 15931 T Remove sacrum pressure sore 0022 19.6472 $1,165.92 $354.45 $233.18 15933 T Remove sacrum pressure sore 0022 19.6472 $1,165.92 $354.45 $233.18 15934 T Remove sacrum pressure sore 0027 18.4182 $1,092.99 $329.72 $218.60 15935 T Remove sacrum pressure sore 0027 18.4182 $1,092.99 $329.72 $218.60 15936 T Remove sacrum pressure sore 0027 18.4182 $1,092.99 $329.72 $218.60 15937 T Remove sacrum pressure sore 0027 18.4182 $1,092.99 $329.72 $218.60 15940 T Remove hip pressure sore 0022 19.6472 $1,165.92 $354.45 $233.18 15941 T Remove hip pressure sore 0022 19.6472 $1,165.92 $354.45 $233.18 15944 T Remove hip pressure sore 0027 18.4182 $1,092.99 $329.72 $218.60 15945 T Remove hip pressure sore 0027 18.4182 $1,092.99 $329.72 $218.60 15946 T Remove hip pressure sore 0027 18.4182 $1,092.99 $329.72 $218.60 15950 T Remove thigh pressure sore 0022 19.6472 $1,165.92 $354.45 $233.18 15951 T Remove thigh pressure sore 0022 19.6472 $1,165.92 $354.45 $233.18 15952 T Remove thigh pressure sore 0027 18.4182 $1,092.99 $329.72 $218.60 15953 T Remove thigh pressure sore 0027 18.4182 $1,092.99 $329.72 $218.60 15956 T Remove thigh pressure sore 0027 18.4182 $1,092.99 $329.72 $218.60 15958 T Remove thigh pressure sore 0027 18.4182 $1,092.99 $329.72 $218.60 15999 T Removal of pressure sore 0019 4.0547 $240.62 $71.87 $48.12 16000 T Initial treatment of burn(s) 0012 0.8497 $50.42 $11.18 $10.08 16010 T Treatment of burn(s) 0016 2.5834 $153.31 $33.57 $30.66 16015 T Treatment of burn(s) 0017 18.4211 $1,093.16 $227.84 $218.63 16020 T Treatment of burn(s) 0013 1.1078 $65.74 $14.20 $13.15 16025 T Treatment of burn(s) 0013 1.1078 $65.74 $14.20 $13.15 16030 T Treatment of burn(s) 0015 1.6514 $98.00 $20.29 $19.60 16035 C Incision of burn scab, initi 16036 C Escharotomy addl incision 17000 T Destroy benign/premlg lesion 0010 0.5719 $33.94 $9.65 $6.79 17003 T Destroy lesions, 2-14 0010 0.5719 $33.94 $9.65 $6.79 17004 T Destroy lesions, 15 or more 0011 2.0839 $123.66 $25.17 $24.73 17106 T Destruction of skin lesions 0011 2.0839 $123.66 $25.17 $24.73 17107 T Destruction of skin lesions 0011 2.0839 $123.66 $25.17 $24.73 17108 T Destruction of skin lesions 0011 2.0839 $123.66 $25.17 $24.73 17110 T Destruct lesion, 1-14 0010 0.5719 $33.94 $9.65 $6.79 17111 T Destruct lesion, 15 or more 0010 0.5719 $33.94 $9.65 $6.79 17250 T Chemical cautery, tissue 0013 1.1078 $65.74 $14.20 $13.15 17260 T Destruction of skin lesions 0015 1.6514 $98.00 $20.29 $19.60 17261 T Destruction of skin lesions 0015 1.6514 $98.00 $20.29 $19.60 17262 T Destruction of skin lesions 0015 1.6514 $98.00 $20.29 $19.60 Start Printed Page 50706 17263 T Destruction of skin lesions 0015 1.6514 $98.00 $20.29 $19.60 17264 T Destruction of skin lesions 0015 1.6514 $98.00 $20.29 $19.60 17266 T Destruction of skin lesions 0016 2.5834 $153.31 $33.57 $30.66 17270 T Destruction of skin lesions 0015 1.6514 $98.00 $20.29 $19.60 17271 T Destruction of skin lesions 0013 1.1078 $65.74 $14.20 $13.15 17272 T Destruction of skin lesions 0015 1.6514 $98.00 $20.29 $19.60 17273 T Destruction of skin lesions 0015 1.6514 $98.00 $20.29 $19.60 17274 T Destruction of skin lesions 0016 2.5834 $153.31 $33.57 $30.66 17276 T Destruction of skin lesions 0016 2.5834 $153.31 $33.57 $30.66 17280 T Destruction of skin lesions 0015 1.6514 $98.00 $20.29 $19.60 17281 T Destruction of skin lesions 0015 1.6514 $98.00 $20.29 $19.60 17282 T Destruction of skin lesions 0015 1.6514 $98.00 $20.29 $19.60 17283 T Destruction of skin lesions 0015 1.6514 $98.00 $20.29 $19.60 17284 T Destruction of skin lesions 0016 2.5834 $153.31 $33.57 $30.66 17286 T Destruction of skin lesions 0015 1.6514 $98.00 $20.29 $19.60 17304 T Chemosurgery of skin lesion 0694 3.8452 $228.19 $61.86 $45.64 17305 T 2 stage mohs, up to 5 spec 0694 3.8452 $228.19 $61.86 $45.64 17306 T 3 stage mohs, up to 5 spec 0694 3.8452 $228.19 $61.86 $45.64 17307 T Mohs addl stage up to 5 spec 0694 3.8452 $228.19 $61.86 $45.64 17310 T Extensive skin chemosurgery 0694 3.8452 $228.19 $61.86 $45.64 17340 T Cryotherapy of skin 0012 0.8497 $50.42 $11.18 $10.08 17360 T Skin peel therapy 0013 1.1078 $65.74 $14.20 $13.15 17380 T Hair removal by electrolysis 0013 1.1078 $65.74 $14.20 $13.15 17999 T Skin tissue procedure 0006 1.55 $91.98 $22.28 $18.40 19000 T Drainage of breast lesion 0004 1.7646 $104.72 $22.36 $20.94 19001 T Drain breast lesion add-on 0004 1.7646 $104.72 $22.36 $20.94 19020 T Incision of breast lesion 0008 16.4989 $979.09 $195.82 19030 N Injection for breast x-ray 19100 T Bx breast percut w/o image 0005 3.5994 $213.60 $71.59 $42.72 19101 T Biopsy of breast, open 0028 19.5801 $1,161.94 $303.74 $232.39 19102 T Bx breast percut w/image 0005 3.5994 $213.60 $71.59 $42.72 19103 T Bx breast percut w/device 0658 6.1049 $362.28 $72.46 19110 T nipple exploration 0028 19.5801 $1,161.94 $303.74 $232.39 19112 T Excise breast duct fistula 0028 19.5801 $1,161.94 $303.74 $232.39 19120 T Removal of breast lesion 0028 19.5801 $1,161.94 $303.74 $232.39 19125 T Excision, breast lesion 0028 19.5801 $1,161.94 $303.74 $232.39 19126 T Excision, addl breast lesion 0028 19.5801 $1,161.94 $303.74 $232.39 19140 T Removal of breast tissue 0028 19.5801 $1,161.94 $303.74 $232.39 19160 T Removal of breast tissue 0028 19.5801 $1,161.94 $303.74 $232.39 19162 T Remove breast tissue, nodes 0693 42.2254 $2,505.78 $798.17 $501.16 19180 T Removal of breast 0029 32.0476 $1,901.80 $632.64 $380.36 19182 T Removal of breast 0029 32.0476 $1,901.80 $632.64 $380.36 19200 C Removal of breast 19220 C Removal of breast 19240 T Removal of breast 0030 40.0825 $2,378.62 $763.55 $475.72 19260 T Removal of chest wall lesion 0021 14.9776 $888.82 $219.48 $177.76 19271 C Revision of chest wall 19272 C Extensive chest wall surgery 19290 N Place needle wire, breast 19291 N Place needle wire, breast 19295 S Place breast clip, percut 0657 1.7092 $101.43 $20.29 19296 S Place po breast cath for rad 1524 $3,250.00 $650.00 19297 S Place breast cath for rad 1523 $2,750.00 $550.00 19298 S Place breast rad tube/caths 1524 $3,250.00 $650.00 19316 T Suspension of breast 0029 32.0476 $1,901.80 $632.64 $380.36 19318 T Reduction of large breast 0693 42.2254 $2,505.78 $798.17 $501.16 19324 T Enlarge breast 0693 42.2254 $2,505.78 $798.17 $501.16 19325 T Enlarge breast with implant 0648 50.4459 $2,993.61 $598.72 19328 T Removal of breast implant 0029 32.0476 $1,901.80 $632.64 $380.36 19330 T Removal of implant material 0029 32.0476 $1,901.80 $632.64 $380.36 19340 T Immediate breast prosthesis 0030 40.0825 $2,378.62 $763.55 $475.72 19342 T Delayed breast prosthesis 0648 50.4459 $2,993.61 $598.72 19350 T Breast reconstruction 0028 19.5801 $1,161.94 $303.74 $232.39 19355 T Correct inverted nipple(s) 0029 32.0476 $1,901.80 $632.64 $380.36 19357 T Breast reconstruction 0648 50.4459 $2,993.61 $598.72 19361 C Breast reconstruction Start Printed Page 50707 19364 C Breast reconstruction 19366 T Breast reconstruction 0029 32.0476 $1,901.80 $632.64 $380.36 19367 C Breast reconstruction 19368 C Breast reconstruction 19369 C Breast reconstruction 19370 T Surgery of breast capsule 0029 32.0476 $1,901.80 $632.64 $380.36 19371 T Removal of breast capsule 0029 32.0476 $1,901.80 $632.64 $380.36 19380 T Revise breast reconstruction 0030 40.0825 $2,378.62 $763.55 $475.72 19396 T Design custom breast implant 0029 32.0476 $1,901.80 $632.64 $380.36 19499 T Breast surgery procedure 0028 19.5801 $1,161.94 $303.74 $232.39 20000 T Incision of abscess 0006 1.55 $91.98 $22.28 $18.40 20005 T Incision of deep abscess 0049 20.3707 $1,208.86 $241.77 2000F E Blood pressure, measured 20100 T Explore wound, neck 0023 4.7775 $283.51 $56.70 20101 T Explore wound, chest 0027 18.4182 $1,092.99 $329.72 $218.60 20102 T Explore wound, abdomen 0027 18.4182 $1,092.99 $329.72 $218.60 20103 T Explore wound, extremity 0023 4.7775 $283.51 $56.70 20150 T Excise epiphyseal bar 0051 36.5271 $2,167.63 $433.53 20200 T Muscle biopsy 0021 14.9776 $888.82 $219.48 $177.76 20205 T Deep muscle biopsy 0021 14.9776 $888.82 $219.48 $177.76 20206 T Needle biopsy, muscle 0005 3.5994 $213.60 $71.59 $42.72 20220 T Bone biopsy, trocar/needle 0019 4.0547 $240.62 $71.87 $48.12 20225 T Bone biopsy, trocar/needle 0020 6.9433 $412.04 $107.40 $82.41 20240 T Bone biopsy, excisional 0022 19.6472 $1,165.92 $354.45 $233.18 20245 T Bone biopsy, excisional 0022 19.6472 $1,165.92 $354.45 $233.18 20250 T Open bone biopsy 0049 20.3707 $1,208.86 $241.77 20251 T Open bone biopsy 0049 20.3707 $1,208.86 $241.77 20500 T Injection of sinus tract 0251 2.0101 $119.29 $23.86 20501 N Inject sinus tract for x-ray 20520 T Removal of foreign body 0019 4.0547 $240.62 $71.87 $48.12 20525 T Removal of foreign body 0022 19.6472 $1,165.92 $354.45 $233.18 20526 T Ther injection, carp tunnel 0204 2.191 $130.02 $40.13 $26.00 20550 T Inject tendon/ligament/cyst 0204 2.191 $130.02 $40.13 $26.00 20551 T Inj tendon origin/insertion 0204 2.191 $130.02 $40.13 $26.00 20552 T Inj trigger point, 1/2 muscl 0204 2.191 $130.02 $40.13 $26.00 20553 T Inject trigger points, > 3 0204 2.191 $130.02 $40.13 $26.00 20600 T Drain/inject, joint/bursa 0204 2.191 $130.02 $40.13 $26.00 20605 T Drain/inject, joint/bursa 0204 2.191 $130.02 $40.13 $26.00 20610 T Drain/inject, joint/bursa 0204 2.191 $130.02 $40.13 $26.00 20612 T Aspirate/inj ganglion cyst 0204 2.191 $130.02 $40.13 $26.00 20615 T Treatment of bone cyst 0004 1.7646 $104.72 $22.36 $20.94 20650 T Insert and remove bone pin 0049 20.3707 $1,208.86 $241.77 20660 C Apply, rem fixation device 20661 C Application of head brace 20662 T Application of pelvis brace 0049 20.3707 $1,208.86 $241.77 20663 T Application of thigh brace 0049 20.3707 $1,208.86 $241.77 20664 C Halo brace application 20665 X Removal of fixation device 0340 0.6384 $37.88 $7.58 20670 T Removal of support implant 0021 14.9776 $888.82 $219.48 $177.76 20680 T Removal of support implant 0022 19.6472 $1,165.92 $354.45 $233.18 20690 T Apply bone fixation device 0050 23.9081 $1,418.78 $283.76 20692 T Apply bone fixation device 0050 23.9081 $1,418.78 $283.76 20693 T Adjust bone fixation device 0049 20.3707 $1,208.86 $241.77 20694 T Remove bone fixation device 0049 20.3707 $1,208.86 $241.77 20802 C Replantation, arm, complete 20805 C Replant forearm, complete 20808 C Replantation hand, complete 20816 C Replantation digit, complete 20822 T Replantation digit, complete 0054 25.3711 $1,505.60 $301.12 20824 C Replantation thumb, complete 20827 C Replantation thumb, complete 20838 C Replantation foot, complete 20900 T Removal of bone for graft 0050 23.9081 $1,418.78 $283.76 20902 T Removal of bone for graft 0050 23.9081 $1,418.78 $283.76 20910 T Remove cartilage for graft 0027 18.4182 $1,092.99 $329.72 $218.60 20912 T Remove cartilage for graft 0027 18.4182 $1,092.99 $329.72 $218.60 Start Printed Page 50708 20920 T Removal of fascia for graft 0686 13.8287 $820.64 $164.13 20922 T Removal of fascia for graft 0027 18.4182 $1,092.99 $329.72 $218.60 20924 T Removal of tendon for graft 0050 23.9081 $1,418.78 $283.76 20926 T Removal of tissue for graft 0686 13.8287 $820.64 $164.13 20930 C Spinal bone allograft 20931 C Spinal bone allograft 20936 C Spinal bone autograft 20937 C Spinal bone autograft 20938 C Spinal bone autograft 20950 T Fluid pressure, muscle 0006 1.55 $91.98 $22.28 $18.40 20955 C Fibula bone graft, microvasc 20956 C Iliac bone graft, microvasc 20957 C Mt bone graft, microvasc 20962 C Other bone graft, microvasc 20969 C Bone/skin graft, microvasc 20970 C Bone/skin graft, iliac crest 20972 T Bone/skin graft, metatarsal 0056 40.2957 $2,391.27 $478.25 20973 T Bone/skin graft, great toe 0056 40.2957 $2,391.27 $478.25 20974 A Electrical bone stimulation 20975 X Electrical bone stimulation 0340 0.6384 $37.88 $7.58 20979 A Us bone stimulation 20982 T Ablate, bone tumor(s) perq 1557 $1,850.00 $370.00 20999 T Musculoskeletal surgery 0049 20.3707 $1,208.86 $241.77 21010 T Incision of jaw joint 0254 23.404 $1,388.86 $321.35 $277.77 21015 T Resection of facial tumor 0253 16.1357 $957.54 $282.29 $191.51 21025 T Excision of bone, lower jaw 0256 37.3204 $2,214.70 $442.94 21026 T Excision of facial bone(s) 0256 37.3204 $2,214.70 $442.94 21029 T Contour of face bone lesion 0256 37.3204 $2,214.70 $442.94 21030 T Removal of face bone lesion 0254 23.404 $1,388.86 $321.35 $277.77 21031 T Remove exostosis, mandible 0254 23.404 $1,388.86 $321.35 $277.77 21032 T Remove exostosis, maxilla 0254 23.404 $1,388.86 $321.35 $277.77 21034 T Removal of face bone lesion 0256 37.3204 $2,214.70 $442.94 21040 T Removal of jaw bone lesion 0254 23.404 $1,388.86 $321.35 $277.77 21044 T Removal of jaw bone lesion 0256 37.3204 $2,214.70 $442.94 21045 C Extensive jaw surgery 21046 T Remove mandible cyst complex 0256 37.3204 $2,214.70 $442.94 21047 T Excise lwr jaw cyst w/repair 0256 37.3204 $2,214.70 $442.94 21048 T Remove maxilla cyst complex 0256 37.3204 $2,214.70 $442.94 21049 T Excis uppr jaw cyst w/repair 0256 37.3204 $2,214.70 $442.94 21050 T Removal of jaw joint 0256 37.3204 $2,214.70 $442.94 21060 T Remove jaw joint cartilage 0256 37.3204 $2,214.70 $442.94 21070 T Remove coronoid process 0256 37.3204 $2,214.70 $442.94 21076 T Prepare face/oral prosthesis 0254 23.404 $1,388.86 $321.35 $277.77 21077 T Prepare face/oral prosthesis 0256 37.3204 $2,214.70 $442.94 21079 T Prepare face/oral prosthesis 0256 37.3204 $2,214.70 $442.94 21080 T Prepare face/oral prosthesis 0256 37.3204 $2,214.70 $442.94 21081 T Prepare face/oral prosthesis 0256 37.3204 $2,214.70 $442.94 21082 T Prepare face/oral prosthesis 0256 37.3204 $2,214.70 $442.94 21083 T Prepare face/oral prosthesis 0256 37.3204 $2,214.70 $442.94 21084 T Prepare face/oral prosthesis 0256 37.3204 $2,214.70 $442.94 21085 T Prepare face/oral prosthesis 0253 16.1357 $957.54 $282.29 $191.51 21086 T Prepare face/oral prosthesis 0256 37.3204 $2,214.70 $442.94 21087 T Prepare face/oral prosthesis 0256 37.3204 $2,214.70 $442.94 21088 T Prepare face/oral prosthesis 0256 37.3204 $2,214.70 $442.94 21089 T Prepare face/oral prosthesis 0251 2.0101 $119.29 $23.86 21100 T Maxillofacial fixation 0256 37.3204 $2,214.70 $442.94 21110 T Interdental fixation 0252 7.8673 $466.87 $113.41 $93.37 21116 N Injection, jaw joint x-ray 21120 T Reconstruction of chin 0254 23.404 $1,388.86 $321.35 $277.77 21121 T Reconstruction of chin 0254 23.404 $1,388.86 $321.35 $277.77 21122 T Reconstruction of chin 0254 23.404 $1,388.86 $321.35 $277.77 21123 T Reconstruction of chin 0254 23.404 $1,388.86 $321.35 $277.77 21125 T Augmentation, lower jaw bone 0254 23.404 $1,388.86 $321.35 $277.77 21127 T Augmentation, lower jaw bone 0256 37.3204 $2,214.70 $442.94 21137 T Reduction of forehead 0254 23.404 $1,388.86 $321.35 $277.77 21138 T Reduction of forehead 0256 37.3204 $2,214.70 $442.94 Start Printed Page 50709 21139 T Reduction of forehead 0256 37.3204 $2,214.70 $442.94 21141 C Reconstruct midface, lefort 21142 C Reconstruct midface, lefort 21143 C Reconstruct midface, lefort 21145 C Reconstruct midface, lefort 21146 C Reconstruct midface, lefort 21147 C Reconstruct midface, lefort 21150 T Reconstruct midface, lefort 0256 37.3204 $2,214.70 $442.94 21151 C Reconstruct midface, lefort 21154 C Reconstruct midface, lefort 21155 C Reconstruct midface, lefort 21159 C Reconstruct midface, lefort 21160 C Reconstruct midface, lefort 21172 C Reconstruct orbit/forehead 21175 T Reconstruct orbit/forehead 0256 37.3204 $2,214.70 $442.94 21179 C Reconstruct entire forehead 21180 C Reconstruct entire forehead 21181 T Contour cranial bone lesion 0254 23.404 $1,388.86 $321.35 $277.77 21182 C Reconstruct cranial bone 21183 C Reconstruct cranial bone 21184 C Reconstruct cranial bone 21188 C Reconstruction of midface 21193 C Reconst lwr jaw w/o graft 21194 C Reconst lwr jaw w/graft 21195 T Reconst lwr jaw w/o fixation 0256 37.3204 $2,214.70 $442.94 21196 C Reconst lwr jaw w/fixation 21198 T Reconstr lwr jaw segment 0256 37.3204 $2,214.70 $442.94 21199 T Reconstr lwr jaw w/advance 0256 37.3204 $2,214.70 $442.94 21206 T Reconstruct upper jaw bone 0256 37.3204 $2,214.70 $442.94 21208 T Augmentation of facial bones 0256 37.3204 $2,214.70 $442.94 21209 T Reduction of facial bones 0256 37.3204 $2,214.70 $442.94 21210 T Face bone graft 0256 37.3204 $2,214.70 $442.94 21215 T Lower jaw bone graft 0256 37.3204 $2,214.70 $442.94 21230 T Rib cartilage graft 0256 37.3204 $2,214.70 $442.94 21235 T Ear cartilage graft 0254 23.404 $1,388.86 $321.35 $277.77 21240 T Reconstruction of jaw joint 0256 37.3204 $2,214.70 $442.94 21242 T Reconstruction of jaw joint 0256 37.3204 $2,214.70 $442.94 21243 T Reconstruction of jaw joint 0256 37.3204 $2,214.70 $442.94 21244 T Reconstruction of lower jaw 0256 37.3204 $2,214.70 $442.94 21245 T Reconstruction of jaw 0256 37.3204 $2,214.70 $442.94 21246 T Reconstruction of jaw 0256 37.3204 $2,214.70 $442.94 21247 C Reconstruct lower jaw bone 21248 T Reconstruction of jaw 0256 37.3204 $2,214.70 $442.94 21249 T Reconstruction of jaw 0256 37.3204 $2,214.70 $442.94 21255 C Reconstruct lower jaw bone 21256 C Reconstruction of orbit 21260 T Revise eye sockets 0256 37.3204 $2,214.70 $442.94 21261 T Revise eye sockets 0256 37.3204 $2,214.70 $442.94 21263 T Revise eye sockets 0256 37.3204 $2,214.70 $442.94 21267 T Revise eye sockets 0256 37.3204 $2,214.70 $442.94 21268 C Revise eye sockets 21270 T Augmentation, cheek bone 0256 37.3204 $2,214.70 $442.94 21275 T Revision, orbitofacial bones 0256 37.3204 $2,214.70 $442.94 21280 T Revision of eyelid 0256 37.3204 $2,214.70 $442.94 21282 T Revision of eyelid 0253 16.1357 $957.54 $282.29 $191.51 21295 T Revision of jaw muscle/bone 0252 7.8673 $466.87 $113.41 $93.37 21296 T Revision of jaw muscle/bone 0254 23.404 $1,388.86 $321.35 $277.77 21299 T Cranio/maxillofacial surgery 0251 2.0101 $119.29 $23.86 21300 T Treatment of skull fracture 0253 16.1357 $957.54 $282.29 $191.51 21310 T Treatment of nose fracture 0251 2.0101 $119.29 $23.86 21315 T Treatment of nose fracture 0251 2.0101 $119.29 $23.86 21320 T Treatment of nose fracture 0252 7.8673 $466.87 $113.41 $93.37 21325 T Treatment of nose fracture 0254 23.404 $1,388.86 $321.35 $277.77 21330 T Treatment of nose fracture 0254 23.404 $1,388.86 $321.35 $277.77 21335 T Treatment of nose fracture 0254 23.404 $1,388.86 $321.35 $277.77 21336 T Treat nasal septal fracture 0046 37.7023 $2,237.37 $535.76 $447.47 Start Printed Page 50710 21337 T Treat nasal septal fracture 0253 16.1357 $957.54 $282.29 $191.51 21338 T Treat nasoethmoid fracture 0254 23.404 $1,388.86 $321.35 $277.77 21339 T Treat nasoethmoid fracture 0254 23.404 $1,388.86 $321.35 $277.77 21340 T Treatment of nose fracture 0256 37.3204 $2,214.70 $442.94 21343 C Treatment of sinus fracture 21344 C Treatment of sinus fracture 21345 T Treat nose/jaw fracture 0254 23.404 $1,388.86 $321.35 $277.77 21346 C Treat nose/jaw fracture 21347 C Treat nose/jaw fracture 21348 C Treat nose/jaw fracture 21355 T Treat cheek bone fracture 0256 37.3204 $2,214.70 $442.94 21356 T Treat cheek bone fracture 0254 23.404 $1,388.86 $321.35 $277.77 21360 C Treat cheek bone fracture 21365 C Treat cheek bone fracture 21366 C Treat cheek bone fracture 21385 C Treat eye socket fracture 21386 C Treat eye socket fracture 21387 C Treat eye socket fracture 21390 T Treat eye socket fracture 0256 37.3204 $2,214.70 $442.94 21395 C Treat eye socket fracture 21400 T Treat eye socket fracture 0252 7.8673 $466.87 $113.41 $93.37 21401 T Treat eye socket fracture 0253 16.1357 $957.54 $282.29 $191.51 21406 T Treat eye socket fracture 0256 37.3204 $2,214.70 $442.94 21407 T Treat eye socket fracture 0256 37.3204 $2,214.70 $442.94 21408 T Treat eye socket fracture 0256 37.3204 $2,214.70 $442.94 21421 T Treat mouth roof fracture 0254 23.404 $1,388.86 $321.35 $277.77 21422 C Treat mouth roof fracture 21423 C Treat mouth roof fracture 21431 C Treat craniofacial fracture 21432 C Treat craniofacial fracture 21433 C Treat craniofacial fracture 21435 C Treat craniofacial fracture 21436 C Treat craniofacial fracture 21440 T Treat dental ridge fracture 0254 23.404 $1,388.86 $321.35 $277.77 21445 T Treat dental ridge fracture 0254 23.404 $1,388.86 $321.35 $277.77 21450 T Treat lower jaw fracture 0251 2.0101 $119.29 $23.86 21451 T Treat lower jaw fracture 0252 7.8673 $466.87 $113.41 $93.37 21452 T Treat lower jaw fracture 0253 16.1357 $957.54 $282.29 $191.51 21453 T Treat lower jaw fracture 0256 37.3204 $2,214.70 $442.94 21454 T Treat lower jaw fracture 0254 23.404 $1,388.86 $321.35 $277.77 21461 T Treat lower jaw fracture 0256 37.3204 $2,214.70 $442.94 21462 T Treat lower jaw fracture 0256 37.3204 $2,214.70 $442.94 21465 T Treat lower jaw fracture 0256 37.3204 $2,214.70 $442.94 21470 T Treat lower jaw fracture 0256 37.3204 $2,214.70 $442.94 21480 T Reset dislocated jaw 0251 2.0101 $119.29 $23.86 21485 T Reset dislocated jaw 0253 16.1357 $957.54 $282.29 $191.51 21490 T Repair dislocated jaw 0256 37.3204 $2,214.70 $442.94 21493 T Treat hyoid bone fracture 0252 7.8673 $466.87 $113.41 $93.37 21494 T Treat hyoid bone fracture 0252 7.8673 $466.87 $113.41 $93.37 21495 T Treat hyoid bone fracture 0253 16.1357 $957.54 $282.29 $191.51 21497 T Interdental wiring 0253 16.1357 $957.54 $282.29 $191.51 21499 T Head surgery procedure 0251 2.0101 $119.29 $23.86 21501 T Drain neck/chest lesion 0008 16.4989 $979.09 $195.82 21502 T Drain chest lesion 0049 20.3707 $1,208.86 $241.77 21510 C Drainage of bone lesion 21550 T Biopsy of neck/chest 0021 14.9776 $888.82 $219.48 $177.76 21555 T Remove lesion, neck/chest 0022 19.6472 $1,165.92 $354.45 $233.18 21556 T Remove lesion, neck/chest 0022 19.6472 $1,165.92 $354.45 $233.18 21557 T Remove tumor, neck/chest 0022 19.6472 $1,165.92 $354.45 $233.18 21600 T Partial removal of rib 0050 23.9081 $1,418.78 $283.76 21610 T Partial removal of rib 0050 23.9081 $1,418.78 $283.76 21615 C Removal of rib 21616 C Removal of rib and nerves 21620 C Partial removal of sternum 21627 C Sternal debridement 21630 C Extensive sternum surgery Start Printed Page 50711 21632 C Extensive sternum surgery 21685 T Hyoid myotomy & suspension 0252 7.8673 $466.87 $113.41 $93.37 21700 T Revision of neck muscle 0049 20.3707 $1,208.86 $241.77 21705 C Revision of neck muscle/rib 21720 T Revision of neck muscle 0049 20.3707 $1,208.86 $241.77 21725 T Revision of neck muscle 0006 1.55 $91.98 $22.28 $18.40 21740 C Reconstruction of sternum 21742 T Repair stern/nuss w/o scope 0051 36.5271 $2,167.63 $433.53 21743 T Repair sternum/nuss w/scope 0051 36.5271 $2,167.63 $433.53 21750 C Repair of sternum separation 21800 T Treatment of rib fracture 0043 1.7694 $105.00 $21.00 21805 T Treatment of rib fracture 0046 37.7023 $2,237.37 $535.76 $447.47 21810 C Treatment of rib fracture(s) 21820 T Treat sternum fracture 0043 1.7694 $105.00 $21.00 21825 C Treat sternum fracture 21899 T Neck/chest surgery procedure 0251 2.0101 $119.29 $23.86 21920 T Biopsy soft tissue of back 0020 6.9433 $412.04 $107.40 $82.41 21925 T Biopsy soft tissue of back 0022 19.6472 $1,165.92 $354.45 $233.18 21930 T Remove lesion, back or flank 0022 19.6472 $1,165.92 $354.45 $233.18 21935 T Remove tumor, back 0022 19.6472 $1,165.92 $354.45 $233.18 22100 T Remove part of neck vertebra 0208 42.3409 $2,512.64 $502.53 22101 T Remove part, thorax vertebra 0208 42.3409 $2,512.64 $502.53 22102 T Remove part, lumbar vertebra 0208 42.3409 $2,512.64 $502.53 22103 T Remove extra spine segment 0208 42.3409 $2,512.64 $502.53 22110 C Remove part of neck vertebra 22112 C Remove part, thorax vertebra 22114 C Remove part, lumbar vertebra 22116 C Remove extra spine segment 22210 C Revision of neck spine 22212 C Revision of thorax spine 22214 C Revision of lumbar spine 22216 C Revise, extra spine segment 22220 C Revision of neck spine 22222 T Revision of thorax spine 0208 42.3409 $2,512.64 $502.53 22224 C Revision of lumbar spine 22226 C Revise, extra spine segment 22305 T Treat spine process fracture 0043 1.7694 $105.00 $21.00 22310 T Treat spine fracture 0043 1.7694 $105.00 $21.00 22315 T Treat spine fracture 0043 1.7694 $105.00 $21.00 22318 C Treat odontoid fx w/o graft 22319 C Treat odontoid fx w/graft 22325 C Treat spine fracture 22326 C Treat neck spine fracture 22327 C Treat thorax spine fracture 22328 C Treat each add spine fx 22505 T Manipulation of spine 0045 14.4945 $860.15 $268.47 $172.03 22520 T Percut vertebroplasty thor 0050 23.9081 $1,418.78 $283.76 22521 T Percut vertebroplasty lumb 0050 23.9081 $1,418.78 $283.76 22522 T Percut vertebroplasty add'l 0050 23.9081 $1,418.78 $283.76 22532 C Lat thorax spine fusion 22533 C Lat lumbar spine fusion 22534 C Lat thor/lumb, add'l seg 22548 C Neck spine fusion 22554 C Neck spine fusion 22556 C Thorax spine fusion 22558 C Lumbar spine fusion 22585 C Additional spinal fusion 22590 C Spine & skull spinal fusion 22595 C Neck spinal fusion 22600 C Neck spine fusion 22610 C Thorax spine fusion 22612 T Lumbar spine fusion 0208 42.3409 $2,512.64 $502.53 22614 T Spine fusion, extra segment 0208 42.3409 $2,512.64 $502.53 22630 C Lumbar spine fusion 22632 C Spine fusion, extra segment 22800 C Fusion of spine Start Printed Page 50712 22802 C Fusion of spine 22804 C Fusion of spine 22808 C Fusion of spine 22810 C Fusion of spine 22812 C Fusion of spine 22818 C Kyphectomy, 1-2 segments 22819 C Kyphectomy, 3 or more 22830 C Exploration of spinal fusion 22840 C Insert spine fixation device 22841 C Insert spine fixation device 22842 C Insert spine fixation device 22843 C Insert spine fixation device 22844 C Insert spine fixation device 22845 C Insert spine fixation device 22846 C Insert spine fixation device 22847 C Insert spine fixation device 22848 C Insert pelv fixation device 22849 C Reinsert spinal fixation 22850 C Remove spine fixation device 22851 C Apply spine prosth device 22852 C Remove spine fixation device 22855 C Remove spine fixation device 22899 T Spine surgery procedure 0043 1.7694 $105.00 $21.00 22900 T Remove abdominal wall lesion 0022 19.6472 $1,165.92 $354.45 $233.18 22999 T Abdomen surgery procedure 0019 4.0547 $240.62 $71.87 $48.12 23000 T Removal of calcium deposits 0021 14.9776 $888.82 $219.48 $177.76 23020 T Release shoulder joint 0051 36.5271 $2,167.63 $433.53 23030 T Drain shoulder lesion 0008 16.4989 $979.09 $195.82 23031 T Drain shoulder bursa 0008 16.4989 $979.09 $195.82 23035 T Drain shoulder bone lesion 0049 20.3707 $1,208.86 $241.77 23040 T Exploratory shoulder surgery 0050 23.9081 $1,418.78 $283.76 23044 T Exploratory shoulder surgery 0050 23.9081 $1,418.78 $283.76 23065 T Biopsy shoulder tissues 0021 14.9776 $888.82 $219.48 $177.76 23066 T Biopsy shoulder tissues 0022 19.6472 $1,165.92 $354.45 $233.18 23075 T Removal of shoulder lesion 0021 14.9776 $888.82 $219.48 $177.76 23076 T Removal of shoulder lesion 0022 19.6472 $1,165.92 $354.45 $233.18 23077 T Remove tumor of shoulder 0022 19.6472 $1,165.92 $354.45 $233.18 23100 T Biopsy of shoulder joint 0049 20.3707 $1,208.86 $241.77 23101 T Shoulder joint surgery 0050 23.9081 $1,418.78 $283.76 23105 T Remove shoulder joint lining 0050 23.9081 $1,418.78 $283.76 23106 T Incision of collarbone joint 0050 23.9081 $1,418.78 $283.76 23107 T Explore treat shoulder joint 0050 23.9081 $1,418.78 $283.76 23120 T Partial removal, collar bone 0051 36.5271 $2,167.63 $433.53 23125 T Removal of collar bone 0051 36.5271 $2,167.63 $433.53 23130 T Remove shoulder bone, part 0051 36.5271 $2,167.63 $433.53 23140 T Removal of bone lesion 0049 20.3707 $1,208.86 $241.77 23145 T Removal of bone lesion 0050 23.9081 $1,418.78 $283.76 23146 T Removal of bone lesion 0050 23.9081 $1,418.78 $283.76 23150 T Removal of humerus lesion 0050 23.9081 $1,418.78 $283.76 23155 T Removal of humerus lesion 0050 23.9081 $1,418.78 $283.76 23156 T Removal of humerus lesion 0050 23.9081 $1,418.78 $283.76 23170 T Remove collar bone lesion 0050 23.9081 $1,418.78 $283.76 23172 T Remove shoulder blade lesion 0050 23.9081 $1,418.78 $283.76 23174 T Remove humerus lesion 0050 23.9081 $1,418.78 $283.76 23180 T Remove collar bone lesion 0050 23.9081 $1,418.78 $283.76 23182 T Remove shoulder blade lesion 0050 23.9081 $1,418.78 $283.76 23184 T Remove humerus lesion 0050 23.9081 $1,418.78 $283.76 23190 T Partial removal of scapula 0050 23.9081 $1,418.78 $283.76 23195 T Removal of head of humerus 0050 23.9081 $1,418.78 $283.76 23200 C Removal of collar bone 23210 C Removal of shoulder blade 23220 C Partial removal of humerus 23221 C Partial removal of humerus 23222 C Partial removal of humerus 23330 T Remove shoulder foreign body 0020 6.9433 $412.04 $107.40 $82.41 23331 T Remove shoulder foreign body 0022 19.6472 $1,165.92 $354.45 $233.18 Start Printed Page 50713 23332 C Remove shoulder foreign body 23350 N Injection for shoulder x-ray 23395 T Muscle transfer,shoulder/arm 0051 36.5271 $2,167.63 $433.53 23397 T Muscle transfers 0052 43.9378 $2,607.40 $521.48 23400 T Fixation of shoulder blade 0050 23.9081 $1,418.78 $283.76 23405 T Incision of tendon & muscle 0050 23.9081 $1,418.78 $283.76 23406 T Incise tendon(s) & muscle(s) 0050 23.9081 $1,418.78 $283.76 23410 T Repair of tendon(s) 0052 43.9378 $2,607.40 $521.48 23412 T Repair rotator cuff, chronic 0052 43.9378 $2,607.40 $521.48 23415 T Release of shoulder ligament 0051 36.5271 $2,167.63 $433.53 23420 T Repair of shoulder 0052 43.9378 $2,607.40 $521.48 23430 T Repair biceps tendon 0052 43.9378 $2,607.40 $521.48 23440 T Remove/transplant tendon 0052 43.9378 $2,607.40 $521.48 23450 T Repair shoulder capsule 0052 43.9378 $2,607.40 $521.48 23455 T Repair shoulder capsule 0052 43.9378 $2,607.40 $521.48 23460 T Repair shoulder capsule 0052 43.9378 $2,607.40 $521.48 23462 T Repair shoulder capsule 0052 43.9378 $2,607.40 $521.48 23465 T Repair shoulder capsule 0052 43.9378 $2,607.40 $521.48 23466 T Repair shoulder capsule 0052 43.9378 $2,607.40 $521.48 23470 T Reconstruct shoulder joint 0425 100.2058 $5,946.51 $1,378.01 $1,189.30 23472 C Reconstruct shoulder joint 23480 T Revision of collar bone 0051 36.5271 $2,167.63 $433.53 23485 T Revision of collar bone 0051 36.5271 $2,167.63 $433.53 23490 T Reinforce clavicle 0051 36.5271 $2,167.63 $433.53 23491 T Reinforce shoulder bones 0051 36.5271 $2,167.63 $433.53 23500 T Treat clavicle fracture 0043 1.7694 $105.00 $21.00 23505 T Treat clavicle fracture 0043 1.7694 $105.00 $21.00 23515 T Treat clavicle fracture 0046 37.7023 $2,237.37 $535.76 $447.47 23520 T Treat clavicle dislocation 0043 1.7694 $105.00 $21.00 23525 T Treat clavicle dislocation 0043 1.7694 $105.00 $21.00 23530 T Treat clavicle dislocation 0046 37.7023 $2,237.37 $535.76 $447.47 23532 T Treat clavicle dislocation 0046 37.7023 $2,237.37 $535.76 $447.47 23540 T Treat clavicle dislocation 0043 1.7694 $105.00 $21.00 23545 T Treat clavicle dislocation 0043 1.7694 $105.00 $21.00 23550 T Treat clavicle dislocation 0046 37.7023 $2,237.37 $535.76 $447.47 23552 T Treat clavicle dislocation 0046 37.7023 $2,237.37 $535.76 $447.47 23570 T Treat shoulder blade fx 0043 1.7694 $105.00 $21.00 23575 T Treat shoulder blade fx 0043 1.7694 $105.00 $21.00 23585 T Treat scapula fracture 0046 37.7023 $2,237.37 $535.76 $447.47 23600 T Treat humerus fracture 0043 1.7694 $105.00 $21.00 23605 T Treat humerus fracture 0043 1.7694 $105.00 $21.00 23615 T Treat humerus fracture 0046 37.7023 $2,237.37 $535.76 $447.47 23616 T Treat humerus fracture 0046 37.7023 $2,237.37 $535.76 $447.47 23620 T Treat humerus fracture 0043 1.7694 $105.00 $21.00 23625 T Treat humerus fracture 0043 1.7694 $105.00 $21.00 23630 T Treat humerus fracture 0046 37.7023 $2,237.37 $535.76 $447.47 23650 T Treat shoulder dislocation 0043 1.7694 $105.00 $21.00 23655 T Treat shoulder dislocation 0045 14.4945 $860.15 $268.47 $172.03 23660 T Treat shoulder dislocation 0046 37.7023 $2,237.37 $535.76 $447.47 23665 T Treat dislocation/fracture 0043 1.7694 $105.00 $21.00 23670 T Treat dislocation/fracture 0046 37.7023 $2,237.37 $535.76 $447.47 23675 T Treat dislocation/fracture 0043 1.7694 $105.00 $21.00 23680 T Treat dislocation/fracture 0046 37.7023 $2,237.37 $535.76 $447.47 23700 T Fixation of shoulder 0045 14.4945 $860.15 $268.47 $172.03 23800 T Fusion of shoulder joint 0051 36.5271 $2,167.63 $433.53 23802 T Fusion of shoulder joint 0051 36.5271 $2,167.63 $433.53 23900 C Amputation of arm & girdle 23920 C Amputation at shoulder joint 23921 T Amputation follow-up surgery 0025 5.4938 $326.02 $101.85 $65.20 23929 T Shoulder surgery procedure 0043 1.7694 $105.00 $21.00 23930 T Drainage of arm lesion 0008 16.4989 $979.09 $195.82 23931 T Drainage of arm bursa 0008 16.4989 $979.09 $195.82 23935 T Drain arm/elbow bone lesion 0049 20.3707 $1,208.86 $241.77 24000 T Exploratory elbow surgery 0050 23.9081 $1,418.78 $283.76 24006 T Release elbow joint 0050 23.9081 $1,418.78 $283.76 24065 T Biopsy arm/elbow soft tissue 0021 14.9776 $888.82 $219.48 $177.76 Start Printed Page 50714 24066 T Biopsy arm/elbow soft tissue 0021 14.9776 $888.82 $219.48 $177.76 24075 T Remove arm/elbow lesion 0021 14.9776 $888.82 $219.48 $177.76 24076 T Remove arm/elbow lesion 0022 19.6472 $1,165.92 $354.45 $233.18 24077 T Remove tumor of arm/elbow 0022 19.6472 $1,165.92 $354.45 $233.18 24100 T Biopsy elbow joint lining 0049 20.3707 $1,208.86 $241.77 24101 T Explore/treat elbow joint 0050 23.9081 $1,418.78 $283.76 24102 T Remove elbow joint lining 0050 23.9081 $1,418.78 $283.76 24105 T Removal of elbow bursa 0049 20.3707 $1,208.86 $241.77 24110 T Remove humerus lesion 0049 20.3707 $1,208.86 $241.77 24115 T Remove/graft bone lesion 0050 23.9081 $1,418.78 $283.76 24116 T Remove/graft bone lesion 0050 23.9081 $1,418.78 $283.76 24120 T Remove elbow lesion 0049 20.3707 $1,208.86 $241.77 24125 T Remove/graft bone lesion 0050 23.9081 $1,418.78 $283.76 24126 T Remove/graft bone lesion 0050 23.9081 $1,418.78 $283.76 24130 T Removal of head of radius 0050 23.9081 $1,418.78 $283.76 24134 T Removal of arm bone lesion 0050 23.9081 $1,418.78 $283.76 24136 T Remove radius bone lesion 0050 23.9081 $1,418.78 $283.76 24138 T Remove elbow bone lesion 0050 23.9081 $1,418.78 $283.76 24140 T Partial removal of arm bone 0050 23.9081 $1,418.78 $283.76 24145 T Partial removal of radius 0050 23.9081 $1,418.78 $283.76 24147 T Partial removal of elbow 0050 23.9081 $1,418.78 $283.76 24149 T Radical resection of elbow 0050 23.9081 $1,418.78 $283.76 24150 T Extensive humerus surgery 0052 43.9378 $2,607.40 $521.48 24151 T Extensive humerus surgery 0052 43.9378 $2,607.40 $521.48 24152 T Extensive radius surgery 0052 43.9378 $2,607.40 $521.48 24153 T Extensive radius surgery 0052 43.9378 $2,607.40 $521.48 24155 T Removal of elbow joint 0051 36.5271 $2,167.63 $433.53 24160 T Remove elbow joint implant 0050 23.9081 $1,418.78 $283.76 24164 T Remove radius head implant 0050 23.9081 $1,418.78 $283.76 24200 T Removal of arm foreign body 0019 4.0547 $240.62 $71.87 $48.12 24201 T Removal of arm foreign body 0021 14.9776 $888.82 $219.48 $177.76 24220 N Injection for elbow x-ray 24300 T Manipulate elbow w/anesth 0045 14.4945 $860.15 $268.47 $172.03 24301 T Muscle/tendon transfer 0050 23.9081 $1,418.78 $283.76 24305 T Arm tendon lengthening 0050 23.9081 $1,418.78 $283.76 24310 T Revision of arm tendon 0049 20.3707 $1,208.86 $241.77 24320 T Repair of arm tendon 0051 36.5271 $2,167.63 $433.53 24330 T Revision of arm muscles 0051 36.5271 $2,167.63 $433.53 24331 T Revision of arm muscles 0051 36.5271 $2,167.63 $433.53 24332 T Tenolysis, triceps 0049 20.3707 $1,208.86 $241.77 24340 T Repair of biceps tendon 0051 36.5271 $2,167.63 $433.53 24341 T Repair arm tendon/muscle 0051 36.5271 $2,167.63 $433.53 24342 T Repair of ruptured tendon 0051 36.5271 $2,167.63 $433.53 24343 T Repr elbow lat ligmnt w/tiss 0050 23.9081 $1,418.78 $283.76 24344 T Reconstruct elbow lat ligmnt 0051 36.5271 $2,167.63 $433.53 24345 T Repr elbw med ligmnt w/tissu 0050 23.9081 $1,418.78 $283.76 24346 T Reconstruct elbow med ligmnt 0051 36.5271 $2,167.63 $433.53 24350 T Repair of tennis elbow 0050 23.9081 $1,418.78 $283.76 24351 T Repair of tennis elbow 0050 23.9081 $1,418.78 $283.76 24352 T Repair of tennis elbow 0050 23.9081 $1,418.78 $283.76 24354 T Repair of tennis elbow 0050 23.9081 $1,418.78 $283.76 24356 T Revision of tennis elbow 0050 23.9081 $1,418.78 $283.76 24360 T Reconstruct elbow joint 0047 31.6107 $1,875.87 $537.03 $375.17 24361 T Reconstruct elbow joint 0425 100.2058 $5,946.51 $1,378.01 $1,189.30 24362 T Reconstruct elbow joint 0048 43.1288 $2,559.39 $570.30 $511.88 24363 T Replace elbow joint 0425 100.2058 $5,946.51 $1,378.01 $1,189.30 24365 T Reconstruct head of radius 0047 31.6107 $1,875.87 $537.03 $375.17 24366 T Reconstruct head of radius 0425 100.2058 $5,946.51 $1,378.01 $1,189.30 24400 T Revision of humerus 0050 23.9081 $1,418.78 $283.76 24410 T Revision of humerus 0050 23.9081 $1,418.78 $283.76 24420 T Revision of humerus 0051 36.5271 $2,167.63 $433.53 24430 T Repair of humerus 0051 36.5271 $2,167.63 $433.53 24435 T Repair humerus with graft 0051 36.5271 $2,167.63 $433.53 24470 T Revision of elbow joint 0051 36.5271 $2,167.63 $433.53 24495 T Decompression of forearm 0050 23.9081 $1,418.78 $283.76 24498 T Reinforce humerus 0051 36.5271 $2,167.63 $433.53 Start Printed Page 50715 24500 T Treat humerus fracture 0043 1.7694 $105.00 $21.00 24505 T Treat humerus fracture 0043 1.7694 $105.00 $21.00 24515 T Treat humerus fracture 0046 37.7023 $2,237.37 $535.76 $447.47 24516 T Treat humerus fracture 0046 37.7023 $2,237.37 $535.76 $447.47 24530 T Treat humerus fracture 0043 1.7694 $105.00 $21.00 24535 T Treat humerus fracture 0043 1.7694 $105.00 $21.00 24538 T Treat humerus fracture 0046 37.7023 $2,237.37 $535.76 $447.47 24545 T Treat humerus fracture 0046 37.7023 $2,237.37 $535.76 $447.47 24546 T Treat humerus fracture 0046 37.7023 $2,237.37 $535.76 $447.47 24560 T Treat humerus fracture 0043 1.7694 $105.00 $21.00 24565 T Treat humerus fracture 0043 1.7694 $105.00 $21.00 24566 T Treat humerus fracture 0046 37.7023 $2,237.37 $535.76 $447.47 24575 T Treat humerus fracture 0046 37.7023 $2,237.37 $535.76 $447.47 24576 T Treat humerus fracture 0043 1.7694 $105.00 $21.00 24577 T Treat humerus fracture 0043 1.7694 $105.00 $21.00 24579 T Treat humerus fracture 0046 37.7023 $2,237.37 $535.76 $447.47 24582 T Treat humerus fracture 0046 37.7023 $2,237.37 $535.76 $447.47 24586 T Treat elbow fracture 0046 37.7023 $2,237.37 $535.76 $447.47 24587 T Treat elbow fracture 0046 37.7023 $2,237.37 $535.76 $447.47 24600 T Treat elbow dislocation 0043 1.7694 $105.00 $21.00 24605 T Treat elbow dislocation 0045 14.4945 $860.15 $268.47 $172.03 24615 T Treat elbow dislocation 0046 37.7023 $2,237.37 $535.76 $447.47 24620 T Treat elbow fracture 0043 1.7694 $105.00 $21.00 24635 T Treat elbow fracture 0046 37.7023 $2,237.37 $535.76 $447.47 24640 T Treat elbow dislocation 0043 1.7694 $105.00 $21.00 24650 T Treat radius fracture 0043 1.7694 $105.00 $21.00 24655 T Treat radius fracture 0043 1.7694 $105.00 $21.00 24665 T Treat radius fracture 0046 37.7023 $2,237.37 $535.76 $447.47 24666 T Treat radius fracture 0046 37.7023 $2,237.37 $535.76 $447.47 24670 T Treat ulnar fracture 0043 1.7694 $105.00 $21.00 24675 T Treat ulnar fracture 0043 1.7694 $105.00 $21.00 24685 T Treat ulnar fracture 0046 37.7023 $2,237.37 $535.76 $447.47 24800 T Fusion of elbow joint 0051 36.5271 $2,167.63 $433.53 24802 T Fusion/graft of elbow joint 0051 36.5271 $2,167.63 $433.53 24900 C Amputation of upper arm 24920 C Amputation of upper arm 24925 T Amputation follow-up surgery 0049 20.3707 $1,208.86 $241.77 24930 C Amputation follow-up surgery 24931 C Amputate upper arm & implant 24935 T Revision of amputation 0052 43.9378 $2,607.40 $521.48 24940 C Revision of upper arm 24999 T Upper arm/elbow surgery 0043 1.7694 $105.00 $21.00 25000 T Incision of tendon sheath 0049 20.3707 $1,208.86 $241.77 25001 T Incise flexor carpi radialis 0049 20.3707 $1,208.86 $241.77 25020 T Decompress forearm 1 space 0049 20.3707 $1,208.86 $241.77 25023 T Decompress forearm 1 space 0050 23.9081 $1,418.78 $283.76 25024 T Decompress forearm 2 spaces 0050 23.9081 $1,418.78 $283.76 25025 T Decompress forearm 2 spaces 0050 23.9081 $1,418.78 $283.76 25028 T Drainage of forearm lesion 0049 20.3707 $1,208.86 $241.77 25031 T Drainage of forearm bursa 0049 20.3707 $1,208.86 $241.77 25035 T Treat forearm bone lesion 0049 20.3707 $1,208.86 $241.77 25040 T Explore/treat wrist joint 0050 23.9081 $1,418.78 $283.76 25065 T Biopsy forearm soft tissues 0021 14.9776 $888.82 $219.48 $177.76 25066 T Biopsy forearm soft tissues 0022 19.6472 $1,165.92 $354.45 $233.18 25075 T Removel forearm lesion subcu 0021 14.9776 $888.82 $219.48 $177.76 25076 T Removel forearm lesion deep 0022 19.6472 $1,165.92 $354.45 $233.18 25077 T Remove tumor, forearm/wrist 0022 19.6472 $1,165.92 $354.45 $233.18 25085 T Incision of wrist capsule 0049 20.3707 $1,208.86 $241.77 25100 T Biopsy of wrist joint 0049 20.3707 $1,208.86 $241.77 25101 T Explore/treat wrist joint 0050 23.9081 $1,418.78 $283.76 25105 T Remove wrist joint lining 0050 23.9081 $1,418.78 $283.76 25107 T Remove wrist joint cartilage 0050 23.9081 $1,418.78 $283.76 25110 T Remove wrist tendon lesion 0049 20.3707 $1,208.86 $241.77 25111 T Remove wrist tendon lesion 0053 15.6795 $930.47 $253.49 $186.09 25112 T Reremove wrist tendon lesion 0053 15.6795 $930.47 $253.49 $186.09 25115 T Remove wrist/forearm lesion 0049 20.3707 $1,208.86 $241.77 Start Printed Page 50716 25116 T Remove wrist/forearm lesion 0049 20.3707 $1,208.86 $241.77 25118 T Excise wrist tendon sheath 0050 23.9081 $1,418.78 $283.76 25119 T Partial removal of ulna 0050 23.9081 $1,418.78 $283.76 25120 T Removal of forearm lesion 0050 23.9081 $1,418.78 $283.76 25125 T Remove/graft forearm lesion 0050 23.9081 $1,418.78 $283.76 25126 T Remove/graft forearm lesion 0050 23.9081 $1,418.78 $283.76 25130 T Removal of wrist lesion 0050 23.9081 $1,418.78 $283.76 25135 T Remove & graft wrist lesion 0050 23.9081 $1,418.78 $283.76 25136 T Remove & graft wrist lesion 0050 23.9081 $1,418.78 $283.76 25145 T Remove forearm bone lesion 0050 23.9081 $1,418.78 $283.76 25150 T Partial removal of ulna 0050 23.9081 $1,418.78 $283.76 25151 T Partial removal of radius 0050 23.9081 $1,418.78 $283.76 25170 T Extensive forearm surgery 0052 43.9378 $2,607.40 $521.48 25210 T Removal of wrist bone 0054 25.3711 $1,505.60 $301.12 25215 T Removal of wrist bones 0054 25.3711 $1,505.60 $301.12 25230 T Partial removal of radius 0050 23.9081 $1,418.78 $283.76 25240 T Partial removal of ulna 0050 23.9081 $1,418.78 $283.76 25246 N Injection for wrist x-ray 25248 T Remove forearm foreign body 0049 20.3707 $1,208.86 $241.77 25250 T Removal of wrist prosthesis 0050 23.9081 $1,418.78 $283.76 25251 T Removal of wrist prosthesis 0050 23.9081 $1,418.78 $283.76 25259 T Manipulate wrist w/anesthes 0043 1.7694 $105.00 $21.00 25260 T Repair forearm tendon/muscle 0050 23.9081 $1,418.78 $283.76 25263 T Repair forearm tendon/muscle 0050 23.9081 $1,418.78 $283.76 25265 T Repair forearm tendon/muscle 0050 23.9081 $1,418.78 $283.76 25270 T Repair forearm tendon/muscle 0050 23.9081 $1,418.78 $283.76 25272 T Repair forearm tendon/muscle 0050 23.9081 $1,418.78 $283.76 25274 T Repair forearm tendon/muscle 0050 23.9081 $1,418.78 $283.76 25275 T Repair forearm tendon sheath 0050 23.9081 $1,418.78 $283.76 25280 T Revise wrist/forearm tendon 0050 23.9081 $1,418.78 $283.76 25290 T Incise wrist/forearm tendon 0050 23.9081 $1,418.78 $283.76 25295 T Release wrist/forearm tendon 0049 20.3707 $1,208.86 $241.77 25300 T Fusion of tendons at wrist 0050 23.9081 $1,418.78 $283.76 25301 T Fusion of tendons at wrist 0050 23.9081 $1,418.78 $283.76 25310 T Transplant forearm tendon 0051 36.5271 $2,167.63 $433.53 25312 T Transplant forearm tendon 0051 36.5271 $2,167.63 $433.53 25315 T Revise palsy hand tendon(s) 0051 36.5271 $2,167.63 $433.53 25316 T Revise palsy hand tendon(s) 0051 36.5271 $2,167.63 $433.53 25320 T Repair/revise wrist joint 0051 36.5271 $2,167.63 $433.53 25332 T Revise wrist joint 0047 31.6107 $1,875.87 $537.03 $375.17 25335 T Realignment of hand 0051 36.5271 $2,167.63 $433.53 25337 T Reconstruct ulna/radioulnar 0051 36.5271 $2,167.63 $433.53 25350 T Revision of radius 0051 36.5271 $2,167.63 $433.53 25355 T Revision of radius 0051 36.5271 $2,167.63 $433.53 25360 T Revision of ulna 0050 23.9081 $1,418.78 $283.76 25365 T Revise radius & ulna 0050 23.9081 $1,418.78 $283.76 25370 T Revise radius or ulna 0051 36.5271 $2,167.63 $433.53 25375 T Revise radius & ulna 0051 36.5271 $2,167.63 $433.53 25390 T Shorten radius or ulna 0050 23.9081 $1,418.78 $283.76 25391 T Lengthen radius or ulna 0051 36.5271 $2,167.63 $433.53 25392 T Shorten radius & ulna 0050 23.9081 $1,418.78 $283.76 25393 T Lengthen radius & ulna 0051 36.5271 $2,167.63 $433.53 25394 T Repair carpal bone, shorten 0053 15.6795 $930.47 $253.49 $186.09 25400 T Repair radius or ulna 0050 23.9081 $1,418.78 $283.76 25405 T Repair/graft radius or ulna 0050 23.9081 $1,418.78 $283.76 25415 T Repair radius & ulna 0050 23.9081 $1,418.78 $283.76 25420 T Repair/graft radius & ulna 0051 36.5271 $2,167.63 $433.53 25425 T Repair/graft radius or ulna 0051 36.5271 $2,167.63 $433.53 25426 T Repair/graft radius & ulna 0051 36.5271 $2,167.63 $433.53 25430 T Vasc graft into carpal bone 0054 25.3711 $1,505.60 $301.12 25431 T Repair nonunion carpal bone 0054 25.3711 $1,505.60 $301.12 25440 T Repair/graft wrist bone 0051 36.5271 $2,167.63 $433.53 25441 T Reconstruct wrist joint 0425 100.2058 $5,946.51 $1,378.01 $1,189.30 25442 T Reconstruct wrist joint 0425 100.2058 $5,946.51 $1,378.01 $1,189.30 25443 T Reconstruct wrist joint 0048 43.1288 $2,559.39 $570.30 $511.88 25444 T Reconstruct wrist joint 0048 43.1288 $2,559.39 $570.30 $511.88 Start Printed Page 50717 25445 T Reconstruct wrist joint 0048 43.1288 $2,559.39 $570.30 $511.88 25446 T Wrist replacement 0425 100.2058 $5,946.51 $1,378.01 $1,189.30 25447 T Repair wrist joint(s) 0047 31.6107 $1,875.87 $537.03 $375.17 25449 T Remove wrist joint implant 0047 31.6107 $1,875.87 $537.03 $375.17 25450 T Revision of wrist joint 0051 36.5271 $2,167.63 $433.53 25455 T Revision of wrist joint 0051 36.5271 $2,167.63 $433.53 25490 T Reinforce radius 0051 36.5271 $2,167.63 $433.53 25491 T Reinforce ulna 0051 36.5271 $2,167.63 $433.53 25492 T Reinforce radius and ulna 0051 36.5271 $2,167.63 $433.53 25500 T Treat fracture of radius 0043 1.7694 $105.00 $21.00 25505 T Treat fracture of radius 0043 1.7694 $105.00 $21.00 25515 T Treat fracture of radius 0046 37.7023 $2,237.37 $535.76 $447.47 25520 T Treat fracture of radius 0043 1.7694 $105.00 $21.00 25525 T Treat fracture of radius 0046 37.7023 $2,237.37 $535.76 $447.47 25526 T Treat fracture of radius 0046 37.7023 $2,237.37 $535.76 $447.47 25530 T Treat fracture of ulna 0043 1.7694 $105.00 $21.00 25535 T Treat fracture of ulna 0043 1.7694 $105.00 $21.00 25545 T Treat fracture of ulna 0046 37.7023 $2,237.37 $535.76 $447.47 25560 T Treat fracture radius & ulna 0043 1.7694 $105.00 $21.00 25565 T Treat fracture radius & ulna 0043 1.7694 $105.00 $21.00 25574 T Treat fracture radius & ulna 0046 37.7023 $2,237.37 $535.76 $447.47 25575 T Treat fracture radius/ulna 0046 37.7023 $2,237.37 $535.76 $447.47 25600 T Treat fracture radius/ulna 0043 1.7694 $105.00 $21.00 25605 T Treat fracture radius/ulna 0043 1.7694 $105.00 $21.00 25611 T Treat fracture radius/ulna 0046 37.7023 $2,237.37 $535.76 $447.47 25620 T Treat fracture radius/ulna 0046 37.7023 $2,237.37 $535.76 $447.47 25622 T Treat wrist bone fracture 0043 1.7694 $105.00 $21.00 25624 T Treat wrist bone fracture 0043 1.7694 $105.00 $21.00 25628 T Treat wrist bone fracture 0046 37.7023 $2,237.37 $535.76 $447.47 25630 T Treat wrist bone fracture 0043 1.7694 $105.00 $21.00 25635 T Treat wrist bone fracture 0043 1.7694 $105.00 $21.00 25645 T Treat wrist bone fracture 0046 37.7023 $2,237.37 $535.76 $447.47 25650 T Treat wrist bone fracture 0043 1.7694 $105.00 $21.00 25651 T Pin ulnar styloid fracture 0046 37.7023 $2,237.37 $535.76 $447.47 25652 T Treat fracture ulnar styloid 0046 37.7023 $2,237.37 $535.76 $447.47 25660 T Treat wrist dislocation 0043 1.7694 $105.00 $21.00 25670 T Treat wrist dislocation 0046 37.7023 $2,237.37 $535.76 $447.47 25671 T Pin radioulnar dislocation 0046 37.7023 $2,237.37 $535.76 $447.47 25675 T Treat wrist dislocation 0043 1.7694 $105.00 $21.00 25676 T Treat wrist dislocation 0046 37.7023 $2,237.37 $535.76 $447.47 25680 T Treat wrist fracture 0043 1.7694 $105.00 $21.00 25685 T Treat wrist fracture 0046 37.7023 $2,237.37 $535.76 $447.47 25690 T Treat wrist dislocation 0043 1.7694 $105.00 $21.00 25695 T Treat wrist dislocation 0046 37.7023 $2,237.37 $535.76 $447.47 25800 T Fusion of wrist joint 0051 36.5271 $2,167.63 $433.53 25805 T Fusion/graft of wrist joint 0051 36.5271 $2,167.63 $433.53 25810 T Fusion/graft of wrist joint 0051 36.5271 $2,167.63 $433.53 25820 T Fusion of hand bones 0053 15.6795 $930.47 $253.49 $186.09 25825 T Fuse hand bones with graft 0054 25.3711 $1,505.60 $301.12 25830 T Fusion, radioulnar jnt/ulna 0051 36.5271 $2,167.63 $433.53 25900 C Amputation of forearm 25905 C Amputation of forearm 25907 T Amputation follow-up surgery 0049 20.3707 $1,208.86 $241.77 25909 C Amputation follow-up surgery 25915 C Amputation of forearm 25920 C Amputate hand at wrist 25922 T Amputate hand at wrist 0049 20.3707 $1,208.86 $241.77 25924 C Amputation follow-up surgery 25927 C Amputation of hand 25929 T Amputation follow-up surgery 0686 13.8287 $820.64 $164.13 25931 C Amputation follow-up surgery 25999 T Forearm or wrist surgery 0043 1.7694 $105.00 $21.00 26010 T Drainage of finger abscess 0006 1.55 $91.98 $22.28 $18.40 26011 T Drainage of finger abscess 0007 11.4501 $679.48 $135.90 26020 T Drain hand tendon sheath 0053 15.6795 $930.47 $253.49 $186.09 26025 T Drainage of palm bursa 0053 15.6795 $930.47 $253.49 $186.09 Start Printed Page 50718 26030 T Drainage of palm bursa(s) 0053 15.6795 $930.47 $253.49 $186.09 26034 T Treat hand bone lesion 0053 15.6795 $930.47 $253.49 $186.09 26035 T Decompress fingers/hand 0053 15.6795 $930.47 $253.49 $186.09 26037 T Decompress fingers/hand 0053 15.6795 $930.47 $253.49 $186.09 26040 T Release palm contracture 0054 25.3711 $1,505.60 $301.12 26045 T Release palm contracture 0054 25.3711 $1,505.60 $301.12 26055 T Incise finger tendon sheath 0053 15.6795 $930.47 $253.49 $186.09 26060 T Incision of finger tendon 0053 15.6795 $930.47 $253.49 $186.09 26070 T Explore/treat hand joint 0053 15.6795 $930.47 $253.49 $186.09 26075 T Explore/treat finger joint 0053 15.6795 $930.47 $253.49 $186.09 26080 T Explore/treat finger joint 0053 15.6795 $930.47 $253.49 $186.09 26100 T Biopsy hand joint lining 0053 15.6795 $930.47 $253.49 $186.09 26105 T Biopsy finger joint lining 0053 15.6795 $930.47 $253.49 $186.09 26110 T Biopsy finger joint lining 0053 15.6795 $930.47 $253.49 $186.09 26115 T Removel hand lesion subcut 0022 19.6472 $1,165.92 $354.45 $233.18 26116 T Removel hand lesion, deep 0022 19.6472 $1,165.92 $354.45 $233.18 26117 T Remove tumor, hand/finger 0022 19.6472 $1,165.92 $354.45 $233.18 26121 T Release palm contracture 0054 25.3711 $1,505.60 $301.12 26123 T Release palm contracture 0054 25.3711 $1,505.60 $301.12 26125 T Release palm contracture 0053 15.6795 $930.47 $253.49 $186.09 26130 T Remove wrist joint lining 0053 15.6795 $930.47 $253.49 $186.09 26135 T Revise finger joint, each 0054 25.3711 $1,505.60 $301.12 26140 T Revise finger joint, each 0053 15.6795 $930.47 $253.49 $186.09 26145 T Tendon excision, palm/finger 0053 15.6795 $930.47 $253.49 $186.09 26160 T Remove tendon sheath lesion 0053 15.6795 $930.47 $253.49 $186.09 26170 T Removal of palm tendon, each 0053 15.6795 $930.47 $253.49 $186.09 26180 T Removal of finger tendon 0053 15.6795 $930.47 $253.49 $186.09 26185 T Remove finger bone 0053 15.6795 $930.47 $253.49 $186.09 26200 T Remove hand bone lesion 0053 15.6795 $930.47 $253.49 $186.09 26205 T Remove/graft bone lesion 0054 25.3711 $1,505.60 $301.12 26210 T Removal of finger lesion 0053 15.6795 $930.47 $253.49 $186.09 26215 T Remove/graft finger lesion 0053 15.6795 $930.47 $253.49 $186.09 26230 T Partial removal of hand bone 0053 15.6795 $930.47 $253.49 $186.09 26235 T Partial removal, finger bone 0053 15.6795 $930.47 $253.49 $186.09 26236 T Partial removal, finger bone 0053 15.6795 $930.47 $253.49 $186.09 26250 T Extensive hand surgery 0053 15.6795 $930.47 $253.49 $186.09 26255 T Extensive hand surgery 0054 25.3711 $1,505.60 $301.12 26260 T Extensive finger surgery 0053 15.6795 $930.47 $253.49 $186.09 26261 T Extensive finger surgery 0053 15.6795 $930.47 $253.49 $186.09 26262 T Partial removal of finger 0053 15.6795 $930.47 $253.49 $186.09 26320 T Removal of implant from hand 0021 14.9776 $888.82 $219.48 $177.76 26340 T Manipulate finger w/anesth 0043 1.7694 $105.00 $21.00 26350 T Repair finger/hand tendon 0054 25.3711 $1,505.60 $301.12 26352 T Repair/graft hand tendon 0054 25.3711 $1,505.60 $301.12 26356 T Repair finger/hand tendon 0054 25.3711 $1,505.60 $301.12 26357 T Repair finger/hand tendon 0054 25.3711 $1,505.60 $301.12 26358 T Repair/graft hand tendon 0054 25.3711 $1,505.60 $301.12 26370 T Repair finger/hand tendon 0054 25.3711 $1,505.60 $301.12 26372 T Repair/graft hand tendon 0054 25.3711 $1,505.60 $301.12 26373 T Repair finger/hand tendon 0054 25.3711 $1,505.60 $301.12 26390 T Revise hand/finger tendon 0054 25.3711 $1,505.60 $301.12 26392 T Repair/graft hand tendon 0054 25.3711 $1,505.60 $301.12 26410 T Repair hand tendon 0053 15.6795 $930.47 $253.49 $186.09 26412 T Repair/graft hand tendon 0054 25.3711 $1,505.60 $301.12 26415 T Excision, hand/finger tendon 0054 25.3711 $1,505.60 $301.12 26416 T Graft hand or finger tendon 0054 25.3711 $1,505.60 $301.12 26418 T Repair finger tendon 0053 15.6795 $930.47 $253.49 $186.09 26420 T Repair/graft finger tendon 0054 25.3711 $1,505.60 $301.12 26426 T Repair finger/hand tendon 0054 25.3711 $1,505.60 $301.12 26428 T Repair/graft finger tendon 0054 25.3711 $1,505.60 $301.12 26432 T Repair finger tendon 0053 15.6795 $930.47 $253.49 $186.09 26433 T Repair finger tendon 0053 15.6795 $930.47 $253.49 $186.09 26434 T Repair/graft finger tendon 0054 25.3711 $1,505.60 $301.12 26437 T Realignment of tendons 0053 15.6795 $930.47 $253.49 $186.09 26440 T Release palm/finger tendon 0053 15.6795 $930.47 $253.49 $186.09 26442 T Release palm & finger tendon 0054 25.3711 $1,505.60 $301.12 Start Printed Page 50719 26445 T Release hand/finger tendon 0053 15.6795 $930.47 $253.49 $186.09 26449 T Release forearm/hand tendon 0054 25.3711 $1,505.60 $301.12 26450 T Incision of palm tendon 0053 15.6795 $930.47 $253.49 $186.09 26455 T Incision of finger tendon 0053 15.6795 $930.47 $253.49 $186.09 26460 T Incise hand/finger tendon 0053 15.6795 $930.47 $253.49 $186.09 26471 T Fusion of finger tendons 0053 15.6795 $930.47 $253.49 $186.09 26474 T Fusion of finger tendons 0053 15.6795 $930.47 $253.49 $186.09 26476 T Tendon lengthening 0053 15.6795 $930.47 $253.49 $186.09 26477 T Tendon shortening 0053 15.6795 $930.47 $253.49 $186.09 26478 T Lengthening of hand tendon 0053 15.6795 $930.47 $253.49 $186.09 26479 T Shortening of hand tendon 0053 15.6795 $930.47 $253.49 $186.09 26480 T Transplant hand tendon 0054 25.3711 $1,505.60 $301.12 26483 T Transplant/graft hand tendon 0054 25.3711 $1,505.60 $301.12 26485 T Transplant palm tendon 0054 25.3711 $1,505.60 $301.12 26489 T Transplant/graft palm tendon 0054 25.3711 $1,505.60 $301.12 26490 T Revise thumb tendon 0054 25.3711 $1,505.60 $301.12 26492 T Tendon transfer with graft 0054 25.3711 $1,505.60 $301.12 26494 T Hand tendon/muscle transfer 0054 25.3711 $1,505.60 $301.12 26496 T Revise thumb tendon 0054 25.3711 $1,505.60 $301.12 26497 T Finger tendon transfer 0054 25.3711 $1,505.60 $301.12 26498 T Finger tendon transfer 0054 25.3711 $1,505.60 $301.12 26499 T Revision of finger 0054 25.3711 $1,505.60 $301.12 26500 T Hand tendon reconstruction 0053 15.6795 $930.47 $253.49 $186.09 26502 T Hand tendon reconstruction 0054 25.3711 $1,505.60 $301.12 26504 T Hand tendon reconstruction 0054 25.3711 $1,505.60 $301.12 26508 T Release thumb contracture 0053 15.6795 $930.47 $253.49 $186.09 26510 T Thumb tendon transfer 0054 25.3711 $1,505.60 $301.12 26516 T Fusion of knuckle joint 0054 25.3711 $1,505.60 $301.12 26517 T Fusion of knuckle joints 0054 25.3711 $1,505.60 $301.12 26518 T Fusion of knuckle joints 0054 25.3711 $1,505.60 $301.12 26520 T Release knuckle contracture 0053 15.6795 $930.47 $253.49 $186.09 26525 T Release finger contracture 0053 15.6795 $930.47 $253.49 $186.09 26530 T Revise knuckle joint 0047 31.6107 $1,875.87 $537.03 $375.17 26531 T Revise knuckle with implant 0048 43.1288 $2,559.39 $570.30 $511.88 26535 T Revise finger joint 0047 31.6107 $1,875.87 $537.03 $375.17 26536 T Revise/implant finger joint 0048 43.1288 $2,559.39 $570.30 $511.88 26540 T Repair hand joint 0053 15.6795 $930.47 $253.49 $186.09 26541 T Repair hand joint with graft 0054 25.3711 $1,505.60 $301.12 26542 T Repair hand joint with graft 0053 15.6795 $930.47 $253.49 $186.09 26545 T Reconstruct finger joint 0054 25.3711 $1,505.60 $301.12 26546 T Repair nonunion hand 0054 25.3711 $1,505.60 $301.12 26548 T Reconstruct finger joint 0054 25.3711 $1,505.60 $301.12 26550 T Construct thumb replacement 0054 25.3711 $1,505.60 $301.12 26551 C Great toe-hand transfer 26553 C Single transfer, toe-hand 26554 C Double transfer, toe-hand 26555 T Positional change of finger 0054 25.3711 $1,505.60 $301.12 26556 C Toe joint transfer 26560 T Repair of web finger 0053 15.6795 $930.47 $253.49 $186.09 26561 T Repair of web finger 0054 25.3711 $1,505.60 $301.12 26562 T Repair of web finger 0054 25.3711 $1,505.60 $301.12 26565 T Correct metacarpal flaw 0054 25.3711 $1,505.60 $301.12 26567 T Correct finger deformity 0054 25.3711 $1,505.60 $301.12 26568 T Lengthen metacarpal/finger 0054 25.3711 $1,505.60 $301.12 26580 T Repair hand deformity 0053 15.6795 $930.47 $253.49 $186.09 26587 T Reconstruct extra finger 0053 15.6795 $930.47 $253.49 $186.09 26590 T Repair finger deformity 0053 15.6795 $930.47 $253.49 $186.09 26591 T Repair muscles of hand 0054 25.3711 $1,505.60 $301.12 26593 T Release muscles of hand 0053 15.6795 $930.47 $253.49 $186.09 26596 T Excision constricting tissue 0053 15.6795 $930.47 $253.49 $186.09 26600 T Treat metacarpal fracture 0043 1.7694 $105.00 $21.00 26605 T Treat metacarpal fracture 0043 1.7694 $105.00 $21.00 26607 T Treat metacarpal fracture 0043 1.7694 $105.00 $21.00 26608 T Treat metacarpal fracture 0046 37.7023 $2,237.37 $535.76 $447.47 26615 T Treat metacarpal fracture 0046 37.7023 $2,237.37 $535.76 $447.47 26641 T Treat thumb dislocation 0043 1.7694 $105.00 $21.00 Start Printed Page 50720 26645 T Treat thumb fracture 0043 1.7694 $105.00 $21.00 26650 T Treat thumb fracture 0046 37.7023 $2,237.37 $535.76 $447.47 26665 T Treat thumb fracture 0046 37.7023 $2,237.37 $535.76 $447.47 26670 T Treat hand dislocation 0043 1.7694 $105.00 $21.00 26675 T Treat hand dislocation 0043 1.7694 $105.00 $21.00 26676 T Pin hand dislocation 0046 37.7023 $2,237.37 $535.76 $447.47 26685 T Treat hand dislocation 0046 37.7023 $2,237.37 $535.76 $447.47 26686 T Treat hand dislocation 0046 37.7023 $2,237.37 $535.76 $447.47 26700 T Treat knuckle dislocation 0043 1.7694 $105.00 $21.00 26705 T Treat knuckle dislocation 0043 1.7694 $105.00 $21.00 26706 T Pin knuckle dislocation 0043 1.7694 $105.00 $21.00 26715 T Treat knuckle dislocation 0046 37.7023 $2,237.37 $535.76 $447.47 26720 T Treat finger fracture, each 0043 1.7694 $105.00 $21.00 26725 T Treat finger fracture, each 0043 1.7694 $105.00 $21.00 26727 T Treat finger fracture, each 0046 37.7023 $2,237.37 $535.76 $447.47 26735 T Treat finger fracture, each 0046 37.7023 $2,237.37 $535.76 $447.47 26740 T Treat finger fracture, each 0043 1.7694 $105.00 $21.00 26742 T Treat finger fracture, each 0043 1.7694 $105.00 $21.00 26746 T Treat finger fracture, each 0046 37.7023 $2,237.37 $535.76 $447.47 26750 T Treat finger fracture, each 0043 1.7694 $105.00 $21.00 26755 T Treat finger fracture, each 0043 1.7694 $105.00 $21.00 26756 T Pin finger fracture, each 0046 37.7023 $2,237.37 $535.76 $447.47 26765 T Treat finger fracture, each 0046 37.7023 $2,237.37 $535.76 $447.47 26770 T Treat finger dislocation 0043 1.7694 $105.00 $21.00 26775 T Treat finger dislocation 0045 14.4945 $860.15 $268.47 $172.03 26776 T Pin finger dislocation 0046 37.7023 $2,237.37 $535.76 $447.47 26785 T Treat finger dislocation 0046 37.7023 $2,237.37 $535.76 $447.47 26820 T Thumb fusion with graft 0054 25.3711 $1,505.60 $301.12 26841 T Fusion of thumb 0054 25.3711 $1,505.60 $301.12 26842 T Thumb fusion with graft 0054 25.3711 $1,505.60 $301.12 26843 T Fusion of hand joint 0054 25.3711 $1,505.60 $301.12 26844 T Fusion/graft of hand joint 0054 25.3711 $1,505.60 $301.12 26850 T Fusion of knuckle 0054 25.3711 $1,505.60 $301.12 26852 T Fusion of knuckle with graft 0054 25.3711 $1,505.60 $301.12 26860 T Fusion of finger joint 0054 25.3711 $1,505.60 $301.12 26861 T Fusion of finger jnt, add-on 0054 25.3711 $1,505.60 $301.12 26862 T Fusion/graft of finger joint 0054 25.3711 $1,505.60 $301.12 26863 T Fuse/graft added joint 0054 25.3711 $1,505.60 $301.12 26910 T Amputate metacarpal bone 0054 25.3711 $1,505.60 $301.12 26951 T Amputation of finger/thumb 0053 15.6795 $930.47 $253.49 $186.09 26952 T Amputation of finger/thumb 0053 15.6795 $930.47 $253.49 $186.09 26989 T Hand/finger surgery 0043 1.7694 $105.00 $21.00 26990 T Drainage of pelvis lesion 0049 20.3707 $1,208.86 $241.77 26991 T Drainage of pelvis bursa 0049 20.3707 $1,208.86 $241.77 26992 C Drainage of bone lesion 27000 T Incision of hip tendon 0049 20.3707 $1,208.86 $241.77 27001 T Incision of hip tendon 0050 23.9081 $1,418.78 $283.76 27003 T Incision of hip tendon 0050 23.9081 $1,418.78 $283.76 27005 C Incision of hip tendon 27006 C Incision of hip tendons 27025 C Incision of hip/thigh fascia 27030 C Drainage of hip joint 27033 T Exploration of hip joint 0051 36.5271 $2,167.63 $433.53 27035 T Denervation of hip joint 0052 43.9378 $2,607.40 $521.48 27036 C Excision of hip joint/muscle 27040 T Biopsy of soft tissues 0020 6.9433 $412.04 $107.40 $82.41 27041 T Biopsy of soft tissues 0020 6.9433 $412.04 $107.40 $82.41 27047 T Remove hip/pelvis lesion 0022 19.6472 $1,165.92 $354.45 $233.18 27048 T Remove hip/pelvis lesion 0022 19.6472 $1,165.92 $354.45 $233.18 27049 T Remove tumor, hip/pelvis 0022 19.6472 $1,165.92 $354.45 $233.18 27050 T Biopsy of sacroiliac joint 0049 20.3707 $1,208.86 $241.77 27052 T Biopsy of hip joint 0049 20.3707 $1,208.86 $241.77 27054 C Removal of hip joint lining 27060 T Removal of ischial bursa 0049 20.3707 $1,208.86 $241.77 27062 T Remove femur lesion/bursa 0049 20.3707 $1,208.86 $241.77 27065 T Removal of hip bone lesion 0049 20.3707 $1,208.86 $241.77 Start Printed Page 50721 27066 T Removal of hip bone lesion 0050 23.9081 $1,418.78 $283.76 27067 T Remove/graft hip bone lesion 0050 23.9081 $1,418.78 $283.76 27070 C Partial removal of hip bone 27071 C Partial removal of hip bone 27075 C Extensive hip surgery 27076 C Extensive hip surgery 27077 C Extensive hip surgery 27078 C Extensive hip surgery 27079 C Extensive hip surgery 27080 T Removal of tail bone 0050 23.9081 $1,418.78 $283.76 27086 T Remove hip foreign body 0020 6.9433 $412.04 $107.40 $82.41 27087 T Remove hip foreign body 0049 20.3707 $1,208.86 $241.77 27090 C Removal of hip prosthesis 27091 C Removal of hip prosthesis 27093 N Injection for hip x-ray 27095 N Injection for hip x-ray 27096 B Inject sacroiliac joint 27097 T Revision of hip tendon 0050 23.9081 $1,418.78 $283.76 27098 T Transfer tendon to pelvis 0050 23.9081 $1,418.78 $283.76 27100 T Transfer of abdominal muscle 0051 36.5271 $2,167.63 $433.53 27105 T Transfer of spinal muscle 0051 36.5271 $2,167.63 $433.53 27110 T Transfer of iliopsoas muscle 0051 36.5271 $2,167.63 $433.53 27111 T Transfer of iliopsoas muscle 0051 36.5271 $2,167.63 $433.53 27120 C Reconstruction of hip socket 27122 C Reconstruction of hip socket 27125 C Partial hip replacement 27130 C Total hip arthroplasty 27132 C Total hip arthroplasty 27134 C Revise hip joint replacement 27137 C Revise hip joint replacement 27138 C Revise hip joint replacement 27140 C Transplant femur ridge 27146 C Incision of hip bone 27147 C Revision of hip bone 27151 C Incision of hip bones 27156 C Revision of hip bones 27158 C Revision of pelvis 27161 C Incision of neck of femur 27165 C Incision/fixation of femur 27170 C Repair/graft femur head/neck 27175 C Treat slipped epiphysis 27176 C Treat slipped epiphysis 27177 C Treat slipped epiphysis 27178 C Treat slipped epiphysis 27179 C Revise head/neck of femur 27181 C Treat slipped epiphysis 27185 C Revision of femur epiphysis 27187 C Reinforce hip bones 27193 T Treat pelvic ring fracture 0043 1.7694 $105.00 $21.00 27194 T Treat pelvic ring fracture 0045 14.4945 $860.15 $268.47 $172.03 27200 T Treat tail bone fracture 0043 1.7694 $105.00 $21.00 27202 T Treat tail bone fracture 0046 37.7023 $2,237.37 $535.76 $447.47 27215 C Treat pelvic fracture(s) 27216 T Treat pelvic ring fracture 0050 23.9081 $1,418.78 $283.76 27217 C Treat pelvic ring fracture 27218 C Treat pelvic ring fracture 27220 T Treat hip socket fracture 0043 1.7694 $105.00 $21.00 27222 C Treat hip socket fracture 27226 C Treat hip wall fracture 27227 C Treat hip fracture(s) 27228 C Treat hip fracture(s) 27230 T Treat thigh fracture 0043 1.7694 $105.00 $21.00 27232 C Treat thigh fracture 27235 T Treat thigh fracture 0050 23.9081 $1,418.78 $283.76 27236 C Treat thigh fracture 27238 T Treat thigh fracture 0043 1.7694 $105.00 $21.00 Start Printed Page 50722 27240 C Treat thigh fracture 27244 C Treat thigh fracture 27245 C Treat thigh fracture 27246 T Treat thigh fracture 0043 1.7694 $105.00 $21.00 27248 C Treat thigh fracture 27250 T Treat hip dislocation 0043 1.7694 $105.00 $21.00 27252 T Treat hip dislocation 0045 14.4945 $860.15 $268.47 $172.03 27253 C Treat hip dislocation 27254 C Treat hip dislocation 27256 T Treat hip dislocation 0043 1.7694 $105.00 $21.00 27257 T Treat hip dislocation 0045 14.4945 $860.15 $268.47 $172.03 27258 C Treat hip dislocation 27259 C Treat hip dislocation 27265 T Treat hip dislocation 0043 1.7694 $105.00 $21.00 27266 T Treat hip dislocation 0045 14.4945 $860.15 $268.47 $172.03 27275 T Manipulation of hip joint 0045 14.4945 $860.15 $268.47 $172.03 27280 C Fusion of sacroiliac joint 27282 C Fusion of pubic bones 27284 C Fusion of hip joint 27286 C Fusion of hip joint 27290 C Amputation of leg at hip 27295 C Amputation of leg at hip 27299 T Pelvis/hip joint surgery 0043 1.7694 $105.00 $21.00 27301 T Drain thigh/knee lesion 0008 16.4989 $979.09 $195.82 27303 C Drainage of bone lesion 27305 T Incise thigh tendon & fascia 0049 20.3707 $1,208.86 $241.77 27306 T Incision of thigh tendon 0049 20.3707 $1,208.86 $241.77 27307 T Incision of thigh tendons 0049 20.3707 $1,208.86 $241.77 27310 T Exploration of knee joint 0050 23.9081 $1,418.78 $283.76 27315 T Partial removal, thigh nerve 0220 17.3586 $1,030.11 $206.02 27320 T Partial removal, thigh nerve 0220 17.3586 $1,030.11 $206.02 27323 T Biopsy, thigh soft tissues 0021 14.9776 $888.82 $219.48 $177.76 27324 T Biopsy, thigh soft tissues 0022 19.6472 $1,165.92 $354.45 $233.18 27327 T Removal of thigh lesion 0022 19.6472 $1,165.92 $354.45 $233.18 27328 T Removal of thigh lesion 0022 19.6472 $1,165.92 $354.45 $233.18 27329 T Remove tumor, thigh/knee 0022 19.6472 $1,165.92 $354.45 $233.18 27330 T Biopsy, knee joint lining 0050 23.9081 $1,418.78 $283.76 27331 T Explore/treat knee joint 0050 23.9081 $1,418.78 $283.76 27332 T Removal of knee cartilage 0050 23.9081 $1,418.78 $283.76 27333 T Removal of knee cartilage 0050 23.9081 $1,418.78 $283.76 27334 T Remove knee joint lining 0050 23.9081 $1,418.78 $283.76 27335 T Remove knee joint lining 0050 23.9081 $1,418.78 $283.76 27340 T Removal of kneecap bursa 0049 20.3707 $1,208.86 $241.77 27345 T Removal of knee cyst 0049 20.3707 $1,208.86 $241.77 27347 T Remove knee cyst 0049 20.3707 $1,208.86 $241.77 27350 T Removal of kneecap 0050 23.9081 $1,418.78 $283.76 27355 T Remove femur lesion 0050 23.9081 $1,418.78 $283.76 27356 T Remove femur lesion/graft 0050 23.9081 $1,418.78 $283.76 27357 T Remove femur lesion/graft 0050 23.9081 $1,418.78 $283.76 27358 T Remove femur lesion/fixation 0050 23.9081 $1,418.78 $283.76 27360 T Partial removal, leg bone(s) 0050 23.9081 $1,418.78 $283.76 27365 C Extensive leg surgery 27370 N Injection for knee x-ray 27372 T Removal of foreign body 0022 19.6472 $1,165.92 $354.45 $233.18 27380 T Repair of kneecap tendon 0049 20.3707 $1,208.86 $241.77 27381 T Repair/graft kneecap tendon 0049 20.3707 $1,208.86 $241.77 27385 T Repair of thigh muscle 0049 20.3707 $1,208.86 $241.77 27386 T Repair/graft of thigh muscle 0049 20.3707 $1,208.86 $241.77 27390 T Incision of thigh tendon 0049 20.3707 $1,208.86 $241.77 27391 T Incision of thigh tendons 0049 20.3707 $1,208.86 $241.77 27392 T Incision of thigh tendons 0049 20.3707 $1,208.86 $241.77 27393 T Lengthening of thigh tendon 0050 23.9081 $1,418.78 $283.76 27394 T Lengthening of thigh tendons 0050 23.9081 $1,418.78 $283.76 27395 T Lengthening of thigh tendons 0051 36.5271 $2,167.63 $433.53 27396 T Transplant of thigh tendon 0050 23.9081 $1,418.78 $283.76 27397 T Transplants of thigh tendons 0051 36.5271 $2,167.63 $433.53 Start Printed Page 50723 27400 T Revise thigh muscles/tendons 0051 36.5271 $2,167.63 $433.53 27403 T Repair of knee cartilage 0050 23.9081 $1,418.78 $283.76 27405 T Repair of knee ligament 0051 36.5271 $2,167.63 $433.53 27407 T Repair of knee ligament 0051 36.5271 $2,167.63 $433.53 27409 T Repair of knee ligaments 0051 36.5271 $2,167.63 $433.53 27412 T Autochondrocyte implant knee 0042 43.9753 $2,609.63 $804.74 $521.93 27415 T Osteochondral knee allograft 0042 43.9753 $2,609.63 $804.74 $521.93 27418 T Repair degenerated kneecap 0051 36.5271 $2,167.63 $433.53 27420 T Revision of unstable kneecap 0051 36.5271 $2,167.63 $433.53 27422 T Revision of unstable kneecap 0051 36.5271 $2,167.63 $433.53 27424 T Revision/removal of kneecap 0051 36.5271 $2,167.63 $433.53 27425 T Lateral retinacular release 0050 23.9081 $1,418.78 $283.76 27427 T Reconstruction, knee 0052 43.9378 $2,607.40 $521.48 27428 T Reconstruction, knee 0052 43.9378 $2,607.40 $521.48 27429 T Reconstruction, knee 0052 43.9378 $2,607.40 $521.48 27430 T Revision of thigh muscles 0051 36.5271 $2,167.63 $433.53 27435 T Incision of knee joint 0051 36.5271 $2,167.63 $433.53 27437 T Revise kneecap 0047 31.6107 $1,875.87 $537.03 $375.17 27438 T Revise kneecap with implant 0048 43.1288 $2,559.39 $570.30 $511.88 27440 T Revision of knee joint 0047 31.6107 $1,875.87 $537.03 $375.17 27441 T Revision of knee joint 0047 31.6107 $1,875.87 $537.03 $375.17 27442 T Revision of knee joint 0047 31.6107 $1,875.87 $537.03 $375.17 27443 T Revision of knee joint 0047 31.6107 $1,875.87 $537.03 $375.17 27445 C Revision of knee joint 27446 T Revision of knee joint 0681 137.163 $8,139.66 $2,081.48 $1,627.93 27447 C Total knee arthroplasty 27448 C Incision of thigh 27450 C Incision of thigh 27454 C Realignment of thigh bone 27455 C Realignment of knee 27457 C Realignment of knee 27465 C Shortening of thigh bone 27466 C Lengthening of thigh bone 27468 C Shorten/lengthen thighs 27470 C Repair of thigh 27472 C Repair/graft of thigh 27475 T Surgery to stop leg growth 0050 23.9081 $1,418.78 $283.76 27477 C Surgery to stop leg growth 27479 C Surgery to stop leg growth 27485 C Surgery to stop leg growth 27486 C Revise/replace knee joint 27487 C Revise/replace knee joint 27488 C Removal of knee prosthesis 27495 C Reinforce thigh 27496 T Decompression of thigh/knee 0049 20.3707 $1,208.86 $241.77 27497 T Decompression of thigh/knee 0049 20.3707 $1,208.86 $241.77 27498 T Decompression of thigh/knee 0049 20.3707 $1,208.86 $241.77 27499 T Decompression of thigh/knee 0049 20.3707 $1,208.86 $241.77 27500 T Treatment of thigh fracture 0043 1.7694 $105.00 $21.00 27501 T Treatment of thigh fracture 0043 1.7694 $105.00 $21.00 27502 T Treatment of thigh fracture 0043 1.7694 $105.00 $21.00 27503 T Treatment of thigh fracture 0043 1.7694 $105.00 $21.00 27506 C Treatment of thigh fracture 27507 C Treatment of thigh fracture 27508 T Treatment of thigh fracture 0043 1.7694 $105.00 $21.00 27509 T Treatment of thigh fracture 0046 37.7023 $2,237.37 $535.76 $447.47 27510 T Treatment of thigh fracture 0043 1.7694 $105.00 $21.00 27511 C Treatment of thigh fracture 27513 C Treatment of thigh fracture 27514 C Treatment of thigh fracture 27516 T Treat thigh fx growth plate 0043 1.7694 $105.00 $21.00 27517 T Treat thigh fx growth plate 0043 1.7694 $105.00 $21.00 27519 C Treat thigh fx growth plate 27520 T Treat kneecap fracture 0043 1.7694 $105.00 $21.00 27524 T Treat kneecap fracture 0046 37.7023 $2,237.37 $535.76 $447.47 27530 T Treat knee fracture 0043 1.7694 $105.00 $21.00 Start Printed Page 50724 27532 T Treat knee fracture 0043 1.7694 $105.00 $21.00 27535 C Treat knee fracture 27536 C Treat knee fracture 27538 T Treat knee fracture(s) 0043 1.7694 $105.00 $21.00 27540 C Treat knee fracture 27550 T Treat knee dislocation 0043 1.7694 $105.00 $21.00 27552 T Treat knee dislocation 0045 14.4945 $860.15 $268.47 $172.03 27556 C Treat knee dislocation 27557 C Treat knee dislocation 27558 C Treat knee dislocation 27560 T Treat kneecap dislocation 0043 1.7694 $105.00 $21.00 27562 T Treat kneecap dislocation 0045 14.4945 $860.15 $268.47 $172.03 27566 T Treat kneecap dislocation 0046 37.7023 $2,237.37 $535.76 $447.47 27570 T Fixation of knee joint 0045 14.4945 $860.15 $268.47 $172.03 27580 C Fusion of knee 27590 C Amputate leg at thigh 27591 C Amputate leg at thigh 27592 C Amputate leg at thigh 27594 T Amputation follow-up surgery 0049 20.3707 $1,208.86 $241.77 27596 C Amputation follow-up surgery 27598 C Amputate lower leg at knee 27599 T Leg surgery procedure 0043 1.7694 $105.00 $21.00 27600 T Decompression of lower leg 0049 20.3707 $1,208.86 $241.77 27601 T Decompression of lower leg 0049 20.3707 $1,208.86 $241.77 27602 T Decompression of lower leg 0049 20.3707 $1,208.86 $241.77 27603 T Drain lower leg lesion 0008 16.4989 $979.09 $195.82 27604 T Drain lower leg bursa 0049 20.3707 $1,208.86 $241.77 27605 T Incision of achilles tendon 0055 20.0692 $1,190.97 $355.34 $238.19 27606 T Incision of achilles tendon 0049 20.3707 $1,208.86 $241.77 27607 T Treat lower leg bone lesion 0049 20.3707 $1,208.86 $241.77 27610 T Explore/treat ankle joint 0050 23.9081 $1,418.78 $283.76 27612 T Exploration of ankle joint 0050 23.9081 $1,418.78 $283.76 27613 T Biopsy lower leg soft tissue 0020 6.9433 $412.04 $107.40 $82.41 27614 T Biopsy lower leg soft tissue 0022 19.6472 $1,165.92 $354.45 $233.18 27615 T Remove tumor, lower leg 0046 37.7023 $2,237.37 $535.76 $447.47 27618 T Remove lower leg lesion 0021 14.9776 $888.82 $219.48 $177.76 27619 T Remove lower leg lesion 0022 19.6472 $1,165.92 $354.45 $233.18 27620 T Explore/treat ankle joint 0050 23.9081 $1,418.78 $283.76 27625 T Remove ankle joint lining 0050 23.9081 $1,418.78 $283.76 27626 T Remove ankle joint lining 0050 23.9081 $1,418.78 $283.76 27630 T Removal of tendon lesion 0049 20.3707 $1,208.86 $241.77 27635 T Remove lower leg bone lesion 0050 23.9081 $1,418.78 $283.76 27637 T Remove/graft leg bone lesion 0050 23.9081 $1,418.78 $283.76 27638 T Remove/graft leg bone lesion 0050 23.9081 $1,418.78 $283.76 27640 T Partial removal of tibia 0051 36.5271 $2,167.63 $433.53 27641 T Partial removal of fibula 0050 23.9081 $1,418.78 $283.76 27645 C Extensive lower leg surgery 27646 C Extensive lower leg surgery 27647 T Extensive ankle/heel surgery 0051 36.5271 $2,167.63 $433.53 27648 N Injection for ankle x-ray 27650 T Repair achilles tendon 0051 36.5271 $2,167.63 $433.53 27652 T Repair/graft achilles tendon 0051 36.5271 $2,167.63 $433.53 27654 T Repair of achilles tendon 0051 36.5271 $2,167.63 $433.53 27656 T Repair leg fascia defect 0049 20.3707 $1,208.86 $241.77 27658 T Repair of leg tendon, each 0049 20.3707 $1,208.86 $241.77 27659 T Repair of leg tendon, each 0049 20.3707 $1,208.86 $241.77 27664 T Repair of leg tendon, each 0049 20.3707 $1,208.86 $241.77 27665 T Repair of leg tendon, each 0050 23.9081 $1,418.78 $283.76 27675 T Repair lower leg tendons 0049 20.3707 $1,208.86 $241.77 27676 T Repair lower leg tendons 0050 23.9081 $1,418.78 $283.76 27680 T Release of lower leg tendon 0050 23.9081 $1,418.78 $283.76 27681 T Release of lower leg tendons 0050 23.9081 $1,418.78 $283.76 27685 T Revision of lower leg tendon 0050 23.9081 $1,418.78 $283.76 27686 T Revise lower leg tendons 0050 23.9081 $1,418.78 $283.76 27687 T Revision of calf tendon 0050 23.9081 $1,418.78 $283.76 27690 T Revise lower leg tendon 0051 36.5271 $2,167.63 $433.53 Start Printed Page 50725 27691 T Revise lower leg tendon 0051 36.5271 $2,167.63 $433.53 27692 T Revise additional leg tendon 0051 36.5271 $2,167.63 $433.53 27695 T Repair of ankle ligament 0050 23.9081 $1,418.78 $283.76 27696 T Repair of ankle ligaments 0050 23.9081 $1,418.78 $283.76 27698 T Repair of ankle ligament 0050 23.9081 $1,418.78 $283.76 27700 T Revision of ankle joint 0047 31.6107 $1,875.87 $537.03 $375.17 27702 C Reconstruct ankle joint 27703 C Reconstruction, ankle joint 27704 T Removal of ankle implant 0049 20.3707 $1,208.86 $241.77 27705 T Incision of tibia 0051 36.5271 $2,167.63 $433.53 27707 T Incision of fibula 0049 20.3707 $1,208.86 $241.77 27709 T Incision of tibia & fibula 0050 23.9081 $1,418.78 $283.76 27712 C Realignment of lower leg 27715 C Revision of lower leg 27720 C Repair of tibia 27722 C Repair/graft of tibia 27724 C Repair/graft of tibia 27725 C Repair of lower leg 27727 C Repair of lower leg 27730 T Repair of tibia epiphysis 0050 23.9081 $1,418.78 $283.76 27732 T Repair of fibula epiphysis 0050 23.9081 $1,418.78 $283.76 27734 T Repair lower leg epiphyses 0050 23.9081 $1,418.78 $283.76 27740 T Repair of leg epiphyses 0050 23.9081 $1,418.78 $283.76 27742 T Repair of leg epiphyses 0051 36.5271 $2,167.63 $433.53 27745 T Reinforce tibia 0051 36.5271 $2,167.63 $433.53 27750 T Treatment of tibia fracture 0043 1.7694 $105.00 $21.00 27752 T Treatment of tibia fracture 0043 1.7694 $105.00 $21.00 27756 T Treatment of tibia fracture 0046 37.7023 $2,237.37 $535.76 $447.47 27758 T Treatment of tibia fracture 0046 37.7023 $2,237.37 $535.76 $447.47 27759 T Treatment of tibia fracture 0046 37.7023 $2,237.37 $535.76 $447.47 27760 T Treatment of ankle fracture 0043 1.7694 $105.00 $21.00 27762 T Treatment of ankle fracture 0043 1.7694 $105.00 $21.00 27766 T Treatment of ankle fracture 0046 37.7023 $2,237.37 $535.76 $447.47 27780 T Treatment of fibula fracture 0043 1.7694 $105.00 $21.00 27781 T Treatment of fibula fracture 0043 1.7694 $105.00 $21.00 27784 T Treatment of fibula fracture 0046 37.7023 $2,237.37 $535.76 $447.47 27786 T Treatment of ankle fracture 0043 1.7694 $105.00 $21.00 27788 T Treatment of ankle fracture 0043 1.7694 $105.00 $21.00 27792 T Treatment of ankle fracture 0046 37.7023 $2,237.37 $535.76 $447.47 27808 T Treatment of ankle fracture 0043 1.7694 $105.00 $21.00 27810 T Treatment of ankle fracture 0043 1.7694 $105.00 $21.00 27814 T Treatment of ankle fracture 0046 37.7023 $2,237.37 $535.76 $447.47 27816 T Treatment of ankle fracture 0043 1.7694 $105.00 $21.00 27818 T Treatment of ankle fracture 0043 1.7694 $105.00 $21.00 27822 T Treatment of ankle fracture 0046 37.7023 $2,237.37 $535.76 $447.47 27823 T Treatment of ankle fracture 0046 37.7023 $2,237.37 $535.76 $447.47 27824 T Treat lower leg fracture 0043 1.7694 $105.00 $21.00 27825 T Treat lower leg fracture 0043 1.7694 $105.00 $21.00 27826 T Treat lower leg fracture 0046 37.7023 $2,237.37 $535.76 $447.47 27827 T Treat lower leg fracture 0046 37.7023 $2,237.37 $535.76 $447.47 27828 T Treat lower leg fracture 0046 37.7023 $2,237.37 $535.76 $447.47 27829 T Treat lower leg joint 0046 37.7023 $2,237.37 $535.76 $447.47 27830 T Treat lower leg dislocation 0043 1.7694 $105.00 $21.00 27831 T Treat lower leg dislocation 0043 1.7694 $105.00 $21.00 27832 T Treat lower leg dislocation 0046 37.7023 $2,237.37 $535.76 $447.47 27840 T Treat ankle dislocation 0043 1.7694 $105.00 $21.00 27842 T Treat ankle dislocation 0045 14.4945 $860.15 $268.47 $172.03 27846 T Treat ankle dislocation 0046 37.7023 $2,237.37 $535.76 $447.47 27848 T Treat ankle dislocation 0046 37.7023 $2,237.37 $535.76 $447.47 27860 T Fixation of ankle joint 0045 14.4945 $860.15 $268.47 $172.03 27870 T Fusion of ankle joint 0051 36.5271 $2,167.63 $433.53 27871 T Fusion of tibiofibular joint 0051 36.5271 $2,167.63 $433.53 27880 C Amputation of lower leg 27881 C Amputation of lower leg 27882 C Amputation of lower leg 27884 T Amputation follow-up surgery 0049 20.3707 $1,208.86 $241.77 Start Printed Page 50726 27886 C Amputation follow-up surgery 27888 C Amputation of foot at ankle 27889 T Amputation of foot at ankle 0050 23.9081 $1,418.78 $283.76 27892 T Decompression of leg 0049 20.3707 $1,208.86 $241.77 27893 T Decompression of leg 0049 20.3707 $1,208.86 $241.77 27894 T Decompression of leg 0049 20.3707 $1,208.86 $241.77 27899 T Leg/ankle surgery procedure 0043 1.7694 $105.00 $21.00 28001 T Drainage of bursa of foot 0007 11.4501 $679.48 $135.90 28002 T Treatment of foot infection 0049 20.3707 $1,208.86 $241.77 28003 T Treatment of foot infection 0049 20.3707 $1,208.86 $241.77 28005 T Treat foot bone lesion 0055 20.0692 $1,190.97 $355.34 $238.19 28008 T Incision of foot fascia 0055 20.0692 $1,190.97 $355.34 $238.19 28010 T Incision of toe tendon 0055 20.0692 $1,190.97 $355.34 $238.19 28011 T Incision of toe tendons 0055 20.0692 $1,190.97 $355.34 $238.19 28020 T Exploration of foot joint 0055 20.0692 $1,190.97 $355.34 $238.19 28022 T Exploration of foot joint 0055 20.0692 $1,190.97 $355.34 $238.19 28024 T Exploration of toe joint 0055 20.0692 $1,190.97 $355.34 $238.19 28030 T Removal of foot nerve 0220 17.3586 $1,030.11 $206.02 28035 T Decompression of tibia nerve 0220 17.3586 $1,030.11 $206.02 28043 T Excision of foot lesion 0021 14.9776 $888.82 $219.48 $177.76 28045 T Excision of foot lesion 0055 20.0692 $1,190.97 $355.34 $238.19 28046 T Resection of tumor, foot 0055 20.0692 $1,190.97 $355.34 $238.19 28050 T Biopsy of foot joint lining 0055 20.0692 $1,190.97 $355.34 $238.19 28052 T Biopsy of foot joint lining 0055 20.0692 $1,190.97 $355.34 $238.19 28054 T Biopsy of toe joint lining 0055 20.0692 $1,190.97 $355.34 $238.19 28060 T Partial removal, foot fascia 0055 20.0692 $1,190.97 $355.34 $238.19 28062 T Removal of foot fascia 0055 20.0692 $1,190.97 $355.34 $238.19 28070 T Removal of foot joint lining 0055 20.0692 $1,190.97 $355.34 $238.19 28072 T Removal of foot joint lining 0055 20.0692 $1,190.97 $355.34 $238.19 28080 T Removal of foot lesion 0055 20.0692 $1,190.97 $355.34 $238.19 28086 T Excise foot tendon sheath 0055 20.0692 $1,190.97 $355.34 $238.19 28088 T Excise foot tendon sheath 0055 20.0692 $1,190.97 $355.34 $238.19 28090 T Removal of foot lesion 0055 20.0692 $1,190.97 $355.34 $238.19 28092 T Removal of toe lesions 0055 20.0692 $1,190.97 $355.34 $238.19 28100 T Removal of ankle/heel lesion 0055 20.0692 $1,190.97 $355.34 $238.19 28102 T Remove/graft foot lesion 0056 40.2957 $2,391.27 $478.25 28103 T Remove/graft foot lesion 0056 40.2957 $2,391.27 $478.25 28104 T Removal of foot lesion 0055 20.0692 $1,190.97 $355.34 $238.19 28106 T Remove/graft foot lesion 0056 40.2957 $2,391.27 $478.25 28107 T Remove/graft foot lesion 0056 40.2957 $2,391.27 $478.25 28108 T Removal of toe lesions 0055 20.0692 $1,190.97 $355.34 $238.19 28110 T Part removal of metatarsal 0055 20.0692 $1,190.97 $355.34 $238.19 28111 T Part removal of metatarsal 0055 20.0692 $1,190.97 $355.34 $238.19 28112 T Part removal of metatarsal 0055 20.0692 $1,190.97 $355.34 $238.19 28113 T Part removal of metatarsal 0055 20.0692 $1,190.97 $355.34 $238.19 28114 T Removal of metatarsal heads 0055 20.0692 $1,190.97 $355.34 $238.19 28116 T Revision of foot 0055 20.0692 $1,190.97 $355.34 $238.19 28118 T Removal of heel bone 0055 20.0692 $1,190.97 $355.34 $238.19 28119 T Removal of heel spur 0055 20.0692 $1,190.97 $355.34 $238.19 28120 T Part removal of ankle/heel 0055 20.0692 $1,190.97 $355.34 $238.19 28122 T Partial removal of foot bone 0055 20.0692 $1,190.97 $355.34 $238.19 28124 T Partial removal of toe 0055 20.0692 $1,190.97 $355.34 $238.19 28126 T Partial removal of toe 0055 20.0692 $1,190.97 $355.34 $238.19 28130 T Removal of ankle bone 0055 20.0692 $1,190.97 $355.34 $238.19 28140 T Removal of metatarsal 0055 20.0692 $1,190.97 $355.34 $238.19 28150 T Removal of toe 0055 20.0692 $1,190.97 $355.34 $238.19 28153 T Partial removal of toe 0055 20.0692 $1,190.97 $355.34 $238.19 28160 T Partial removal of toe 0055 20.0692 $1,190.97 $355.34 $238.19 28171 T Extensive foot surgery 0055 20.0692 $1,190.97 $355.34 $238.19 28173 T Extensive foot surgery 0055 20.0692 $1,190.97 $355.34 $238.19 28175 T Extensive foot surgery 0055 20.0692 $1,190.97 $355.34 $238.19 28190 T Removal of foot foreign body 0019 4.0547 $240.62 $71.87 $48.12 28192 T Removal of foot foreign body 0021 14.9776 $888.82 $219.48 $177.76 28193 T Removal of foot foreign body 0020 6.9433 $412.04 $107.40 $82.41 28200 T Repair of foot tendon 0055 20.0692 $1,190.97 $355.34 $238.19 28202 T Repair/graft of foot tendon 0055 20.0692 $1,190.97 $355.34 $238.19 Start Printed Page 50727 28208 T Repair of foot tendon 0055 20.0692 $1,190.97 $355.34 $238.19 28210 T Repair/graft of foot tendon 0056 40.2957 $2,391.27 $478.25 28220 T Release of foot tendon 0055 20.0692 $1,190.97 $355.34 $238.19 28222 T Release of foot tendons 0055 20.0692 $1,190.97 $355.34 $238.19 28225 T Release of foot tendon 0055 20.0692 $1,190.97 $355.34 $238.19 28226 T Release of foot tendons 0055 20.0692 $1,190.97 $355.34 $238.19 28230 T Incision of foot tendon(s) 0055 20.0692 $1,190.97 $355.34 $238.19 28232 T Incision of toe tendon 0055 20.0692 $1,190.97 $355.34 $238.19 28234 T Incision of foot tendon 0055 20.0692 $1,190.97 $355.34 $238.19 28238 T Revision of foot tendon 0056 40.2957 $2,391.27 $478.25 28240 T Release of big toe 0055 20.0692 $1,190.97 $355.34 $238.19 28250 T Revision of foot fascia 0055 20.0692 $1,190.97 $355.34 $238.19 28260 T Release of midfoot joint 0055 20.0692 $1,190.97 $355.34 $238.19 28261 T Revision of foot tendon 0055 20.0692 $1,190.97 $355.34 $238.19 28262 T Revision of foot and ankle 0055 20.0692 $1,190.97 $355.34 $238.19 28264 T Release of midfoot joint 0056 40.2957 $2,391.27 $478.25 28270 T Release of foot contracture 0055 20.0692 $1,190.97 $355.34 $238.19 28272 T Release of toe joint, each 0055 20.0692 $1,190.97 $355.34 $238.19 28280 T Fusion of toes 0055 20.0692 $1,190.97 $355.34 $238.19 28285 T Repair of hammertoe 0055 20.0692 $1,190.97 $355.34 $238.19 28286 T Repair of hammertoe 0055 20.0692 $1,190.97 $355.34 $238.19 28288 T Partial removal of foot bone 0055 20.0692 $1,190.97 $355.34 $238.19 28289 T Repair hallux rigidus 0055 20.0692 $1,190.97 $355.34 $238.19 28290 T Correction of bunion 0057 27.5493 $1,634.86 $475.91 $326.97 28292 T Correction of bunion 0057 27.5493 $1,634.86 $475.91 $326.97 28293 T Correction of bunion 0057 27.5493 $1,634.86 $475.91 $326.97 28294 T Correction of bunion 0057 27.5493 $1,634.86 $475.91 $326.97 28296 T Correction of bunion 0057 27.5493 $1,634.86 $475.91 $326.97 28297 T Correction of bunion 0057 27.5493 $1,634.86 $475.91 $326.97 28298 T Correction of bunion 0057 27.5493 $1,634.86 $475.91 $326.97 28299 T Correction of bunion 0057 27.5493 $1,634.86 $475.91 $326.97 28300 T Incision of heel bone 0056 40.2957 $2,391.27 $478.25 28302 T Incision of ankle bone 0055 20.0692 $1,190.97 $355.34 $238.19 28304 T Incision of midfoot bones 0056 40.2957 $2,391.27 $478.25 28305 T Incise/graft midfoot bones 0056 40.2957 $2,391.27 $478.25 28306 T Incision of metatarsal 0055 20.0692 $1,190.97 $355.34 $238.19 28307 T Incision of metatarsal 0055 20.0692 $1,190.97 $355.34 $238.19 28308 T Incision of metatarsal 0055 20.0692 $1,190.97 $355.34 $238.19 28309 T Incision of metatarsals 0056 40.2957 $2,391.27 $478.25 28310 T Revision of big toe 0055 20.0692 $1,190.97 $355.34 $238.19 28312 T Revision of toe 0055 20.0692 $1,190.97 $355.34 $238.19 28313 T Repair deformity of toe 0055 20.0692 $1,190.97 $355.34 $238.19 28315 T Removal of sesamoid bone 0055 20.0692 $1,190.97 $355.34 $238.19 28320 T Repair of foot bones 0056 40.2957 $2,391.27 $478.25 28322 T Repair of metatarsals 0056 40.2957 $2,391.27 $478.25 28340 T Resect enlarged toe tissue 0055 20.0692 $1,190.97 $355.34 $238.19 28341 T Resect enlarged toe 0055 20.0692 $1,190.97 $355.34 $238.19 28344 T Repair extra toe(s) 0055 20.0692 $1,190.97 $355.34 $238.19 28345 T Repair webbed toe(s) 0055 20.0692 $1,190.97 $355.34 $238.19 28360 T Reconstruct cleft foot 0056 40.2957 $2,391.27 $478.25 28400 T Treatment of heel fracture 0043 1.7694 $105.00 $21.00 28405 T Treatment of heel fracture 0043 1.7694 $105.00 $21.00 28406 T Treatment of heel fracture 0046 37.7023 $2,237.37 $535.76 $447.47 28415 T Treat heel fracture 0046 37.7023 $2,237.37 $535.76 $447.47 28420 T Treat/graft heel fracture 0046 37.7023 $2,237.37 $535.76 $447.47 28430 T Treatment of ankle fracture 0043 1.7694 $105.00 $21.00 28435 T Treatment of ankle fracture 0043 1.7694 $105.00 $21.00 28436 T Treatment of ankle fracture 0046 37.7023 $2,237.37 $535.76 $447.47 28445 T Treat ankle fracture 0046 37.7023 $2,237.37 $535.76 $447.47 28450 T Treat midfoot fracture, each 0043 1.7694 $105.00 $21.00 28455 T Treat midfoot fracture, each 0043 1.7694 $105.00 $21.00 28456 T Treat midfoot fracture 0046 37.7023 $2,237.37 $535.76 $447.47 28465 T Treat midfoot fracture, each 0046 37.7023 $2,237.37 $535.76 $447.47 28470 T Treat metatarsal fracture 0043 1.7694 $105.00 $21.00 28475 T Treat metatarsal fracture 0043 1.7694 $105.00 $21.00 28476 T Treat metatarsal fracture 0046 37.7023 $2,237.37 $535.76 $447.47 Start Printed Page 50728 28485 T Treat metatarsal fracture 0046 37.7023 $2,237.37 $535.76 $447.47 28490 T Treat big toe fracture 0043 1.7694 $105.00 $21.00 28495 T Treat big toe fracture 0043 1.7694 $105.00 $21.00 28496 T Treat big toe fracture 0046 37.7023 $2,237.37 $535.76 $447.47 28505 T Treat big toe fracture 0046 37.7023 $2,237.37 $535.76 $447.47 28510 T Treatment of toe fracture 0043 1.7694 $105.00 $21.00 28515 T Treatment of toe fracture 0043 1.7694 $105.00 $21.00 28525 T Treat toe fracture 0046 37.7023 $2,237.37 $535.76 $447.47 28530 T Treat sesamoid bone fracture 0043 1.7694 $105.00 $21.00 28531 T Treat sesamoid bone fracture 0046 37.7023 $2,237.37 $535.76 $447.47 28540 T Treat foot dislocation 0043 1.7694 $105.00 $21.00 28545 T Treat foot dislocation 0045 14.4945 $860.15 $268.47 $172.03 28546 T Treat foot dislocation 0046 37.7023 $2,237.37 $535.76 $447.47 28555 T Repair foot dislocation 0046 37.7023 $2,237.37 $535.76 $447.47 28570 T Treat foot dislocation 0043 1.7694 $105.00 $21.00 28575 T Treat foot dislocation 0043 1.7694 $105.00 $21.00 28576 T Treat foot dislocation 0046 37.7023 $2,237.37 $535.76 $447.47 28585 T Repair foot dislocation 0046 37.7023 $2,237.37 $535.76 $447.47 28600 T Treat foot dislocation 0043 1.7694 $105.00 $21.00 28605 T Treat foot dislocation 0043 1.7694 $105.00 $21.00 28606 T Treat foot dislocation 0046 37.7023 $2,237.37 $535.76 $447.47 28615 T Repair foot dislocation 0046 37.7023 $2,237.37 $535.76 $447.47 28630 T Treat toe dislocation 0043 1.7694 $105.00 $21.00 28635 T Treat toe dislocation 0045 14.4945 $860.15 $268.47 $172.03 28636 T Treat toe dislocation 0046 37.7023 $2,237.37 $535.76 $447.47 28645 T Repair toe dislocation 0046 37.7023 $2,237.37 $535.76 $447.47 28660 T Treat toe dislocation 0043 1.7694 $105.00 $21.00 28665 T Treat toe dislocation 0045 14.4945 $860.15 $268.47 $172.03 28666 T Treat toe dislocation 0046 37.7023 $2,237.37 $535.76 $447.47 28675 T Repair of toe dislocation 0046 37.7023 $2,237.37 $535.76 $447.47 28705 T Fusion of foot bones 0056 40.2957 $2,391.27 $478.25 28715 T Fusion of foot bones 0056 40.2957 $2,391.27 $478.25 28725 T Fusion of foot bones 0056 40.2957 $2,391.27 $478.25 28730 T Fusion of foot bones 0056 40.2957 $2,391.27 $478.25 28735 T Fusion of foot bones 0056 40.2957 $2,391.27 $478.25 28737 T Revision of foot bones 0056 40.2957 $2,391.27 $478.25 28740 T Fusion of foot bones 0056 40.2957 $2,391.27 $478.25 28750 T Fusion of big toe joint 0056 40.2957 $2,391.27 $478.25 28755 T Fusion of big toe joint 0055 20.0692 $1,190.97 $355.34 $238.19 28760 T Fusion of big toe joint 0056 40.2957 $2,391.27 $478.25 28800 C Amputation of midfoot 28805 C Amputation thru metatarsal 28810 T Amputation toe & metatarsal 0055 20.0692 $1,190.97 $355.34 $238.19 28820 T Amputation of toe 0055 20.0692 $1,190.97 $355.34 $238.19 28825 T Partial amputation of toe 0055 20.0692 $1,190.97 $355.34 $238.19 28899 T Foot/toes surgery procedure 0043 1.7694 $105.00 $21.00 29000 S Application of body cast 0058 1.0934 $64.89 $12.98 29010 S Application of body cast 0426 2.1243 $126.06 $25.21 29015 S Application of body cast 0426 2.1243 $126.06 $25.21 29020 S Application of body cast 0058 1.0934 $64.89 $12.98 29025 S Application of body cast 0058 1.0934 $64.89 $12.98 29035 S Application of body cast 0426 2.1243 $126.06 $25.21 29040 S Application of body cast 0058 1.0934 $64.89 $12.98 29044 S Application of body cast 0426 2.1243 $126.06 $25.21 29046 S Application of body cast 0426 2.1243 $126.06 $25.21 29049 S Application of figure eight 0058 1.0934 $64.89 $12.98 29055 S Application of shoulder cast 0426 2.1243 $126.06 $25.21 29058 S Application of shoulder cast 0058 1.0934 $64.89 $12.98 29065 S Application of long arm cast 0426 2.1243 $126.06 $25.21 29075 S Application of forearm cast 0426 2.1243 $126.06 $25.21 29085 S Apply hand/wrist cast 0058 1.0934 $64.89 $12.98 29086 S Apply finger cast 0058 1.0934 $64.89 $12.98 29105 S Apply long arm splint 0058 1.0934 $64.89 $12.98 29125 S Apply forearm splint 0058 1.0934 $64.89 $12.98 29126 S Apply forearm splint 0058 1.0934 $64.89 $12.98 29130 S Application of finger splint 0058 1.0934 $64.89 $12.98 Start Printed Page 50729 29131 S Application of finger splint 0058 1.0934 $64.89 $12.98 29200 S Strapping of chest 0058 1.0934 $64.89 $12.98 29220 S Strapping of low back 0058 1.0934 $64.89 $12.98 29240 S Strapping of shoulder 0058 1.0934 $64.89 $12.98 29260 S Strapping of elbow or wrist 0058 1.0934 $64.89 $12.98 29280 S Strapping of hand or finger 0058 1.0934 $64.89 $12.98 29305 S Application of hip cast 0426 2.1243 $126.06 $25.21 29325 S Application of hip casts 0426 2.1243 $126.06 $25.21 29345 S Application of long leg cast 0426 2.1243 $126.06 $25.21 29355 S Application of long leg cast 0426 2.1243 $126.06 $25.21 29358 S Apply long leg cast brace 0426 2.1243 $126.06 $25.21 29365 S Application of long leg cast 0426 2.1243 $126.06 $25.21 29405 S Apply short leg cast 0426 2.1243 $126.06 $25.21 29425 S Apply short leg cast 0426 2.1243 $126.06 $25.21 29435 S Apply short leg cast 0426 2.1243 $126.06 $25.21 29440 S Addition of walker to cast 0058 1.0934 $64.89 $12.98 29445 S Apply rigid leg cast 0426 2.1243 $126.06 $25.21 29450 S Application of leg cast 0058 1.0934 $64.89 $12.98 29505 S Application, long leg splint 0058 1.0934 $64.89 $12.98 29515 S Application lower leg splint 0058 1.0934 $64.89 $12.98 29520 S Strapping of hip 0058 1.0934 $64.89 $12.98 29530 S Strapping of knee 0058 1.0934 $64.89 $12.98 29540 S Strapping of ankle 0058 1.0934 $64.89 $12.98 29550 S Strapping of toes 0058 1.0934 $64.89 $12.98 29580 S Application of paste boot 0058 1.0934 $64.89 $12.98 29590 S Application of foot splint 0058 1.0934 $64.89 $12.98 29700 S Removal/revision of cast 0058 1.0934 $64.89 $12.98 29705 S Removal/revision of cast 0058 1.0934 $64.89 $12.98 29710 S Removal/revision of cast 0426 2.1243 $126.06 $25.21 29715 S Removal/revision of cast 0058 1.0934 $64.89 $12.98 29720 S Repair of body cast 0058 1.0934 $64.89 $12.98 29730 S Windowing of cast 0058 1.0934 $64.89 $12.98 29740 S Wedging of cast 0058 1.0934 $64.89 $12.98 29750 S Wedging of clubfoot cast 0058 1.0934 $64.89 $12.98 29799 S Casting/strapping procedure 0058 1.0934 $64.89 $12.98 29800 T Jaw arthroscopy/surgery 0041 28.1318 $1,669.43 $333.89 29804 T Jaw arthroscopy/surgery 0041 28.1318 $1,669.43 $333.89 29805 T Shoulder arthroscopy, dx 0041 28.1318 $1,669.43 $333.89 29806 T Shoulder arthroscopy/surgery 0042 43.9753 $2,609.63 $804.74 $521.93 29807 T Shoulder arthroscopy/surgery 0042 43.9753 $2,609.63 $804.74 $521.93 29819 T Shoulder arthroscopy/surgery 0041 28.1318 $1,669.43 $333.89 29820 T Shoulder arthroscopy/surgery 0041 28.1318 $1,669.43 $333.89 29821 T Shoulder arthroscopy/surgery 0041 28.1318 $1,669.43 $333.89 29822 T Shoulder arthroscopy/surgery 0041 28.1318 $1,669.43 $333.89 29823 T Shoulder arthroscopy/surgery 0041 28.1318 $1,669.43 $333.89 29824 T Shoulder arthroscopy/surgery 0041 28.1318 $1,669.43 $333.89 29825 T Shoulder arthroscopy/surgery 0041 28.1318 $1,669.43 $333.89 29826 T Shoulder arthroscopy/surgery 0042 43.9753 $2,609.63 $804.74 $521.93 29827 T Arthroscop rotator cuff repr 0042 43.9753 $2,609.63 $804.74 $521.93 29830 T Elbow arthroscopy 0041 28.1318 $1,669.43 $333.89 29834 T Elbow arthroscopy/surgery 0041 28.1318 $1,669.43 $333.89 29835 T Elbow arthroscopy/surgery 0041 28.1318 $1,669.43 $333.89 29836 T Elbow arthroscopy/surgery 0041 28.1318 $1,669.43 $333.89 29837 T Elbow arthroscopy/surgery 0041 28.1318 $1,669.43 $333.89 29838 T Elbow arthroscopy/surgery 0041 28.1318 $1,669.43 $333.89 29840 T Wrist arthroscopy 0041 28.1318 $1,669.43 $333.89 29843 T Wrist arthroscopy/surgery 0041 28.1318 $1,669.43 $333.89 29844 T Wrist arthroscopy/surgery 0041 28.1318 $1,669.43 $333.89 29845 T Wrist arthroscopy/surgery 0041 28.1318 $1,669.43 $333.89 29846 T Wrist arthroscopy/surgery 0041 28.1318 $1,669.43 $333.89 29847 T Wrist arthroscopy/surgery 0041 28.1318 $1,669.43 $333.89 29848 T Wrist endoscopy/surgery 0041 28.1318 $1,669.43 $333.89 29850 T Knee arthroscopy/surgery 0041 28.1318 $1,669.43 $333.89 29851 T Knee arthroscopy/surgery 0042 43.9753 $2,609.63 $804.74 $521.93 29855 T Tibial arthroscopy/surgery 0042 43.9753 $2,609.63 $804.74 $521.93 29856 T Tibial arthroscopy/surgery 0041 28.1318 $1,669.43 $333.89 Start Printed Page 50730 29860 T Hip arthroscopy, dx 0041 28.1318 $1,669.43 $333.89 29861 T Hip arthroscopy/surgery 0041 28.1318 $1,669.43 $333.89 29862 T Hip arthroscopy/surgery 0042 43.9753 $2,609.63 $804.74 $521.93 29863 T Hip arthroscopy/surgery 0042 43.9753 $2,609.63 $804.74 $521.93 29866 T Autgrft implnt, knee w/scope 0042 43.9753 $2,609.63 $804.74 $521.93 29867 T Allgrft implnt, knee w/scope 0042 43.9753 $2,609.63 $804.74 $521.93 29868 T Meniscal trnspl, knee w/scpe 0042 43.9753 $2,609.63 $804.74 $521.93 29870 T Knee arthroscopy, dx 0041 28.1318 $1,669.43 $333.89 29871 T Knee arthroscopy/drainage 0041 28.1318 $1,669.43 $333.89 29873 T Knee arthroscopy/surgery 0041 28.1318 $1,669.43 $333.89 29874 T Knee arthroscopy/surgery 0041 28.1318 $1,669.43 $333.89 29875 T Knee arthroscopy/surgery 0041 28.1318 $1,669.43 $333.89 29876 T Knee arthroscopy/surgery 0041 28.1318 $1,669.43 $333.89 29877 T Knee arthroscopy/surgery 0041 28.1318 $1,669.43 $333.89 29879 T Knee arthroscopy/surgery 0041 28.1318 $1,669.43 $333.89 29880 T Knee arthroscopy/surgery 0041 28.1318 $1,669.43 $333.89 29881 T Knee arthroscopy/surgery 0041 28.1318 $1,669.43 $333.89 29882 T Knee arthroscopy/surgery 0041 28.1318 $1,669.43 $333.89 29883 T Knee arthroscopy/surgery 0041 28.1318 $1,669.43 $333.89 29884 T Knee arthroscopy/surgery 0041 28.1318 $1,669.43 $333.89 29885 T Knee arthroscopy/surgery 0042 43.9753 $2,609.63 $804.74 $521.93 29886 T Knee arthroscopy/surgery 0041 28.1318 $1,669.43 $333.89 29887 T Knee arthroscopy/surgery 0041 28.1318 $1,669.43 $333.89 29888 T Knee arthroscopy/surgery 0042 43.9753 $2,609.63 $804.74 $521.93 29889 T Knee arthroscopy/surgery 0042 43.9753 $2,609.63 $804.74 $521.93 29891 T Ankle arthroscopy/surgery 0041 28.1318 $1,669.43 $333.89 29892 T Ankle arthroscopy/surgery 0041 28.1318 $1,669.43 $333.89 29893 T Scope, plantar fasciotomy 0055 20.0692 $1,190.97 $355.34 $238.19 29894 T Ankle arthroscopy/surgery 0041 28.1318 $1,669.43 $333.89 29895 T Ankle arthroscopy/surgery 0041 28.1318 $1,669.43 $333.89 29897 T Ankle arthroscopy/surgery 0041 28.1318 $1,669.43 $333.89 29898 T Ankle arthroscopy/surgery 0041 28.1318 $1,669.43 $333.89 29899 T Ankle arthroscopy/surgery 0042 43.9753 $2,609.63 $804.74 $521.93 29900 T Mcp joint arthroscopy, dx 0053 15.6795 $930.47 $253.49 $186.09 29901 T Mcp joint arthroscopy, surg 0053 15.6795 $930.47 $253.49 $186.09 29902 T Mcp joint arthroscopy, surg 0053 15.6795 $930.47 $253.49 $186.09 29999 T Arthroscopy of joint 0041 28.1318 $1,669.43 $333.89 30000 T Drainage of nose lesion 0251 2.0101 $119.29 $23.86 30020 T Drainage of nose lesion 0251 2.0101 $119.29 $23.86 30100 T Intranasal biopsy 0252 7.8673 $466.87 $113.41 $93.37 30110 T Removal of nose polyp(s) 0253 16.1357 $957.54 $282.29 $191.51 30115 T Removal of nose polyp(s) 0253 16.1357 $957.54 $282.29 $191.51 30117 T Removal of intranasal lesion 0253 16.1357 $957.54 $282.29 $191.51 30118 T Removal of intranasal lesion 0254 23.404 $1,388.86 $321.35 $277.77 30120 T Revision of nose 0253 16.1357 $957.54 $282.29 $191.51 30124 T Removal of nose lesion 0252 7.8673 $466.87 $113.41 $93.37 30125 T Removal of nose lesion 0256 37.3204 $2,214.70 $442.94 30130 T Removal of turbinate bones 0253 16.1357 $957.54 $282.29 $191.51 30140 T Removal of turbinate bones 0254 23.404 $1,388.86 $321.35 $277.77 30150 T Partial removal of nose 0256 37.3204 $2,214.70 $442.94 30160 T Removal of nose 0256 37.3204 $2,214.70 $442.94 30200 T Injection treatment of nose 0252 7.8673 $466.87 $113.41 $93.37 30210 T Nasal sinus therapy 0252 7.8673 $466.87 $113.41 $93.37 30220 T Insert nasal septal button 0252 7.8673 $466.87 $113.41 $93.37 30300 X Remove nasal foreign body 0340 0.6384 $37.88 $7.58 30310 T Remove nasal foreign body 0253 16.1357 $957.54 $282.29 $191.51 30320 T Remove nasal foreign body 0253 16.1357 $957.54 $282.29 $191.51 30400 T Reconstruction of nose 0256 37.3204 $2,214.70 $442.94 30410 T Reconstruction of nose 0256 37.3204 $2,214.70 $442.94 30420 T Reconstruction of nose 0256 37.3204 $2,214.70 $442.94 30430 T Revision of nose 0254 23.404 $1,388.86 $321.35 $277.77 30435 T Revision of nose 0256 37.3204 $2,214.70 $442.94 30450 T Revision of nose 0256 37.3204 $2,214.70 $442.94 30460 T Revision of nose 0256 37.3204 $2,214.70 $442.94 30462 T Revision of nose 0256 37.3204 $2,214.70 $442.94 30465 T Repair nasal stenosis 0256 37.3204 $2,214.70 $442.94 Start Printed Page 50731 30520 T Repair of nasal septum 0254 23.404 $1,388.86 $321.35 $277.77 30540 T Repair nasal defect 0256 37.3204 $2,214.70 $442.94 30545 T Repair nasal defect 0256 37.3204 $2,214.70 $442.94 30560 T Release of nasal adhesions 0251 2.0101 $119.29 $23.86 30580 T Repair upper jaw fistula 0256 37.3204 $2,214.70 $442.94 30600 T Repair mouth/nose fistula 0256 37.3204 $2,214.70 $442.94 30620 T Intranasal reconstruction 0256 37.3204 $2,214.70 $442.94 30630 T Repair nasal septum defect 0254 23.404 $1,388.86 $321.35 $277.77 30801 T Cauterization, inner nose 0252 7.8673 $466.87 $113.41 $93.37 30802 T Cauterization, inner nose 0252 7.8673 $466.87 $113.41 $93.37 30901 T Control of nosebleed 0250 1.2896 $76.53 $26.79 $15.31 30903 T Control of nosebleed 0250 1.2896 $76.53 $26.79 $15.31 30905 T Control of nosebleed 0250 1.2896 $76.53 $26.79 $15.31 30906 T Repeat control of nosebleed 0250 1.2896 $76.53 $26.79 $15.31 30915 T Ligation, nasal sinus artery 0091 28.9999 $1,720.94 $348.23 $344.19 30920 T Ligation, upper jaw artery 0092 26.482 $1,571.52 $505.37 $314.30 30930 T Therapy, fracture of nose 0253 16.1357 $957.54 $282.29 $191.51 30999 T Nasal surgery procedure 0251 2.0101 $119.29 $23.86 31000 T Irrigation, maxillary sinus 0251 2.0101 $119.29 $23.86 31002 T Irrigation, sphenoid sinus 0252 7.8673 $466.87 $113.41 $93.37 31020 T Exploration, maxillary sinus 0254 23.404 $1,388.86 $321.35 $277.77 31030 T Exploration, maxillary sinus 0256 37.3204 $2,214.70 $442.94 31032 T Explore sinus, remove polyps 0256 37.3204 $2,214.70 $442.94 31040 T Exploration behind upper jaw 0254 23.404 $1,388.86 $321.35 $277.77 31050 T Exploration, sphenoid sinus 0256 37.3204 $2,214.70 $442.94 31051 T Sphenoid sinus surgery 0256 37.3204 $2,214.70 $442.94 31070 T Exploration of frontal sinus 0254 23.404 $1,388.86 $321.35 $277.77 31075 T Exploration of frontal sinus 0256 37.3204 $2,214.70 $442.94 31080 T Removal of frontal sinus 0256 37.3204 $2,214.70 $442.94 31081 T Removal of frontal sinus 0256 37.3204 $2,214.70 $442.94 31084 T Removal of frontal sinus 0256 37.3204 $2,214.70 $442.94 31085 T Removal of frontal sinus 0256 37.3204 $2,214.70 $442.94 31086 T Removal of frontal sinus 0256 37.3204 $2,214.70 $442.94 31087 T Removal of frontal sinus 0256 37.3204 $2,214.70 $442.94 31090 T Exploration of sinuses 0256 37.3204 $2,214.70 $442.94 31200 T Removal of ethmoid sinus 0256 37.3204 $2,214.70 $442.94 31201 T Removal of ethmoid sinus 0256 37.3204 $2,214.70 $442.94 31205 T Removal of ethmoid sinus 0256 37.3204 $2,214.70 $442.94 31225 C Removal of upper jaw 31230 C Removal of upper jaw 31231 T Nasal endoscopy, dx 0072 1.4361 $85.22 $21.27 $17.04 31233 T Nasal/sinus endoscopy, dx 0072 1.4361 $85.22 $21.27 $17.04 31235 T Nasal/sinus endoscopy, dx 0074 15.7757 $936.18 $295.70 $187.24 31237 T Nasal/sinus endoscopy, surg 0075 21.3426 $1,266.53 $445.92 $253.31 31238 T Nasal/sinus endoscopy, surg 0074 15.7757 $936.18 $295.70 $187.24 31239 T Nasal/sinus endoscopy, surg 0075 21.3426 $1,266.53 $445.92 $253.31 31240 T Nasal/sinus endoscopy, surg 0074 15.7757 $936.18 $295.70 $187.24 31254 T Revision of ethmoid sinus 0075 21.3426 $1,266.53 $445.92 $253.31 31255 T Removal of ethmoid sinus 0075 21.3426 $1,266.53 $445.92 $253.31 31256 T Exploration maxillary sinus 0075 21.3426 $1,266.53 $445.92 $253.31 31267 T Endoscopy, maxillary sinus 0075 21.3426 $1,266.53 $445.92 $253.31 31276 T Sinus endoscopy, surgical 0075 21.3426 $1,266.53 $445.92 $253.31 31287 T Nasal/sinus endoscopy, surg 0075 21.3426 $1,266.53 $445.92 $253.31 31288 T Nasal/sinus endoscopy, surg 0075 21.3426 $1,266.53 $445.92 $253.31 31290 C Nasal/sinus endoscopy, surg 31291 C Nasal/sinus endoscopy, surg 31292 T Nasal/sinus endoscopy, surg 0075 21.3426 $1,266.53 $445.92 $253.31 31293 T Nasal/sinus endoscopy, surg 0075 21.3426 $1,266.53 $445.92 $253.31 31294 T Nasal/sinus endoscopy, surg 0075 21.3426 $1,266.53 $445.92 $253.31 31299 T Sinus surgery procedure 0251 2.0101 $119.29 $23.86 31300 T Removal of larynx lesion 0254 23.404 $1,388.86 $321.35 $277.77 31320 T Diagnostic incision, larynx 0256 37.3204 $2,214.70 $442.94 31360 C Removal of larynx 31365 C Removal of larynx 31367 C Partial removal of larynx 31368 C Partial removal of larynx Start Printed Page 50732 31370 C Partial removal of larynx 31375 C Partial removal of larynx 31380 C Partial removal of larynx 31382 C Partial removal of larynx 31390 C Removal of larynx & pharynx 31395 C Reconstruct larynx & pharynx 31400 T Revision of larynx 0256 37.3204 $2,214.70 $442.94 31420 T Removal of epiglottis 0256 37.3204 $2,214.70 $442.94 31500 S Insert emergency airway 0094 2.5363 $150.51 $47.62 $30.10 31502 T Change of windpipe airway 0121 2.2766 $135.10 $43.80 $27.02 31505 T Diagnostic laryngoscopy 0071 0.7915 $46.97 $11.31 $9.39 31510 T Laryngoscopy with biopsy 0074 15.7757 $936.18 $295.70 $187.24 31511 T Remove foreign body, larynx 0072 1.4361 $85.22 $21.27 $17.04 31512 T Removal of larynx lesion 0074 15.7757 $936.18 $295.70 $187.24 31513 T Injection into vocal cord 0072 1.4361 $85.22 $21.27 $17.04 31515 T Laryngoscopy for aspiration 0074 15.7757 $936.18 $295.70 $187.24 31520 T Diagnostic laryngoscopy 0072 1.4361 $85.22 $21.27 $17.04 31525 T Diagnostic laryngoscopy 0074 15.7757 $936.18 $295.70 $187.24 31526 T Diagnostic laryngoscopy 0075 21.3426 $1,266.53 $445.92 $253.31 31527 T Laryngoscopy for treatment 0075 21.3426 $1,266.53 $445.92 $253.31 31528 T Laryngoscopy and dilation 0074 15.7757 $936.18 $295.70 $187.24 31529 T Laryngoscopy and dilation 0074 15.7757 $936.18 $295.70 $187.24 31530 T Operative laryngoscopy 0075 21.3426 $1,266.53 $445.92 $253.31 31531 T Operative laryngoscopy 0075 21.3426 $1,266.53 $445.92 $253.31 31535 T Operative laryngoscopy 0075 21.3426 $1,266.53 $445.92 $253.31 31536 T Operative laryngoscopy 0075 21.3426 $1,266.53 $445.92 $253.31 31540 T Operative laryngoscopy 0075 21.3426 $1,266.53 $445.92 $253.31 31541 T Operative laryngoscopy 0075 21.3426 $1,266.53 $445.92 $253.31 31545 T Remove vc lesion w/scope 0075 21.3426 $1,266.53 $445.92 $253.31 31546 T Remove vc lesion scope/graft 0075 21.3426 $1,266.53 $445.92 $253.31 31560 T Operative laryngoscopy 0075 21.3426 $1,266.53 $445.92 $253.31 31561 T Operative laryngoscopy 0075 21.3426 $1,266.53 $445.92 $253.31 31570 T Laryngoscopy with injection 0074 15.7757 $936.18 $295.70 $187.24 31571 T Laryngoscopy with injection 0075 21.3426 $1,266.53 $445.92 $253.31 31575 T Diagnostic laryngoscopy 0072 1.4361 $85.22 $21.27 $17.04 31576 T Laryngoscopy with biopsy 0075 21.3426 $1,266.53 $445.92 $253.31 31577 T Remove foreign body, larynx 0073 4.1609 $246.92 $73.38 $49.38 31578 T Removal of larynx lesion 0075 21.3426 $1,266.53 $445.92 $253.31 31579 T Diagnostic laryngoscopy 0073 4.1609 $246.92 $73.38 $49.38 31580 T Revision of larynx 0256 37.3204 $2,214.70 $442.94 31582 T Revision of larynx 0256 37.3204 $2,214.70 $442.94 31584 C Treat larynx fracture 31585 T Treat larynx fracture 0253 16.1357 $957.54 $282.29 $191.51 31586 T Treat larynx fracture 0256 37.3204 $2,214.70 $442.94 31587 C Revision of larynx 31588 T Revision of larynx 0256 37.3204 $2,214.70 $442.94 31590 T Reinnervate larynx 0256 37.3204 $2,214.70 $442.94 31595 T Larynx nerve surgery 0256 37.3204 $2,214.70 $442.94 31599 T Larynx surgery procedure 0251 2.0101 $119.29 $23.86 31600 T Incision of windpipe 0254 23.404 $1,388.86 $321.35 $277.77 31601 T Incision of windpipe 0254 23.404 $1,388.86 $321.35 $277.77 31603 T Incision of windpipe 0252 7.8673 $466.87 $113.41 $93.37 31605 T Incision of windpipe 0252 7.8673 $466.87 $113.41 $93.37 31610 T Incision of windpipe 0254 23.404 $1,388.86 $321.35 $277.77 31611 T Surgery/speech prosthesis 0254 23.404 $1,388.86 $321.35 $277.77 31612 T Puncture/clear windpipe 0254 23.404 $1,388.86 $321.35 $277.77 31613 T Repair windpipe opening 0254 23.404 $1,388.86 $321.35 $277.77 31614 T Repair windpipe opening 0256 37.3204 $2,214.70 $442.94 31615 T Visualization of windpipe 0076 9.4592 $561.34 $189.82 $112.27 31620 S Endobronchial us add-on 0670 25.4131 $1,508.09 $472.46 $301.62 31622 T Dx bronchoscope/wash 0076 9.4592 $561.34 $189.82 $112.27 31623 T Dx bronchoscope/brush 0076 9.4592 $561.34 $189.82 $112.27 31624 T Dx bronchoscope/lavage 0076 9.4592 $561.34 $189.82 $112.27 31625 T Bronchoscopy w/biopsy(s) 0076 9.4592 $561.34 $189.82 $112.27 31628 T Bronchoscopy/lung bx, each 0076 9.4592 $561.34 $189.82 $112.27 31629 T Bronchoscopy/needle bx, each 0076 9.4592 $561.34 $189.82 $112.27 Start Printed Page 50733 31630 T Bronchoscopy dilate/fx repr 0415 22.0955 $1,311.21 $459.92 $262.24 31631 T Bronchoscopy, dilate w/stent 0415 22.0955 $1,311.21 $459.92 $262.24 31632 T Bronchoscopy/lung bx, add'l 0076 9.4592 $561.34 $189.82 $112.27 31633 T Bronchoscopy/needle bx add'l 0076 9.4592 $561.34 $189.82 $112.27 31635 T Bronchoscopy w/fb removal 0076 9.4592 $561.34 $189.82 $112.27 31636 T Bronchoscopy, bronch stents 0415 22.0955 $1,311.21 $459.92 $262.24 31637 T Bronchoscopy, stent add-on 0076 9.4592 $561.34 $189.82 $112.27 31638 T Bronchoscopy, revise stent 0415 22.0955 $1,311.21 $459.92 $262.24 31640 T Bronchoscopy w/tumor excise 0415 22.0955 $1,311.21 $459.92 $262.24 31641 T Bronchoscopy, treat blockage 0415 22.0955 $1,311.21 $459.92 $262.24 31643 T Diag bronchoscope/catheter 0076 9.4592 $561.34 $189.82 $112.27 31645 T Bronchoscopy, clear airways 0076 9.4592 $561.34 $189.82 $112.27 31646 T Bronchoscopy, reclear airway 0076 9.4592 $561.34 $189.82 $112.27 31656 T Bronchoscopy, inj for x-ray 0076 9.4592 $561.34 $189.82 $112.27 31700 T Insertion of airway catheter 0072 1.4361 $85.22 $21.27 $17.04 31708 N Instill airway contrast dye 31710 N Insertion of airway catheter 31715 N Injection for bronchus x-ray 31717 T Bronchial brush biopsy 0073 4.1609 $246.92 $73.38 $49.38 31720 T Clearance of airways 0071 0.7915 $46.97 $11.31 $9.39 31725 C Clearance of airways 31730 T Intro, windpipe wire/tube 0073 4.1609 $246.92 $73.38 $49.38 31750 T Repair of windpipe 0256 37.3204 $2,214.70 $442.94 31755 T Repair of windpipe 0256 37.3204 $2,214.70 $442.94 31760 C Repair of windpipe 31766 C Reconstruction of windpipe 31770 C Repair/graft of bronchus 31775 C Reconstruct bronchus 31780 C Reconstruct windpipe 31781 C Reconstruct windpipe 31785 T Remove windpipe lesion 0254 23.404 $1,388.86 $321.35 $277.77 31786 C Remove windpipe lesion 31800 C Repair of windpipe injury 31805 C Repair of windpipe injury 31820 T Closure of windpipe lesion 0253 16.1357 $957.54 $282.29 $191.51 31825 T Repair of windpipe defect 0254 23.404 $1,388.86 $321.35 $277.77 31830 T Revise windpipe scar 0254 23.404 $1,388.86 $321.35 $277.77 31899 T Airways surgical procedure 0076 9.4592 $561.34 $189.82 $112.27 32000 T Drainage of chest 0070 3.2101 $190.50 $38.10 32002 T Treatment of collapsed lung 0070 3.2101 $190.50 $38.10 32005 T Treat lung lining chemically 0070 3.2101 $190.50 $38.10 32019 T Insert pleural catheter 0070 3.2101 $190.50 $38.10 32020 T Insertion of chest tube 0070 3.2101 $190.50 $38.10 32035 C Exploration of chest 32036 C Exploration of chest 32095 C Biopsy through chest wall 32100 C Exploration/biopsy of chest 32110 C Explore/repair chest 32120 C Re-exploration of chest 32124 C Explore chest free adhesions 32140 C Removal of lung lesion(s) 32141 C Remove/treat lung lesions 32150 C Removal of lung lesion(s) 32151 C Remove lung foreign body 32160 C Open chest heart massage 32200 C Drain, open, lung lesion 32201 T Drain, percut, lung lesion 0070 3.2101 $190.50 $38.10 32215 C Treat chest lining 32220 C Release of lung 32225 C Partial release of lung 32310 C Removal of chest lining 32320 C Free/remove chest lining 32400 T Needle biopsy chest lining 0685 6.0174 $357.09 $115.47 $71.42 32402 C Open biopsy chest lining 32405 T Biopsy, lung or mediastinum 0685 6.0174 $357.09 $115.47 $71.42 32420 T Puncture/clear lung 0070 3.2101 $190.50 $38.10 Start Printed Page 50734 32440 C Removal of lung 32442 C Sleeve pneumonectomy 32445 C Removal of lung 32480 C Partial removal of lung 32482 C Bilobectomy 32484 C Segmentectomy 32486 C Sleeve lobectomy 32488 C Completion pneumonectomy 32491 C Lung volume reduction 32500 C Partial removal of lung 32501 C Repair bronchus add-on 32520 C Remove lung & revise chest 32522 C Remove lung & revise chest 32525 C Remove lung & revise chest 32540 C Removal of lung lesion 32601 T Thoracoscopy, diagnostic 0069 30.6775 $1,820.49 $591.64 $364.10 32602 T Thoracoscopy, diagnostic 0069 30.6775 $1,820.49 $591.64 $364.10 32603 T Thoracoscopy, diagnostic 0069 30.6775 $1,820.49 $591.64 $364.10 32604 T Thoracoscopy, diagnostic 0069 30.6775 $1,820.49 $591.64 $364.10 32605 T Thoracoscopy, diagnostic 0069 30.6775 $1,820.49 $591.64 $364.10 32606 T Thoracoscopy, diagnostic 0069 30.6775 $1,820.49 $591.64 $364.10 32650 C Thoracoscopy, surgical 32651 C Thoracoscopy, surgical 32652 C Thoracoscopy, surgical 32653 C Thoracoscopy, surgical 32654 C Thoracoscopy, surgical 32655 C Thoracoscopy, surgical 32656 C Thoracoscopy, surgical 32657 C Thoracoscopy, surgical 32658 C Thoracoscopy, surgical 32659 C Thoracoscopy, surgical 32660 C Thoracoscopy, surgical 32661 C Thoracoscopy, surgical 32662 C Thoracoscopy, surgical 32663 C Thoracoscopy, surgical 32664 C Thoracoscopy, surgical 32665 C Thoracoscopy, surgical 32800 C Repair lung hernia 32810 C Close chest after drainage 32815 C Close bronchial fistula 32820 C Reconstruct injured chest 32850 C Donor pneumonectomy 32851 C Lung transplant, single 32852 C Lung transplant with bypass 32853 C Lung transplant, double 32854 C Lung transplant with bypass 32855 C Prepare donor lung, single 32856 C Prepare donor lung, double 32900 C Removal of rib(s) 32905 C Revise & repair chest wall 32906 C Revise & repair chest wall 32940 C Revision of lung 32960 T Therapeutic pneumothorax 0070 3.2101 $190.50 $38.10 32997 C Total lung lavage 32999 T Chest surgery procedure 0070 3.2101 $190.50 $38.10 33010 T Drainage of heart sac 0070 3.2101 $190.50 $38.10 33011 T Repeat drainage of heart sac 0070 3.2101 $190.50 $38.10 33015 C Incision of heart sac 33020 C Incision of heart sac 33025 C Incision of heart sac 33030 C Partial removal of heart sac 33031 C Partial removal of heart sac 33050 C Removal of heart sac lesion 33120 C Removal of heart lesion 33130 C Removal of heart lesion 33140 C Heart revascularize (tmr) Start Printed Page 50735 33141 C Heart tmr w/other procedure 33200 C Insertion of heart pacemaker 33201 C Insertion of heart pacemaker 33206 T Insertion of heart pacemaker 0089 105.6143 $6,267.47 $1,682.28 $1,253.49 33207 T Insertion of heart pacemaker 0089 105.6143 $6,267.47 $1,682.28 $1,253.49 33208 T Insertion of heart pacemaker 0655 133.7768 $7,938.72 $1,587.74 33210 T Insertion of heart electrode 0106 45.4851 $2,699.22 $539.84 33211 T Insertion of heart electrode 0106 45.4851 $2,699.22 $539.84 33212 T Insertion of pulse generator 0090 89.1574 $5,290.87 $1,612.80 $1,058.17 33213 T Insertion of pulse generator 0654 100.9294 $5,989.45 $1,197.89 33214 T Upgrade of pacemaker system 0655 133.7768 $7,938.72 $1,587.74 33215 T Reposition pacing-defib lead 0105 22.3685 $1,327.41 $370.40 $265.48 33216 T Revise eltrd pacing-defib 0106 45.4851 $2,699.22 $539.84 33217 T Insert lead pace-defib, dual 0106 45.4851 $2,699.22 $539.84 33218 T Repair lead pace-defib, one 0106 45.4851 $2,699.22 $539.84 33220 T Repair lead pace-defib, dual 0106 45.4851 $2,699.22 $539.84 33222 T Revise pocket, acemaker 0027 18.4182 $1,092.99 $329.72 $218.60 33223 T Revise pocket, pacing-defib 0027 18.4182 $1,092.99 $329.72 $218.60 33224 T Insert pacing lead & connect 0418 109.3043 $6,486.45 $1,297.29 33225 T L ventric pacing lead add-on 0418 109.3043 $6,486.45 $1,297.29 33226 T Reposition l ventric lead 0105 22.3685 $1,327.41 $370.40 $265.48 33233 T Removal of pacemaker system 0105 22.3685 $1,327.41 $370.40 $265.48 33234 T Removal of pacemaker system 0105 22.3685 $1,327.41 $370.40 $265.48 33235 T Removal pacemaker electrode 0105 22.3685 $1,327.41 $370.40 $265.48 33236 C Remove electrode/thoracotomy 33237 C Remove electrode/thoracotomy 33238 C Remove electrode/thoracotomy 33240 B Insert pulse generator 33241 T Remove pulse generator 0105 22.3685 $1,327.41 $370.40 $265.48 33243 C Remove eltrd/thoracotomy 33244 T Remove eltrd, transven 0105 22.3685 $1,327.41 $370.40 $265.48 33245 C Insert epic eltrd pace-defib 33246 C Insert epic eltrd/generator 33249 B Eltrd/insert pace-defib 33250 C Ablate heart dysrhythm focus 33251 C Ablate heart dysrhythm focus 33253 C Reconstruct atria 33261 C Ablate heart dysrhythm focus 33282 S Implant pat-active ht record 0680 62.9082 $3,733.16 $746.63 33284 T Remove pat-active ht record 0109 11.0433 $655.34 $131.49 $131.07 33300 C Repair of heart wound 33305 C Repair of heart wound 33310 C Exploratory heart surgery 33315 C Exploratory heart surgery 33320 C Repair major blood vessel(s) 33321 C Repair major vessel 33322 C Repair major blood vessel(s) 33330 C Insert major vessel graft 33332 C Insert major vessel graft 33335 C Insert major vessel graft 33400 C Repair of aortic valve 33401 C Valvuloplasty, open 33403 C Valvuloplasty, w/cp bypass 33404 C Prepare heart-aorta conduit 33405 C Replacement of aortic valve 33406 C Replacement of aortic valve 33410 C Replacement of aortic valve 33411 C Replacement of aortic valve 33412 C Replacement of aortic valve 33413 C Replacement of aortic valve 33414 C Repair of aortic valve 33415 C Revision, subvalvular tissue 33416 C Revise ventricle muscle 33417 C Repair of aortic valve 33420 C Revision of mitral valve 33422 C Revision of mitral valve Start Printed Page 50736 33425 C Repair of mitral valve 33426 C Repair of mitral valve 33427 C Repair of mitral valve 33430 C Replacement of mitral valve 33460 C Revision of tricuspid valve 33463 C Valvuloplasty, tricuspid 33464 C Valvuloplasty, tricuspid 33465 C Replace tricuspid valve 33468 C Revision of tricuspid valve 33470 C Revision of pulmonary valve 33471 C Valvotomy, pulmonary valve 33472 C Revision of pulmonary valve 33474 C Revision of pulmonary valve 33475 C Replacement, pulmonary valve 33476 C Revision of heart chamber 33478 C Revision of heart chamber 33496 C Repair, prosth valve clot 33500 C Repair heart vessel fistula 33501 C Repair heart vessel fistula 33502 C Coronary artery correction 33503 C Coronary artery graft 33504 C Coronary artery graft 33505 C Repair artery w/tunnel 33506 C Repair artery, translocation 33508 N Endoscopic vein harvest 33510 C CABG, vein, single 33511 C CABG, vein, two 33512 C CABG, vein, three 33513 C CABG, vein, four 33514 C CABG, vein, five 33516 C Cabg, vein, six or more 33517 C CABG, artery-vein, single 33518 C CABG, artery-vein, two 33519 C CABG, artery-vein, three 33521 C CABG, artery-vein, four 33522 C CABG, artery-vein, five 33523 C Cabg, art-vein, six or more 33530 C Coronary artery, bypass/reop 33533 C CABG, arterial, single 33534 C CABG, arterial, two 33535 C CABG, arterial, three 33536 C Cabg, arterial, four or more 33542 C Removal of heart lesion 33545 C Repair of heart damage 33572 C Open coronary endarterectomy 33600 C Closure of valve 33602 C Closure of valve 33606 C Anastomosis/artery-aorta 33608 C Repair anomaly w/conduit 33610 C Repair by enlargement 33611 C Repair double ventricle 33612 C Repair double ventricle 33615 C Repair, modified fontan 33617 C Repair single ventricle 33619 C Repair single ventricle 33641 C Repair heart septum defect 33645 C Revision of heart veins 33647 C Repair heart septum defects 33660 C Repair of heart defects 33665 C Repair of heart defects 33670 C Repair of heart chambers 33681 C Repair heart septum defect 33684 C Repair heart septum defect 33688 C Repair heart septum defect 33690 C Reinforce pulmonary artery 33692 C Repair of heart defects Start Printed Page 50737 33694 C Repair of heart defects 33697 C Repair of heart defects 33702 C Repair of heart defects 33710 C Repair of heart defects 33720 C Repair of heart defect 33722 C Repair of heart defect 33730 C Repair heart-vein defect(s) 33732 C Repair heart-vein defect 33735 C Revision of heart chamber 33736 C Revision of heart chamber 33737 C Revision of heart chamber 33750 C Major vessel shunt 33755 C Major vessel shunt 33762 C Major vessel shunt 33764 C Major vessel shunt & graft 33766 C Major vessel shunt 33767 C Major vessel shunt 33770 C Repair great vessels defect 33771 C Repair great vessels defect 33774 C Repair great vessels defect 33775 C Repair great vessels defect 33776 C Repair great vessels defect 33777 C Repair great vessels defect 33778 C Repair great vessels defect 33779 C Repair great vessels defect 33780 C Repair great vessels defect 33781 C Repair great vessels defect 33786 C Repair arterial trunk 33788 C Revision of pulmonary artery 33800 C Aortic suspension 33802 C Repair vessel defect 33803 C Repair vessel defect 33813 C Repair septal defect 33814 C Repair septal defect 33820 C Revise major vessel 33822 C Revise major vessel 33824 C Revise major vessel 33840 C Remove aorta constriction 33845 C Remove aorta constriction 33851 C Remove aorta constriction 33852 C Repair septal defect 33853 C Repair septal defect 33860 C Ascending aortic graft 33861 C Ascending aortic graft 33863 C Ascending aortic graft 33870 C Transverse aortic arch graft 33875 C Thoracic aortic graft 33877 C Thoracoabdominal graft 33910 C Remove lung artery emboli 33915 C Remove lung artery emboli 33916 C Surgery of great vessel 33917 C Repair pulmonary artery 33918 C Repair pulmonary atresia 33919 C Repair pulmonary atresia 33920 C Repair pulmonary atresia 33922 C Transect pulmonary artery 33924 C Remove pulmonary shunt 33930 C Removal of donor heart/lung 33933 C Prepare donor heart/lung 33935 C Transplantation, heart/lung 33940 C Removal of donor heart 33944 C Prepare donor heart 33945 C Transplantation of heart 33960 C External circulation assist 33961 C External circulation assist 33967 C Insert ia percut device Start Printed Page 50738 33968 C Remove aortic assist device 33970 C Aortic circulation assist 33971 C Aortic circulation assist 33973 C Insert balloon device 33974 C Remove intra-aortic balloon 33975 C Implant ventricular device 33976 C Implant ventricular device 33977 C Remove ventricular device 33978 C Remove ventricular device 33979 C Insert intracorporeal device 33980 C Remove intracorporeal device 33999 T Cardiac surgery procedure 0070 3.2101 $190.50 $38.10 34001 C Removal of artery clot 34051 C Removal of artery clot 34101 T Removal of artery clot 0088 36.5617 $2,169.68 $655.22 $433.94 34111 T Removal of arm artery clot 0088 36.5617 $2,169.68 $655.22 $433.94 34151 C Removal of artery clot 34201 T Removal of artery clot 0088 36.5617 $2,169.68 $655.22 $433.94 34203 T Removal of leg artery clot 0088 36.5617 $2,169.68 $655.22 $433.94 34401 C Removal of vein clot 34421 T Removal of vein clot 0088 36.5617 $2,169.68 $655.22 $433.94 34451 C Removal of vein clot 34471 T Removal of vein clot 0088 36.5617 $2,169.68 $655.22 $433.94 34490 T Removal of vein clot 0088 36.5617 $2,169.68 $655.22 $433.94 34501 T Repair valve, femoral vein 0088 36.5617 $2,169.68 $655.22 $433.94 34502 C Reconstruct vena cava 34510 T Transposition of vein valve 0088 36.5617 $2,169.68 $655.22 $433.94 34520 T Cross-over vein graft 0088 36.5617 $2,169.68 $655.22 $433.94 34530 T Leg vein fusion 0088 36.5617 $2,169.68 $655.22 $433.94 34800 C Endovasc abdo repair w/tube 34802 C Endovasc abdo repr w/device 34803 C Endovas aaa repr w/3-p part 34804 C Endovasc abdo repr w/device 34805 C Endovasc abdo repair w/pros 34808 C Endovasc abdo occlud device 34812 C Xpose for endoprosth, aortic 34813 C Femoral endovas graft add-on 34820 C Xpose for endoprosth, iliac 34825 C Endovasc extend prosth, init 34826 C Endovasc exten prosth, add'l 34830 C Open aortic tube prosth repr 34831 C Open aortoiliac prosth repr 34832 C Open aortofemor prosth repr 34833 C Xpose for endoprosth, iliac 34834 C Xpose, endoprosth, brachial 34900 C Endovasc iliac repr w/graft 35001 C Repair defect of artery 35002 C Repair artery rupture, neck 35005 C Repair defect of artery 35011 T Repair defect of artery 0653 30.5339 $1,811.97 $362.39 35013 C Repair artery rupture, arm 35021 C Repair defect of artery 35022 C Repair artery rupture, chest 35045 C Repair defect of arm artery 35081 C Repair defect of artery 35082 C Repair artery rupture, aorta 35091 C Repair defect of artery 35092 C Repair artery rupture, aorta 35102 C Repair defect of artery 35103 C Repair artery rupture, groin 35111 C Repair defect of artery 35112 C Repair artery rupture,spleen 35121 C Repair defect of artery 35122 C Repair artery rupture, belly 35131 C Repair defect of artery 35132 C Repair artery rupture, groin Start Printed Page 50739 35141 C Repair defect of artery 35142 C Repair artery rupture, thigh 35151 C Repair defect of artery 35152 C Repair artery rupture, knee 35180 T Repair blood vessel lesion 0093 23.4516 $1,391.69 $278.34 35182 C Repair blood vessel lesion 35184 T Repair blood vessel lesion 0093 23.4516 $1,391.69 $278.34 35188 T Repair blood vessel lesion 0088 36.5617 $2,169.68 $655.22 $433.94 35189 C Repair blood vessel lesion 35190 T Repair blood vessel lesion 0093 23.4516 $1,391.69 $278.34 35201 T Repair blood vessel lesion 0093 23.4516 $1,391.69 $278.34 35206 T Repair blood vessel lesion 0093 23.4516 $1,391.69 $278.34 35207 T Repair blood vessel lesion 0088 36.5617 $2,169.68 $655.22 $433.94 35211 C Repair blood vessel lesion 35216 C Repair blood vessel lesion 35221 C Repair blood vessel lesion 35226 T Repair blood vessel lesion 0093 23.4516 $1,391.69 $278.34 35231 T Repair blood vessel lesion 0093 23.4516 $1,391.69 $278.34 35236 T Repair blood vessel lesion 0093 23.4516 $1,391.69 $278.34 35241 C Repair blood vessel lesion 35246 C Repair blood vessel lesion 35251 C Repair blood vessel lesion 35256 T Repair blood vessel lesion 0093 23.4516 $1,391.69 $278.34 35261 T Repair blood vessel lesion 0653 30.5339 $1,811.97 $362.39 35266 T Repair blood vessel lesion 0653 30.5339 $1,811.97 $362.39 35271 C Repair blood vessel lesion 35276 C Repair blood vessel lesion 35281 C Repair blood vessel lesion 35286 T Repair blood vessel lesion 0653 30.5339 $1,811.97 $362.39 35301 C Rechanneling of artery 35311 C Rechanneling of artery 35321 T Rechanneling of artery 0093 23.4516 $1,391.69 $278.34 35331 C Rechanneling of artery 35341 C Rechanneling of artery 35351 C Rechanneling of artery 35355 C Rechanneling of artery 35361 C Rechanneling of artery 35363 C Rechanneling of artery 35371 C Rechanneling of artery 35372 C Rechanneling of artery 35381 C Rechanneling of artery 35390 C Reoperation, carotid add-on 35400 C Angioscopy 35450 C Repair arterial blockage 35452 C Repair arterial blockage 35454 C Repair arterial blockage 35456 C Repair arterial blockage 35458 T Repair arterial blockage 0081 34.4473 $2,044.21 $408.84 35459 T Repair arterial blockage 0081 34.4473 $2,044.21 $408.84 35460 T Repair venous blockage 0081 34.4473 $2,044.21 $408.84 35470 T Repair arterial blockage 0081 34.4473 $2,044.21 $408.84 35471 T Repair arterial blockage 0081 34.4473 $2,044.21 $408.84 35472 T Repair arterial blockage 0081 34.4473 $2,044.21 $408.84 35473 T Repair arterial blockage 0081 34.4473 $2,044.21 $408.84 35474 T Repair arterial blockage 0081 34.4473 $2,044.21 $408.84 35475 T Repair arterial blockage 0081 34.4473 $2,044.21 $408.84 35476 T Repair venous blockage 0081 34.4473 $2,044.21 $408.84 35480 C Atherectomy, open 35481 C Atherectomy, open 35482 C Atherectomy, open 35483 C Atherectomy, open 35484 T Atherectomy, open 0081 34.4473 $2,044.21 $408.84 35485 T Atherectomy, open 0081 34.4473 $2,044.21 $408.84 35490 T Atherectomy, percutaneous 0081 34.4473 $2,044.21 $408.84 35491 T Atherectomy, percutaneous 0081 34.4473 $2,044.21 $408.84 35492 T Atherectomy, percutaneous 0081 34.4473 $2,044.21 $408.84 Start Printed Page 50740 35493 T Atherectomy, percutaneous 0081 34.4473 $2,044.21 $408.84 35494 T Atherectomy, percutaneous 0081 34.4473 $2,044.21 $408.84 35495 T Atherectomy, percutaneous 0081 34.4473 $2,044.21 $408.84 35500 T Harvest vein for bypass 0081 34.4473 $2,044.21 $408.84 35501 C Artery bypass graft 35506 C Artery bypass graft 35507 C Artery bypass graft 35508 C Artery bypass graft 35509 C Artery bypass graft 35510 C Artery bypass graft 35511 C Artery bypass graft 35512 C Artery bypass graft 35515 C Artery bypass graft 35516 C Artery bypass graft 35518 C Artery bypass graft 35521 C Artery bypass graft 35522 C Artery bypass graft 35525 C Artery bypass graft 35526 C Artery bypass graft 35531 C Artery bypass graft 35533 C Artery bypass graft 35536 C Artery bypass graft 35541 C Artery bypass graft 35546 C Artery bypass graft 35548 C Artery bypass graft 35549 C Artery bypass graft 35551 C Artery bypass graft 35556 C Artery bypass graft 35558 C Artery bypass graft 35560 C Artery bypass graft 35563 C Artery bypass graft 35565 C Artery bypass graft 35566 C Artery bypass graft 35571 C Artery bypass graft 35572 N Harvest femoropopliteal vein 35583 C Vein bypass graft 35585 C Vein bypass graft 35587 C Vein bypass graft 35600 C Harvest artery for cabg 35601 C Artery bypass graft 35606 C Artery bypass graft 35612 C Artery bypass graft 35616 C Artery bypass graft 35621 C Artery bypass graft 35623 C Bypass graft, not vein 35626 C Artery bypass graft 35631 C Artery bypass graft 35636 C Artery bypass graft 35641 C Artery bypass graft 35642 C Artery bypass graft 35645 C Artery bypass graft 35646 C Artery bypass graft 35647 C Artery bypass graft 35650 C Artery bypass graft 35651 C Artery bypass graft 35654 C Artery bypass graft 35656 C Artery bypass graft 35661 C Artery bypass graft 35663 C Artery bypass graft 35665 C Artery bypass graft 35666 C Artery bypass graft 35671 C Artery bypass graft 35681 C Composite bypass graft 35682 C Composite bypass graft 35683 C Composite bypass graft 35685 T Bypass graft patency/patch 0093 23.4516 $1,391.69 $278.34 Start Printed Page 50741 35686 T Bypass graft/av fist patency 0093 23.4516 $1,391.69 $278.34 35691 C Arterial transposition 35693 C Arterial transposition 35694 C Arterial transposition 35695 C Arterial transposition 35697 C Reimplant artery each 35700 C Reoperation, bypass graft 35701 C Exploration, carotid artery 35721 C Exploration, femoral artery 35741 C Exploration popliteal artery 35761 T Exploration of artery/vein 0115 31.4727 $1,867.68 $459.35 $373.54 35800 C Explore neck vessels 35820 C Explore chest vessels 35840 C Explore abdominal vessels 35860 T Explore limb vessels 0093 23.4516 $1,391.69 $278.34 35870 C Repair vessel graft defect 35875 T Removal of clot in graft 0088 36.5617 $2,169.68 $655.22 $433.94 35876 T Removal of clot in graft 0088 36.5617 $2,169.68 $655.22 $433.94 35879 T Revise graft w/vein 0088 36.5617 $2,169.68 $655.22 $433.94 35881 T Revise graft w/vein 0088 36.5617 $2,169.68 $655.22 $433.94 35901 C Excision, graft, neck 35903 T Excision, graft, extremity 0115 31.4727 $1,867.68 $459.35 $373.54 35905 C Excision, graft, thorax 35907 C Excision, graft, abdomen 36000 N Place needle in vein 36002 S Pseudoaneurysm injection trt 0267 2.6327 $156.23 $62.18 $31.25 36005 N Injection ext venography 36010 N Place catheter in vein 36011 N Place catheter in vein 36012 N Place catheter in vein 36013 N Place catheter in artery 36014 N Place catheter in artery 36015 N Place catheter in artery 36100 N Establish access to artery 36120 N Establish access to artery 36140 N Establish access to artery 36145 N Artery to vein shunt 36160 N Establish access to aorta 36200 N Place catheter in aorta 36215 N Place catheter in artery 36216 N Place catheter in artery 36217 N Place catheter in artery 36218 N Place catheter in artery 36245 N Place catheter in artery 36246 N Place catheter in artery 36247 N Place catheter in artery 36248 N Place catheter in artery 36260 T Insertion of infusion pump 0623 27.1105 $1,608.82 $321.76 36261 T Revision of infusion pump 0623 27.1105 $1,608.82 $321.76 36262 T Removal of infusion pump 0622 21.2671 $1,262.05 $252.41 36299 N Vessel injection procedure 36400 N Bl draw < 3 yrs fem/jugular 36405 N Bl draw < 3 yrs scalp vein 36406 N Bl draw < 3 yrs other vein 36410 N Non-routine bl draw > 3 yrs 36415 A Drawing blood 36416 N Capillary blood draw 36420 T Vein access cutdown < 1 yr 0035 0.7158 $42.48 $8.50 36425 T Vein access cutdown > 1 yr 0035 0.7158 $42.48 $8.50 36430 S Blood transfusion service 0110 3.6594 $217.16 $43.43 36440 S Bl push transfuse, 2 yr or < 0110 3.6594 $217.16 $43.43 36450 S Bl exchange/transfuse, nb 0110 3.6594 $217.16 $43.43 36455 S Bl exchange/transfuse non-nb 0110 3.6594 $217.16 $43.43 36460 S Transfusion service, fetal 0110 3.6594 $217.16 $43.43 36468 T Injection(s), spider veins 0098 1.1346 $67.33 $13.47 36469 T Injection(s), spider veins 0098 1.1346 $67.33 $13.47 Start Printed Page 50742 36470 T Injection therapy of vein 0098 1.1346 $67.33 $13.47 36471 T Injection therapy of veins 0098 1.1346 $67.33 $13.47 36475 T Endovenous rf, 1st vein 0092 26.482 $1,571.52 $505.37 $314.30 36476 T Endovenous rf, vein add-on 0092 26.482 $1,571.52 $505.37 $314.30 36478 T Endovenous laser, 1st vein 0092 26.482 $1,571.52 $505.37 $314.30 36479 T Endovenous laser vein addon 0092 26.482 $1,571.52 $505.37 $314.30 36481 N Insertion of catheter, vein 36500 N Insertion of catheter, vein 36510 N Insertion of catheter, vein 36511 S Apheresis wbc 0111 12.3956 $735.59 $200.18 $147.12 36512 S Apheresis rbc 0111 12.3956 $735.59 $200.18 $147.12 36513 S Apheresis platelets 0111 12.3956 $735.59 $200.18 $147.12 36514 S Apheresis plasma 0111 12.3956 $735.59 $200.18 $147.12 36515 S Apheresis, adsorp/reinfuse 0112 26.7948 $1,590.08 $438.94 $318.02 36516 S Apheresis, selective 0112 26.7948 $1,590.08 $438.94 $318.02 36522 S Photopheresis 0112 26.7948 $1,590.08 $438.94 $318.02 36540 N Collect blood venous device 36550 T Declot vascular device 0676 2.4105 $143.05 $28.61 36555 T Insert non-tunnel cv cath 0621 8.2986 $492.46 $98.49 36556 T Insert non-tunnel cv cath 0621 8.2986 $492.46 $98.49 36557 T Insert tunneled cv cath 0622 21.2671 $1,262.05 $252.41 36558 T Insert tunneled cv cath 0622 21.2671 $1,262.05 $252.41 36560 T Insert tunneled cv cath 0623 27.1105 $1,608.82 $321.76 36561 T Insert tunneled cv cath 0623 27.1105 $1,608.82 $321.76 36563 T Insert tunneled cv cath 0623 27.1105 $1,608.82 $321.76 36565 T Insert tunneled cv cath 0623 27.1105 $1,608.82 $321.76 36566 T Insert tunneled cv cath 1564 $4,750.00 $950.00 36568 T Insert tunneled cv cath 0621 8.2986 $492.46 $98.49 36569 T Insert tunneled cv cath 0621 8.2986 $492.46 $98.49 36570 T Insert tunneled cv cath 0622 21.2671 $1,262.05 $252.41 36571 T Insert tunneled cv cath 0622 21.2671 $1,262.05 $252.41 36575 T Repair tunneled cv cath 0621 8.2986 $492.46 $98.49 36576 T Repair tunneled cv cath 0621 8.2986 $492.46 $98.49 36578 T Replace tunneled cv cath 0622 21.2671 $1,262.05 $252.41 36580 T Replace tunneled cv cath 0621 8.2986 $492.46 $98.49 36581 T Replace tunneled cv cath 0622 21.2671 $1,262.05 $252.41 36582 T Replace tunneled cv cath 0623 27.1105 $1,608.82 $321.76 36583 T Replace tunneled cv cath 0623 27.1105 $1,608.82 $321.76 36584 T Replace tunneled cv cath 0621 8.2986 $492.46 $98.49 36585 T Replace tunneled cv cath 0622 21.2671 $1,262.05 $252.41 36589 T Removal tunneled cv cath 0621 8.2986 $492.46 $98.49 36590 T Removal tunneled cv cath 0621 8.2986 $492.46 $98.49 36595 T Mech remov tunneled cv cath 0622 21.2671 $1,262.05 $252.41 36596 T Mech remov tunneled cv cath 0621 8.2986 $492.46 $98.49 36597 T Reposition venous catheter 0621 8.2986 $492.46 $98.49 36600 N Withdrawal of arterial blood 36620 N Insertion catheter, artery 36625 N Insertion catheter, artery 36640 T Insertion catheter, artery 0623 27.1105 $1,608.82 $321.76 36660 C Insertion catheter, artery 36680 T Insert needle, bone cavity 0002 0.9559 $56.73 $11.35 36800 T Insertion of cannula 0115 31.4727 $1,867.68 $459.35 $373.54 36810 T Insertion of cannula 0115 31.4727 $1,867.68 $459.35 $373.54 36815 T Insertion of cannula 0115 31.4727 $1,867.68 $459.35 $373.54 36818 T Av fuse, uppr arm, cephalic 0088 36.5617 $2,169.68 $655.22 $433.94 36819 T Av fusion/uppr arm vein 0088 36.5617 $2,169.68 $655.22 $433.94 36820 T Av fusion/forearm vein 0088 36.5617 $2,169.68 $655.22 $433.94 36821 T Av fusion direct any site 0088 36.5617 $2,169.68 $655.22 $433.94 36822 C Insertion of cannula(s) 36823 C Insertion of cannula(s) 36825 T Artery-vein autograft 0088 36.5617 $2,169.68 $655.22 $433.94 36830 T Artery-vein graft 0088 36.5617 $2,169.68 $655.22 $433.94 36831 T Open thrombect av fistula 0088 36.5617 $2,169.68 $655.22 $433.94 36832 T Av fistula revision, open 0088 36.5617 $2,169.68 $655.22 $433.94 36833 T Av fistula revision 0088 36.5617 $2,169.68 $655.22 $433.94 36834 T Repair A-V aneurysm 0088 36.5617 $2,169.68 $655.22 $433.94 Start Printed Page 50743 36835 T Artery to vein shunt 0115 31.4727 $1,867.68 $459.35 $373.54 36838 T Dist revas ligation, hemo 0088 36.5617 $2,169.68 $655.22 $433.94 36860 T External cannula declotting 0676 2.4105 $143.05 $28.61 36861 T Cannula declotting 0115 31.4727 $1,867.68 $459.35 $373.54 36870 T Percut thrombect av fistula 0653 30.5339 $1,811.97 $362.39 37140 C Revision of circulation 37145 C Revision of circulation 37160 C Revision of circulation 37180 C Revision of circulation 37181 C Splice spleen/kidney veins 37182 C Insert hepatic shunt (tips) 37183 T Remove hepatic shunt (tips) 0229 64.4545 $3,824.92 $771.23 $764.98 37195 T Thrombolytic therapy, stroke 0676 2.4105 $143.05 $28.61 37200 T Transcatheter biopsy 0685 6.0174 $357.09 $115.47 $71.42 37201 T Transcatheter therapy infuse 0676 2.4105 $143.05 $28.61 37202 T Transcatheter therapy infuse 0676 2.4105 $143.05 $28.61 37203 T Transcatheter retrieval 0103 14.7142 $873.18 $223.63 $174.64 37204 T Transcatheter occlusion 0115 31.4727 $1,867.68 $459.35 $373.54 37205 T Transcatheter stent 0229 64.4545 $3,824.92 $771.23 $764.98 37206 T Transcatheter stent add-on 0229 64.4545 $3,824.92 $771.23 $764.98 37207 T Transcatheter stent 0229 64.4545 $3,824.92 $771.23 $764.98 37208 T Transcatheter stent add-on 0229 64.4545 $3,824.92 $771.23 $764.98 37209 T Exchange arterial catheter 0103 14.7142 $873.18 $223.63 $174.64 37215 C Transcath stent, cca w/eps 37216 C Transcath stent, cca w/o eps 37250 S Iv us first vessel add-on 0416 19.5542 $1,160.40 $232.08 37251 S Iv us each add vessel add-on 0416 19.5542 $1,160.40 $232.08 37500 T Endoscopy ligate perf veins 0092 26.482 $1,571.52 $505.37 $314.30 37501 T Vascular endoscopy procedure 0092 26.482 $1,571.52 $505.37 $314.30 37565 T Ligation of neck vein 0093 23.4516 $1,391.69 $278.34 37600 T Ligation of neck artery 0093 23.4516 $1,391.69 $278.34 37605 T Ligation of neck artery 0091 28.9999 $1,720.94 $348.23 $344.19 37606 T Ligation of neck artery 0091 28.9999 $1,720.94 $348.23 $344.19 37607 T Ligation of a-v fistula 0092 26.482 $1,571.52 $505.37 $314.30 37609 T Temporal artery procedure 0021 14.9776 $888.82 $219.48 $177.76 37615 T Ligation of neck artery 0091 28.9999 $1,720.94 $348.23 $344.19 37616 C Ligation of chest artery 37617 C Ligation of abdomen artery 37618 C Ligation of extremity artery 37620 T Revision of major vein 0091 28.9999 $1,720.94 $348.23 $344.19 37650 T Revision of major vein 0091 28.9999 $1,720.94 $348.23 $344.19 37660 C Revision of major vein 37700 T Revise leg vein 0091 28.9999 $1,720.94 $348.23 $344.19 37720 T Removal of leg vein 0092 26.482 $1,571.52 $505.37 $314.30 37730 T Removal of leg veins 0092 26.482 $1,571.52 $505.37 $314.30 37735 T Removal of leg veins/lesion 0092 26.482 $1,571.52 $505.37 $314.30 37760 T Revision of leg veins 0091 28.9999 $1,720.94 $348.23 $344.19 37765 T Phleb veins - extrem - to 20 0091 28.9999 $1,720.94 $348.23 $344.19 37766 T Phleb veins - extrem 20+ 0091 28.9999 $1,720.94 $348.23 $344.19 37780 T Revision of leg vein 0091 28.9999 $1,720.94 $348.23 $344.19 37785 T Ligate/divide/excise vein 0091 28.9999 $1,720.94 $348.23 $344.19 37788 C Revascularization, penis 37790 T Penile venous occlusion 0181 30.8663 $1,831.70 $621.82 $366.34 37799 T Vascular surgery procedure 0103 14.7142 $873.18 $223.63 $174.64 38100 C Removal of spleen, total 38101 C Removal of spleen, partial 38102 C Removal of spleen, total 38115 C Repair of ruptured spleen 38120 T Laparoscopy, splenectomy 0131 43.3389 $2,571.86 $1,001.89 $514.37 38129 T Laparoscope proc, spleen 0130 31.9271 $1,894.65 $659.53 $378.93 38200 N Injection for spleen x-ray 38204 E Bl donor search management 38205 S Harvest allogenic stem cells 0111 12.3956 $735.59 $200.18 $147.12 38206 S Harvest auto stem cells 0111 12.3956 $735.59 $200.18 $147.12 38207 E Cryopreserve stem cells 38208 E Thaw preserved stem cells Start Printed Page 50744 38209 E Wash harvest stem cells 38210 E T-cell depletion of harvest 38211 E Tumor cell deplete of harvst 38212 E Rbc depletion of harvest 38213 E Platelet deplete of harvest 38214 E Volume deplete of harvest 38215 E Harvest stem cell concentrte 38220 T Bone marrow aspiration 0003 2.653 $157.44 $31.49 38221 T Bone marrow biopsy 0003 2.653 $157.44 $31.49 38230 S Bone marrow collection 0111 12.3956 $735.59 $200.18 $147.12 38240 S Bone marrow/stem transplant 0123 22.9902 $1,364.31 $272.86 38241 S Bone marrow/stem transplant 0123 22.9902 $1,364.31 $272.86 38242 S Lymphocyte infuse transplant 0111 12.3956 $735.59 $200.18 $147.12 38300 T Drainage, lymph node lesion 0007 11.4501 $679.48 $135.90 38305 T Drainage, lymph node lesion 0008 16.4989 $979.09 $195.82 38308 T Incision of lymph channels 0113 21.4653 $1,273.82 $254.76 38380 C Thoracic duct procedure 38381 C Thoracic duct procedure 38382 C Thoracic duct procedure 38500 T Biopsy/removal, lymph nodes 0113 21.4653 $1,273.82 $254.76 38505 T Needle biopsy, lymph nodes 0005 3.5994 $213.60 $71.59 $42.72 38510 T Biopsy/removal, lymph nodes 0113 21.4653 $1,273.82 $254.76 38520 T Biopsy/removal, lymph nodes 0113 21.4653 $1,273.82 $254.76 38525 T Biopsy/removal, lymph nodes 0113 21.4653 $1,273.82 $254.76 38530 T Biopsy/removal, lymph nodes 0113 21.4653 $1,273.82 $254.76 38542 T Explore deep node(s), neck 0114 40.7652 $2,419.13 $485.91 $483.83 38550 T Removal, neck/armpit lesion 0113 21.4653 $1,273.82 $254.76 38555 T Removal, neck/armpit lesion 0113 21.4653 $1,273.82 $254.76 38562 C Removal, pelvic lymph nodes 38564 C Removal, abdomen lymph nodes 38570 T Laparoscopy, lymph node biop 0131 43.3389 $2,571.86 $1,001.89 $514.37 38571 T Laparoscopy, lymphadenectomy 0132 62.9914 $3,738.10 $1,239.22 $747.62 38572 T Laparoscopy, lymphadenectomy 0131 43.3389 $2,571.86 $1,001.89 $514.37 38589 T Laparoscope proc, lymphatic 0130 31.9271 $1,894.65 $659.53 $378.93 38700 T Removal of lymph nodes, neck 0113 21.4653 $1,273.82 $254.76 38720 T Removal of lymph nodes, neck 0113 21.4653 $1,273.82 $254.76 38724 C Removal of lymph nodes, neck 38740 T Remove armpit lymph nodes 0114 40.7652 $2,419.13 $485.91 $483.83 38745 T Remove armpit lymph nodes 0114 40.7652 $2,419.13 $485.91 $483.83 38746 C Remove thoracic lymph nodes 38747 C Remove abdominal lymph nodes 38760 T Remove groin lymph nodes 0113 21.4653 $1,273.82 $254.76 38765 C Remove groin lymph nodes 38770 C Remove pelvis lymph nodes 38780 C Remove abdomen lymph nodes 38790 N Inject for lymphatic x-ray 38792 N Identify sentinel node 38794 N Access thoracic lymph duct 38999 S Blood/lymph system procedure 0110 3.6594 $217.16 $43.43 39000 C Exploration of chest 39010 C Exploration of chest 39200 C Removal chest lesion 39220 C Removal chest lesion 39400 T Visualization of chest 0069 30.6775 $1,820.49 $591.64 $364.10 39499 C Chest procedure 39501 C Repair diaphragm laceration 39502 C Repair paraesophageal hernia 39503 C Repair of diaphragm hernia 39520 C Repair of diaphragm hernia 39530 C Repair of diaphragm hernia 39531 C Repair of diaphragm hernia 39540 C Repair of diaphragm hernia 39541 C Repair of diaphragm hernia 39545 C Revision of diaphragm 39560 C Resect diaphragm, simple 39561 C Resect diaphragm, complex Start Printed Page 50745 39599 C Diaphragm surgery procedure 4000F E Tobacco use txmnt counseling 4001F E Tobacco use txmnt, pharmacol 4002F E Statin therapy, rx 4006F E Beta-blocker therapy, rx 4009F E Ace inhibitor therapy, rx 4011F E Oral antiplatelet tx, rx 40490 T Biopsy of lip 0251 2.0101 $119.29 $23.86 40500 T Partial excision of lip 0253 16.1357 $957.54 $282.29 $191.51 40510 T Partial excision of lip 0254 23.404 $1,388.86 $321.35 $277.77 40520 T Partial excision of lip 0253 16.1357 $957.54 $282.29 $191.51 40525 T Reconstruct lip with flap 0254 23.404 $1,388.86 $321.35 $277.77 40527 T Reconstruct lip with flap 0254 23.404 $1,388.86 $321.35 $277.77 40530 T Partial removal of lip 0254 23.404 $1,388.86 $321.35 $277.77 40650 T Repair lip 0252 7.8673 $466.87 $113.41 $93.37 40652 T Repair lip 0252 7.8673 $466.87 $113.41 $93.37 40654 T Repair lip 0252 7.8673 $466.87 $113.41 $93.37 40700 T Repair cleft lip/nasal 0256 37.3204 $2,214.70 $442.94 40701 T Repair cleft lip/nasal 0256 37.3204 $2,214.70 $442.94 40702 T Repair cleft lip/nasal 0256 37.3204 $2,214.70 $442.94 40720 T Repair cleft lip/nasal 0256 37.3204 $2,214.70 $442.94 40761 T Repair cleft lip/nasal 0256 37.3204 $2,214.70 $442.94 40799 T Lip surgery procedure 0251 2.0101 $119.29 $23.86 40800 T Drainage of mouth lesion 0251 2.0101 $119.29 $23.86 40801 T Drainage of mouth lesion 0252 7.8673 $466.87 $113.41 $93.37 40804 X Removal, foreign body, mouth 0340 0.6384 $37.88 $7.58 40805 T Removal, foreign body, mouth 0252 7.8673 $466.87 $113.41 $93.37 40806 T Incision of lip fold 0251 2.0101 $119.29 $23.86 40808 T Biopsy of mouth lesion 0251 2.0101 $119.29 $23.86 40810 T Excision of mouth lesion 0253 16.1357 $957.54 $282.29 $191.51 40812 T Excise/repair mouth lesion 0253 16.1357 $957.54 $282.29 $191.51 40814 T Excise/repair mouth lesion 0253 16.1357 $957.54 $282.29 $191.51 40816 T Excision of mouth lesion 0254 23.404 $1,388.86 $321.35 $277.77 40818 T Excise oral mucosa for graft 0251 2.0101 $119.29 $23.86 40819 T Excise lip or cheek fold 0252 7.8673 $466.87 $113.41 $93.37 40820 T Treatment of mouth lesion 0253 16.1357 $957.54 $282.29 $191.51 40830 T Repair mouth laceration 0251 2.0101 $119.29 $23.86 40831 T Repair mouth laceration 0252 7.8673 $466.87 $113.41 $93.37 40840 T Reconstruction of mouth 0254 23.404 $1,388.86 $321.35 $277.77 40842 T Reconstruction of mouth 0254 23.404 $1,388.86 $321.35 $277.77 40843 T Reconstruction of mouth 0254 23.404 $1,388.86 $321.35 $277.77 40844 T Reconstruction of mouth 0256 37.3204 $2,214.70 $442.94 40845 T Reconstruction of mouth 0256 37.3204 $2,214.70 $442.94 40899 T Mouth surgery procedure 0251 2.0101 $119.29 $23.86 41000 T Drainage of mouth lesion 0253 16.1357 $957.54 $282.29 $191.51 41005 T Drainage of mouth lesion 0251 2.0101 $119.29 $23.86 41006 T Drainage of mouth lesion 0254 23.404 $1,388.86 $321.35 $277.77 41007 T Drainage of mouth lesion 0253 16.1357 $957.54 $282.29 $191.51 41008 T Drainage of mouth lesion 0253 16.1357 $957.54 $282.29 $191.51 41009 T Drainage of mouth lesion 0251 2.0101 $119.29 $23.86 41010 T Incision of tongue fold 0252 7.8673 $466.87 $113.41 $93.37 41015 T Drainage of mouth lesion 0251 2.0101 $119.29 $23.86 41016 T Drainage of mouth lesion 0252 7.8673 $466.87 $113.41 $93.37 41017 T Drainage of mouth lesion 0252 7.8673 $466.87 $113.41 $93.37 41018 T Drainage of mouth lesion 0252 7.8673 $466.87 $113.41 $93.37 41100 T Biopsy of tongue 0252 7.8673 $466.87 $113.41 $93.37 41105 T Biopsy of tongue 0253 16.1357 $957.54 $282.29 $191.51 41108 T Biopsy of floor of mouth 0252 7.8673 $466.87 $113.41 $93.37 41110 T Excision of tongue lesion 0253 16.1357 $957.54 $282.29 $191.51 41112 T Excision of tongue lesion 0253 16.1357 $957.54 $282.29 $191.51 41113 T Excision of tongue lesion 0253 16.1357 $957.54 $282.29 $191.51 41114 T Excision of tongue lesion 0254 23.404 $1,388.86 $321.35 $277.77 41115 T Excision of tongue fold 0252 7.8673 $466.87 $113.41 $93.37 41116 T Excision of mouth lesion 0253 16.1357 $957.54 $282.29 $191.51 41120 T Partial removal of tongue 0254 23.404 $1,388.86 $321.35 $277.77 41130 C Partial removal of tongue Start Printed Page 50746 41135 C Tongue and neck surgery 41140 C Removal of tongue 41145 C Tongue removal, neck surgery 41150 C Tongue, mouth, jaw surgery 41153 C Tongue, mouth, neck surgery 41155 C Tongue, jaw, & neck surgery 41250 T Repair tongue laceration 0251 2.0101 $119.29 $23.86 41251 T Repair tongue laceration 0251 2.0101 $119.29 $23.86 41252 T Repair tongue laceration 0252 7.8673 $466.87 $113.41 $93.37 41500 T Fixation of tongue 0254 23.404 $1,388.86 $321.35 $277.77 41510 T Tongue to lip surgery 0253 16.1357 $957.54 $282.29 $191.51 41520 T Reconstruction, tongue fold 0252 7.8673 $466.87 $113.41 $93.37 41599 T Tongue and mouth surgery 0251 2.0101 $119.29 $23.86 41800 T Drainage of gum lesion 0251 2.0101 $119.29 $23.86 41805 T Removal foreign body, gum 0254 23.404 $1,388.86 $321.35 $277.77 41806 T Removal foreign body,jawbone 0253 16.1357 $957.54 $282.29 $191.51 41820 T Excision, gum, each quadrant 0252 7.8673 $466.87 $113.41 $93.37 41821 T Excision of gum flap 0252 7.8673 $466.87 $113.41 $93.37 41822 T Excision of gum lesion 0253 16.1357 $957.54 $282.29 $191.51 41823 T Excision of gum lesion 0254 23.404 $1,388.86 $321.35 $277.77 41825 T Excision of gum lesion 0253 16.1357 $957.54 $282.29 $191.51 41826 T Excision of gum lesion 0253 16.1357 $957.54 $282.29 $191.51 41827 T Excision of gum lesion 0254 23.404 $1,388.86 $321.35 $277.77 41828 T Excision of gum lesion 0253 16.1357 $957.54 $282.29 $191.51 41830 T Removal of gum tissue 0253 16.1357 $957.54 $282.29 $191.51 41850 T Treatment of gum lesion 0253 16.1357 $957.54 $282.29 $191.51 41870 T Gum graft 0254 23.404 $1,388.86 $321.35 $277.77 41872 T Repair gum 0253 16.1357 $957.54 $282.29 $191.51 41874 T Repair tooth socket 0254 23.404 $1,388.86 $321.35 $277.77 41899 T Dental surgery procedure 0251 2.0101 $119.29 $23.86 42000 T Drainage mouth roof lesion 0251 2.0101 $119.29 $23.86 42100 T Biopsy roof of mouth 0252 7.8673 $466.87 $113.41 $93.37 42104 T Excision lesion, mouth roof 0253 16.1357 $957.54 $282.29 $191.51 42106 T Excision lesion, mouth roof 0253 16.1357 $957.54 $282.29 $191.51 42107 T Excision lesion, mouth roof 0254 23.404 $1,388.86 $321.35 $277.77 42120 T Remove palate/lesion 0256 37.3204 $2,214.70 $442.94 42140 T Excision of uvula 0252 7.8673 $466.87 $113.41 $93.37 42145 T Repair palate, pharynx/uvula 0254 23.404 $1,388.86 $321.35 $277.77 42160 T Treatment mouth roof lesion 0253 16.1357 $957.54 $282.29 $191.51 42180 T Repair palate 0251 2.0101 $119.29 $23.86 42182 T Repair palate 0256 37.3204 $2,214.70 $442.94 42200 T Reconstruct cleft palate 0256 37.3204 $2,214.70 $442.94 42205 T Reconstruct cleft palate 0256 37.3204 $2,214.70 $442.94 42210 T Reconstruct cleft palate 0256 37.3204 $2,214.70 $442.94 42215 T Reconstruct cleft palate 0256 37.3204 $2,214.70 $442.94 42220 T Reconstruct cleft palate 0256 37.3204 $2,214.70 $442.94 42225 T Reconstruct cleft palate 0256 37.3204 $2,214.70 $442.94 42226 T Lengthening of palate 0256 37.3204 $2,214.70 $442.94 42227 T Lengthening of palate 0256 37.3204 $2,214.70 $442.94 42235 T Repair palate 0253 16.1357 $957.54 $282.29 $191.51 42260 T Repair nose to lip fistula 0254 23.404 $1,388.86 $321.35 $277.77 42280 T Preparation, palate mold 0251 2.0101 $119.29 $23.86 42281 T Insertion, palate prosthesis 0253 16.1357 $957.54 $282.29 $191.51 42299 T Palate/uvula surgery 0251 2.0101 $119.29 $23.86 42300 T Drainage of salivary gland 0253 16.1357 $957.54 $282.29 $191.51 42305 T Drainage of salivary gland 0253 16.1357 $957.54 $282.29 $191.51 42310 T Drainage of salivary gland 0251 2.0101 $119.29 $23.86 42320 T Drainage of salivary gland 0251 2.0101 $119.29 $23.86 42325 T Create salivary cyst drain 0251 2.0101 $119.29 $23.86 42326 T Create salivary cyst drain 0252 7.8673 $466.87 $113.41 $93.37 42330 T Removal of salivary stone 0253 16.1357 $957.54 $282.29 $191.51 42335 T Removal of salivary stone 0253 16.1357 $957.54 $282.29 $191.51 42340 T Removal of salivary stone 0253 16.1357 $957.54 $282.29 $191.51 42400 T Biopsy of salivary gland 0005 3.5994 $213.60 $71.59 $42.72 42405 T Biopsy of salivary gland 0253 16.1357 $957.54 $282.29 $191.51 42408 T Excision of salivary cyst 0253 16.1357 $957.54 $282.29 $191.51 Start Printed Page 50747 42409 T Drainage of salivary cyst 0253 16.1357 $957.54 $282.29 $191.51 42410 T Excise parotid gland/lesion 0256 37.3204 $2,214.70 $442.94 42415 T Excise parotid gland/lesion 0256 37.3204 $2,214.70 $442.94 42420 T Excise parotid gland/lesion 0256 37.3204 $2,214.70 $442.94 42425 T Excise parotid gland/lesion 0256 37.3204 $2,214.70 $442.94 42426 C Excise parotid gland/lesion 42440 T Excise submaxillary gland 0256 37.3204 $2,214.70 $442.94 42450 T Excise sublingual gland 0254 23.404 $1,388.86 $321.35 $277.77 42500 T Repair salivary duct 0254 23.404 $1,388.86 $321.35 $277.77 42505 T Repair salivary duct 0256 37.3204 $2,214.70 $442.94 42507 T Parotid duct diversion 0256 37.3204 $2,214.70 $442.94 42508 T Parotid duct diversion 0256 37.3204 $2,214.70 $442.94 42509 T Parotid duct diversion 0256 37.3204 $2,214.70 $442.94 42510 T Parotid duct diversion 0256 37.3204 $2,214.70 $442.94 42550 N Injection for salivary x-ray 42600 T Closure of salivary fistula 0253 16.1357 $957.54 $282.29 $191.51 42650 T Dilation of salivary duct 0252 7.8673 $466.87 $113.41 $93.37 42660 T Dilation of salivary duct 0251 2.0101 $119.29 $23.86 42665 T Ligation of salivary duct 0254 23.404 $1,388.86 $321.35 $277.77 42699 T Salivary surgery procedure 0251 2.0101 $119.29 $23.86 42700 T Drainage of tonsil abscess 0251 2.0101 $119.29 $23.86 42720 T Drainage of throat abscess 0253 16.1357 $957.54 $282.29 $191.51 42725 T Drainage of throat abscess 0256 37.3204 $2,214.70 $442.94 42800 T Biopsy of throat 0253 16.1357 $957.54 $282.29 $191.51 42802 T Biopsy of throat 0253 16.1357 $957.54 $282.29 $191.51 42804 T Biopsy of upper nose/throat 0253 16.1357 $957.54 $282.29 $191.51 42806 T Biopsy of upper nose/throat 0254 23.404 $1,388.86 $321.35 $277.77 42808 T Excise pharynx lesion 0253 16.1357 $957.54 $282.29 $191.51 42809 X Remove pharynx foreign body 0340 0.6384 $37.88 $7.58 42810 T Excision of neck cyst 0254 23.404 $1,388.86 $321.35 $277.77 42815 T Excision of neck cyst 0256 37.3204 $2,214.70 $442.94 42820 T Remove tonsils and adenoids 0258 22.2466 $1,320.18 $437.25 $264.04 42821 T Remove tonsils and adenoids 0258 22.2466 $1,320.18 $437.25 $264.04 42825 T Removal of tonsils 0258 22.2466 $1,320.18 $437.25 $264.04 42826 T Removal of tonsils 0258 22.2466 $1,320.18 $437.25 $264.04 42830 T Removal of adenoids 0258 22.2466 $1,320.18 $437.25 $264.04 42831 T Removal of adenoids 0258 22.2466 $1,320.18 $437.25 $264.04 42835 T Removal of adenoids 0258 22.2466 $1,320.18 $437.25 $264.04 42836 T Removal of adenoids 0258 22.2466 $1,320.18 $437.25 $264.04 42842 T Extensive surgery of throat 0254 23.404 $1,388.86 $321.35 $277.77 42844 T Extensive surgery of throat 0256 37.3204 $2,214.70 $442.94 42845 C Extensive surgery of throat 42860 T Excision of tonsil tags 0258 22.2466 $1,320.18 $437.25 $264.04 42870 T Excision of lingual tonsil 0258 22.2466 $1,320.18 $437.25 $264.04 42890 T Partial removal of pharynx 0256 37.3204 $2,214.70 $442.94 42892 T Revision of pharyngeal walls 0256 37.3204 $2,214.70 $442.94 42894 C Revision of pharyngeal walls 42900 T Repair throat wound 0252 7.8673 $466.87 $113.41 $93.37 42950 T Reconstruction of throat 0254 23.404 $1,388.86 $321.35 $277.77 42953 C Repair throat, esophagus 42955 T Surgical opening of throat 0254 23.404 $1,388.86 $321.35 $277.77 42960 T Control throat bleeding 0250 1.2896 $76.53 $26.79 $15.31 42961 C Control throat bleeding 42962 T Control throat bleeding 0256 37.3204 $2,214.70 $442.94 42970 T Control nose/throat bleeding 0250 1.2896 $76.53 $26.79 $15.31 42971 C Control nose/throat bleeding 42972 T Control nose/throat bleeding 0253 16.1357 $957.54 $282.29 $191.51 42999 T Throat surgery procedure 0251 2.0101 $119.29 $23.86 43020 T Incision of esophagus 0252 7.8673 $466.87 $113.41 $93.37 43030 T Throat muscle surgery 0253 16.1357 $957.54 $282.29 $191.51 43045 C Incision of esophagus 43100 C Excision of esophagus lesion 43101 C Excision of esophagus lesion 43107 C Removal of esophagus 43108 C Removal of esophagus 43112 C Removal of esophagus Start Printed Page 50748 43113 C Removal of esophagus 43116 C Partial removal of esophagus 43117 C Partial removal of esophagus 43118 C Partial removal of esophagus 43121 C Partial removal of esophagus 43122 C Partial removal of esophagus 43123 C Partial removal of esophagus 43124 C Removal of esophagus 43130 T Removal of esophagus pouch 0254 23.404 $1,388.86 $321.35 $277.77 43135 C Removal of esophagus pouch 43200 T Esophagus endoscopy 0141 8.1835 $485.63 $143.38 $97.13 43201 T Esoph scope w/submucous inj 0141 8.1835 $485.63 $143.38 $97.13 43202 T Esophagus endoscopy, biopsy 0141 8.1835 $485.63 $143.38 $97.13 43204 T Esoph scope w/sclerosis inj 0141 8.1835 $485.63 $143.38 $97.13 43205 T Esophagus endoscopy/ligation 0141 8.1835 $485.63 $143.38 $97.13 43215 T Esophagus endoscopy 0141 8.1835 $485.63 $143.38 $97.13 43216 T Esophagus endoscopy/lesion 0141 8.1835 $485.63 $143.38 $97.13 43217 T Esophagus endoscopy 0141 8.1835 $485.63 $143.38 $97.13 43219 T Esophagus endoscopy 0384 22.3392 $1,325.68 $287.93 $265.14 43220 T Esoph endoscopy, dilation 0141 8.1835 $485.63 $143.38 $97.13 43226 T Esoph endoscopy, dilation 0141 8.1835 $485.63 $143.38 $97.13 43227 T Esoph endoscopy, repair 0141 8.1835 $485.63 $143.38 $97.13 43228 T Esoph endoscopy, ablation 0422 22.9647 $1,362.79 $448.81 $272.56 43231 T Esoph endoscopy w/us exam 0141 8.1835 $485.63 $143.38 $97.13 43232 T Esoph endoscopy w/us fn bx 0141 8.1835 $485.63 $143.38 $97.13 43234 T Upper GI endoscopy, exam 0141 8.1835 $485.63 $143.38 $97.13 43235 T Uppr gi endoscopy, diagnosis 0141 8.1835 $485.63 $143.38 $97.13 43236 T Uppr gi scope w/submuc inj 0141 8.1835 $485.63 $143.38 $97.13 43237 T Endoscopic us exam, esoph 0141 8.1835 $485.63 $143.38 $97.13 43238 T Uppr gi endoscopy w/us fn bx 0141 8.1835 $485.63 $143.38 $97.13 43239 T Upper GI endoscopy, biopsy 0141 8.1835 $485.63 $143.38 $97.13 43240 T Esoph endoscope w/drain cyst 0141 8.1835 $485.63 $143.38 $97.13 43241 T Upper GI endoscopy with tube 0141 8.1835 $485.63 $143.38 $97.13 43242 T Uppr gi endoscopy w/us fn bx 0141 8.1835 $485.63 $143.38 $97.13 43243 T Upper gi endoscopy & inject 0141 8.1835 $485.63 $143.38 $97.13 43244 T Upper GI endoscopy/ligation 0141 8.1835 $485.63 $143.38 $97.13 43245 T Uppr gi scope dilate strictr 0141 8.1835 $485.63 $143.38 $97.13 43246 T Place gastrostomy tube 0141 8.1835 $485.63 $143.38 $97.13 43247 T Operative upper GI endoscopy 0141 8.1835 $485.63 $143.38 $97.13 43248 T Uppr gi endoscopy/guide wire 0141 8.1835 $485.63 $143.38 $97.13 43249 T Esoph endoscopy, dilation 0141 8.1835 $485.63 $143.38 $97.13 43250 T Upper GI endoscopy/tumor 0141 8.1835 $485.63 $143.38 $97.13 43251 T Operative upper GI endoscopy 0141 8.1835 $485.63 $143.38 $97.13 43255 T Operative upper GI endoscopy 0141 8.1835 $485.63 $143.38 $97.13 43256 T Uppr gi endoscopy w stent 0384 22.3392 $1,325.68 $287.93 $265.14 43257 T Uppr gi scope w/thrml txmnt 0422 22.9647 $1,362.79 $448.81 $272.56 43258 T Operative upper GI endoscopy 0141 8.1835 $485.63 $143.38 $97.13 43259 T Endoscopic ultrasound exam 0141 8.1835 $485.63 $143.38 $97.13 43260 T Endo cholangiopancreatograph 0151 18.7338 $1,111.72 $245.46 $222.34 43261 T Endo cholangiopancreatograph 0151 18.7338 $1,111.72 $245.46 $222.34 43262 T Endo cholangiopancreatograph 0151 18.7338 $1,111.72 $245.46 $222.34 43263 T Endo cholangiopancreatograph 0151 18.7338 $1,111.72 $245.46 $222.34 43264 T Endo cholangiopancreatograph 0151 18.7338 $1,111.72 $245.46 $222.34 43265 T Endo cholangiopancreatograph 0151 18.7338 $1,111.72 $245.46 $222.34 43267 T Endo cholangiopancreatograph 0151 18.7338 $1,111.72 $245.46 $222.34 43268 T Endo cholangiopancreatograph 0384 22.3392 $1,325.68 $287.93 $265.14 43269 T Endo cholangiopancreatograph 0384 22.3392 $1,325.68 $287.93 $265.14 43271 T Endo cholangiopancreatograph 0151 18.7338 $1,111.72 $245.46 $222.34 43272 T Endo cholangiopancreatograph 0151 18.7338 $1,111.72 $245.46 $222.34 43280 T Laparoscopy, fundoplasty 0132 62.9914 $3,738.10 $1,239.22 $747.62 43289 T Laparoscope proc, esoph 0130 31.9271 $1,894.65 $659.53 $378.93 43300 C Repair of esophagus 43305 C Repair esophagus and fistula 43310 C Repair of esophagus 43312 C Repair esophagus and fistula 43313 C Esophagoplasty congenital Start Printed Page 50749 43314 C Tracheo-esophagoplasty cong 43320 C Fuse esophagus & stomach 43324 C Revise esophagus & stomach 43325 C Revise esophagus & stomach 43326 C Revise esophagus & stomach 43330 C Repair of esophagus 43331 C Repair of esophagus 43340 C Fuse esophagus & intestine 43341 C Fuse esophagus & intestine 43350 C Surgical opening, esophagus 43351 C Surgical opening, esophagus 43352 C Surgical opening, esophagus 43360 C Gastrointestinal repair 43361 C Gastrointestinal repair 43400 C Ligate esophagus veins 43401 C Esophagus surgery for veins 43405 C Ligate/staple esophagus 43410 C Repair esophagus wound 43415 C Repair esophagus wound 43420 C Repair esophagus opening 43425 C Repair esophagus opening 43450 T Dilate esophagus 0140 5.4737 $324.83 $94.18 $64.97 43453 T Dilate esophagus 0140 5.4737 $324.83 $94.18 $64.97 43456 T Dilate esophagus 0140 5.4737 $324.83 $94.18 $64.97 43458 T Dilate esophagus 0140 5.4737 $324.83 $94.18 $64.97 43460 C Pressure treatment esophagus 43496 C Free jejunum flap, microvasc 43499 T Esophagus surgery procedure 0141 8.1835 $485.63 $143.38 $97.13 43500 C Surgical opening of stomach 43501 C Surgical repair of stomach 43502 C Surgical repair of stomach 43510 T Surgical opening of stomach 0141 8.1835 $485.63 $143.38 $97.13 43520 C Incision of pyloric muscle 43600 T Biopsy of stomach 0141 8.1835 $485.63 $143.38 $97.13 43605 C Biopsy of stomach 43610 C Excision of stomach lesion 43611 C Excision of stomach lesion 43620 C Removal of stomach 43621 C Removal of stomach 43622 C Removal of stomach 43631 C Removal of stomach, partial 43632 C Removal of stomach, partial 43633 C Removal of stomach, partial 43634 C Removal of stomach, partial 43635 C Removal of stomach, partial 43638 C Removal of stomach, partial 43639 C Removal of stomach, partial 43640 C Vagotomy & pylorus repair 43641 C Vagotomy & pylorus repair 43644 C Lap gastric bypass/roux-en-y 43645 C Lap gastr bypass incl smll i 43651 T Laparoscopy, vagus nerve 0132 62.9914 $3,738.10 $1,239.22 $747.62 43652 T Laparoscopy, vagus nerve 0132 62.9914 $3,738.10 $1,239.22 $747.62 43653 T Laparoscopy, gastrostomy 0131 43.3389 $2,571.86 $1,001.89 $514.37 43659 T Laparoscope proc, stom 0130 31.9271 $1,894.65 $659.53 $378.93 43750 T Place gastrostomy tube 0141 8.1835 $485.63 $143.38 $97.13 43752 X Nasal/orogastric w/stent 0272 1.3801 $81.90 $32.76 $16.38 43760 T Change gastrostomy tube 0121 2.2766 $135.10 $43.80 $27.02 43761 T Reposition gastrostomy tube 0122 6.9721 $413.75 $84.85 $82.75 43800 C Reconstruction of pylorus 43810 C Fusion of stomach and bowel 43820 C Fusion of stomach and bowel 43825 C Fusion of stomach and bowel 43830 T Place gastrostomy tube 0422 22.9647 $1,362.79 $448.81 $272.56 43831 T Place gastrostomy tube 0141 8.1835 $485.63 $143.38 $97.13 43832 C Place gastrostomy tube Start Printed Page 50750 43840 C Repair of stomach lesion 43842 C Gastroplasty for obesity 43843 C Gastroplasty for obesity 43845 C Gastroplasty duodenal switch 43846 C Gastric bypass for obesity 43847 C Gastric bypass for obesity 43848 C Revision gastroplasty 43850 C Revise stomach-bowel fusion 43855 C Revise stomach-bowel fusion 43860 C Revise stomach-bowel fusion 43865 C Revise stomach-bowel fusion 43870 T Repair stomach opening 0141 8.1835 $485.63 $143.38 $97.13 43880 C Repair stomach-bowel fistula 43999 T Stomach surgery procedure 0141 8.1835 $485.63 $143.38 $97.13 44005 C Freeing of bowel adhesion 44010 C Incision of small bowel 44015 C Insert needle cath bowel 44020 C Explore small intestine 44021 C Decompress small bowel 44025 C Incision of large bowel 44050 C Reduce bowel obstruction 44055 C Correct malrotation of bowel 44100 T Biopsy of bowel 0141 8.1835 $485.63 $143.38 $97.13 44110 C Excise intestine lesion(s) 44111 C Excision of bowel lesion(s) 44120 C Removal of small intestine 44121 C Removal of small intestine 44125 C Removal of small intestine 44126 C Enterectomy w/o taper, cong 44127 C Enterectomy w/taper, cong 44128 C Enterectomy cong, add-on 44130 C Bowel to bowel fusion 44132 C Enterectomy, cadaver donor 44133 C Enterectomy, live donor 44135 C Intestine transplnt, cadaver 44136 C Intestine transplant, live 44137 C Remove intestinal allograft 44139 C Mobilization of colon 44140 C Partial removal of colon 44141 C Partial removal of colon 44143 C Partial removal of colon 44144 C Partial removal of colon 44145 C Partial removal of colon 44146 C Partial removal of colon 44147 C Partial removal of colon 44150 C Removal of colon 44151 C Removal of colon/ileostomy 44152 C Removal of colon/ileostomy 44153 C Removal of colon/ileostomy 44155 C Removal of colon/ileostomy 44156 C Removal of colon/ileostomy 44160 C Removal of colon 44200 T Laparoscopy, enterolysis 0131 43.3389 $2,571.86 $1,001.89 $514.37 44201 T Laparoscopy, jejunostomy 0131 43.3389 $2,571.86 $1,001.89 $514.37 44202 C Lap resect s/intestine singl 44203 C Lap resect s/intestine, addl 44204 C Laparo partial colectomy 44205 C Lap colectomy part w/ileum 44206 T Lap part colectomy w/stoma 0132 62.9914 $3,738.10 $1,239.22 $747.62 44207 T L colectomy/coloproctostomy 0132 62.9914 $3,738.10 $1,239.22 $747.62 44208 T L colectomy/coloproctostomy 0132 62.9914 $3,738.10 $1,239.22 $747.62 44210 C Laparo total proctocolectomy 44211 C Laparo total proctocolectomy 44212 C Laparo total proctocolectomy 44238 T Laparoscope proc, intestine 0130 31.9271 $1,894.65 $659.53 $378.93 44239 T Laparoscope proc, rectum 0130 31.9271 $1,894.65 $659.53 $378.93 Start Printed Page 50751 44300 C Open bowel to skin 44310 C Ileostomy/jejunostomy 44312 T Revision of ileostomy 0027 18.4182 $1,092.99 $329.72 $218.60 44314 C Revision of ileostomy 44316 C Devise bowel pouch 44320 C Colostomy 44322 C Colostomy with biopsies 44340 T Revision of colostomy 0027 18.4182 $1,092.99 $329.72 $218.60 44345 C Revision of colostomy 44346 C Revision of colostomy 44360 T Small bowel endoscopy 0142 9.3487 $554.78 $152.78 $110.96 44361 T Small bowel endoscopy/biopsy 0142 9.3487 $554.78 $152.78 $110.96 44363 T Small bowel endoscopy 0142 9.3487 $554.78 $152.78 $110.96 44364 T Small bowel endoscopy 0142 9.3487 $554.78 $152.78 $110.96 44365 T Small bowel endoscopy 0142 9.3487 $554.78 $152.78 $110.96 44366 T Small bowel endoscopy 0142 9.3487 $554.78 $152.78 $110.96 44369 T Small bowel endoscopy 0142 9.3487 $554.78 $152.78 $110.96 44370 T Small bowel endoscopy/stent 0384 22.3392 $1,325.68 $287.93 $265.14 44372 T Small bowel endoscopy 0142 9.3487 $554.78 $152.78 $110.96 44373 T Small bowel endoscopy 0142 9.3487 $554.78 $152.78 $110.96 44376 T Small bowel endoscopy 0142 9.3487 $554.78 $152.78 $110.96 44377 T Small bowel endoscopy/biopsy 0142 9.3487 $554.78 $152.78 $110.96 44378 T Small bowel endoscopy 0142 9.3487 $554.78 $152.78 $110.96 44379 T S bowel endoscope w/stent 0384 22.3392 $1,325.68 $287.93 $265.14 44380 T Small bowel endoscopy 0142 9.3487 $554.78 $152.78 $110.96 44382 T Small bowel endoscopy 0142 9.3487 $554.78 $152.78 $110.96 44383 T Ileoscopy w/stent 0384 22.3392 $1,325.68 $287.93 $265.14 44385 T Endoscopy of bowel pouch 0143 8.6869 $515.51 $186.06 $103.10 44386 T Endoscopy, bowel pouch/biop 0143 8.6869 $515.51 $186.06 $103.10 44388 T Colonoscopy 0143 8.6869 $515.51 $186.06 $103.10 44389 T Colonoscopy with biopsy 0143 8.6869 $515.51 $186.06 $103.10 44390 T Colonoscopy for foreign body 0143 8.6869 $515.51 $186.06 $103.10 44391 T Colonoscopy for bleeding 0143 8.6869 $515.51 $186.06 $103.10 44392 T Colonoscopy & polypectomy 0143 8.6869 $515.51 $186.06 $103.10 44393 T Colonoscopy, lesion removal 0143 8.6869 $515.51 $186.06 $103.10 44394 T Colonoscopy w/snare 0143 8.6869 $515.51 $186.06 $103.10 44397 T Colonoscopy w/stent 0384 22.3392 $1,325.68 $287.93 $265.14 44500 T Intro, gastrointestinal tube 0121 2.2766 $135.10 $43.80 $27.02 44602 C Suture, small intestine 44603 C Suture, small intestine 44604 C Suture, large intestine 44605 C Repair of bowel lesion 44615 C Intestinal stricturoplasty 44620 C Repair bowel opening 44625 C Repair bowel opening 44626 C Repair bowel opening 44640 C Repair bowel-skin fistula 44650 C Repair bowel fistula 44660 C Repair bowel-bladder fistula 44661 C Repair bowel-bladder fistula 44680 C Surgical revision, intestine 44700 C Suspend bowel w/prosthesis 44701 N Intraop colon lavage add-on 44715 C Prepare donor intestine 44720 C Prep donor intestine/venous 44721 C Prep donor intestine/artery 44799 T Unlisted procedure intestine 0142 9.3487 $554.78 $152.78 $110.96 44800 C Excision of bowel pouch 44820 C Excision of mesentery lesion 44850 C Repair of mesentery 44899 C Bowel surgery procedure 44900 C Drain app abscess, open 44901 T Drain app abscess, percut 0037 9.4751 $562.28 $224.91 $112.46 44950 C Appendectomy 44955 C Appendectomy add-on 44960 C Appendectomy Start Printed Page 50752 44970 T Laparoscopy, appendectomy 0131 43.3389 $2,571.86 $1,001.89 $514.37 44979 T Laparoscope proc, app 0130 31.9271 $1,894.65 $659.53 $378.93 45000 T Drainage of pelvic abscess 0148 3.7383 $221.84 $57.21 $44.37 45005 T Drainage of rectal abscess 0155 16.2546 $964.60 $192.92 45020 T Drainage of rectal abscess 0155 16.2546 $964.60 $192.92 45100 T Biopsy of rectum 0149 18.0726 $1,072.48 $293.06 $214.50 45108 T Removal of anorectal lesion 0150 23.8654 $1,416.24 $437.12 $283.25 45110 C Removal of rectum 45111 C Partial removal of rectum 45112 C Removal of rectum 45113 C Partial proctectomy 45114 C Partial removal of rectum 45116 C Partial removal of rectum 45119 C Remove rectum w/reservoir 45120 C Removal of rectum 45121 C Removal of rectum and colon 45123 C Partial proctectomy 45126 C Pelvic exenteration 45130 C Excision of rectal prolapse 45135 C Excision of rectal prolapse 45136 C Excise ileoanal reservior 45150 T Excision of rectal stricture 0149 18.0726 $1,072.48 $293.06 $214.50 45160 T Excision of rectal lesion 0150 23.8654 $1,416.24 $437.12 $283.25 45170 T Excision of rectal lesion 0150 23.8654 $1,416.24 $437.12 $283.25 45190 T Destruction, rectal tumor 0150 23.8654 $1,416.24 $437.12 $283.25 45300 T Proctosigmoidoscopy dx 0146 4.6374 $275.20 $64.40 $55.04 45303 T Proctosigmoidoscopy dilate 0147 7.9679 $472.84 $94.57 45305 T Proctosigmoidoscopy w/bx 0147 7.9679 $472.84 $94.57 45307 T Proctosigmoidoscopy fb 0428 19.9022 $1,181.06 $236.21 45308 T Proctosigmoidoscopy removal 0147 7.9679 $472.84 $94.57 45309 T Proctosigmoidoscopy removal 0147 7.9679 $472.84 $94.57 45315 T Proctosigmoidoscopy removal 0147 7.9679 $472.84 $94.57 45317 T Proctosigmoidoscopy bleed 0147 7.9679 $472.84 $94.57 45320 T Proctosigmoidoscopy ablate 0428 19.9022 $1,181.06 $236.21 45321 T Proctosigmoidoscopy volvul 0428 19.9022 $1,181.06 $236.21 45327 T Proctosigmoidoscopy w/stent 0384 22.3392 $1,325.68 $287.93 $265.14 45330 T Diagnostic sigmoidoscopy 0146 4.6374 $275.20 $64.40 $55.04 45331 T Sigmoidoscopy and biopsy 0146 4.6374 $275.20 $64.40 $55.04 45332 T Sigmoidoscopy w/fb removal 0146 4.6374 $275.20 $64.40 $55.04 45333 T Sigmoidoscopy & polypectomy 0147 7.9679 $472.84 $94.57 45334 T Sigmoidoscopy for bleeding 0147 7.9679 $472.84 $94.57 45335 T Sigmoidoscopy w/submuc inj 0146 4.6374 $275.20 $64.40 $55.04 45337 T Sigmoidoscopy & decompress 0146 4.6374 $275.20 $64.40 $55.04 45338 T Sigmoidoscopy w/tumr remove 0147 7.9679 $472.84 $94.57 45339 T Sigmoidoscopy w/ablate tumr 0147 7.9679 $472.84 $94.57 45340 T Sig w/balloon dilation 0147 7.9679 $472.84 $94.57 45341 T Sigmoidoscopy w/ultrasound 0147 7.9679 $472.84 $94.57 45342 T Sigmoidoscopy w/us guide bx 0147 7.9679 $472.84 $94.57 45345 T Sigmoidoscopy w/stent 0384 22.3392 $1,325.68 $287.93 $265.14 45355 T Surgical colonoscopy 0143 8.6869 $515.51 $186.06 $103.10 45378 T Diagnostic colonoscopy 0143 8.6869 $515.51 $186.06 $103.10 45379 T Colonoscopy w/fb removal 0143 8.6869 $515.51 $186.06 $103.10 45380 T Colonoscopy and biopsy 0143 8.6869 $515.51 $186.06 $103.10 45381 T Colonoscopy, submucous inj 0143 8.6869 $515.51 $186.06 $103.10 45382 T Colonoscopy/control bleeding 0143 8.6869 $515.51 $186.06 $103.10 45383 T Lesion removal colonoscopy 0143 8.6869 $515.51 $186.06 $103.10 45384 T Lesion remove colonoscopy 0143 8.6869 $515.51 $186.06 $103.10 45385 T Lesion removal colonoscopy 0143 8.6869 $515.51 $186.06 $103.10 45386 T Colonoscopy dilate stricture 0143 8.6869 $515.51 $186.06 $103.10 45387 T Colonoscopy w/stent 0384 22.3392 $1,325.68 $287.93 $265.14 45391 T Colonoscopy w/endoscope us 0143 8.6869 $515.51 $186.06 $103.10 45392 T Colonoscopy w/endoscopic fnb 0143 8.6869 $515.51 $186.06 $103.10 45500 T Repair of rectum 0149 18.0726 $1,072.48 $293.06 $214.50 45505 T Repair of rectum 0150 23.8654 $1,416.24 $437.12 $283.25 45520 T Treatment of rectal prolapse 0098 1.1346 $67.33 $13.47 45540 C Correct rectal prolapse Start Printed Page 50753 45541 T Correct rectal prolapse 0150 23.8654 $1,416.24 $437.12 $283.25 45550 C Repair rectum/remove sigmoid 45560 T Repair of rectocele 0150 23.8654 $1,416.24 $437.12 $283.25 45562 C Exploration/repair of rectum 45563 C Exploration/repair of rectum 45800 C Repair rect/bladder fistula 45805 C Repair fistula w/colostomy 45820 C Repair rectourethral fistula 45825 C Repair fistula w/colostomy 45900 T Reduction of rectal prolapse 0148 3.7383 $221.84 $57.21 $44.37 45905 T Dilation of anal sphincter 0149 18.0726 $1,072.48 $293.06 $214.50 45910 T Dilation of rectal narrowing 0149 18.0726 $1,072.48 $293.06 $214.50 45915 T Remove rectal obstruction 0148 3.7383 $221.84 $57.21 $44.37 45999 T Rectum surgery procedure 0148 3.7383 $221.84 $57.21 $44.37 46020 T Placement of seton 0150 23.8654 $1,416.24 $437.12 $283.25 46030 T Removal of rectal marker 0148 3.7383 $221.84 $57.21 $44.37 46040 T Incision of rectal abscess 0149 18.0726 $1,072.48 $293.06 $214.50 46045 T Incision of rectal abscess 0150 23.8654 $1,416.24 $437.12 $283.25 46050 T Incision of anal abscess 0148 3.7383 $221.84 $57.21 $44.37 46060 T Incision of rectal abscess 0150 23.8654 $1,416.24 $437.12 $283.25 46070 T Incision of anal septum 0155 16.2546 $964.60 $192.92 46080 T Incision of anal sphincter 0149 18.0726 $1,072.48 $293.06 $214.50 46083 T Incise external hemorrhoid 0148 3.7383 $221.84 $57.21 $44.37 46200 T Removal of anal fissure 0150 23.8654 $1,416.24 $437.12 $283.25 46210 T Removal of anal crypt 0149 18.0726 $1,072.48 $293.06 $214.50 46211 T Removal of anal crypts 0150 23.8654 $1,416.24 $437.12 $283.25 46220 T Removal of anal tag 0149 18.0726 $1,072.48 $293.06 $214.50 46221 T Ligation of hemorrhoid(s) 0148 3.7383 $221.84 $57.21 $44.37 46230 T Removal of anal tags 0149 18.0726 $1,072.48 $293.06 $214.50 46250 T Hemorrhoidectomy 0150 23.8654 $1,416.24 $437.12 $283.25 46255 T Hemorrhoidectomy 0150 23.8654 $1,416.24 $437.12 $283.25 46257 T Remove hemorrhoids & fissure 0150 23.8654 $1,416.24 $437.12 $283.25 46258 T Remove hemorrhoids & fistula 0150 23.8654 $1,416.24 $437.12 $283.25 46260 T Hemorrhoidectomy 0150 23.8654 $1,416.24 $437.12 $283.25 46261 T Remove hemorrhoids & fissure 0150 23.8654 $1,416.24 $437.12 $283.25 46262 T Remove hemorrhoids & fistula 0150 23.8654 $1,416.24 $437.12 $283.25 46270 T Removal of anal fistula 0150 23.8654 $1,416.24 $437.12 $283.25 46275 T Removal of anal fistula 0150 23.8654 $1,416.24 $437.12 $283.25 46280 T Removal of anal fistula 0150 23.8654 $1,416.24 $437.12 $283.25 46285 T Removal of anal fistula 0150 23.8654 $1,416.24 $437.12 $283.25 46288 T Repair anal fistula 0150 23.8654 $1,416.24 $437.12 $283.25 46320 T Removal of hemorrhoid clot 0148 3.7383 $221.84 $57.21 $44.37 46500 T Injection into hemorrhoid(s) 0155 16.2546 $964.60 $192.92 46600 X Diagnostic anoscopy 0340 0.6384 $37.88 $7.58 46604 T Anoscopy and dilation 0147 7.9679 $472.84 $94.57 46606 T Anoscopy and biopsy 0146 4.6374 $275.20 $64.40 $55.04 46608 T Anoscopy, remove for body 0147 7.9679 $472.84 $94.57 46610 T Anoscopy, remove lesion 0428 19.9022 $1,181.06 $236.21 46611 T Anoscopy 0147 7.9679 $472.84 $94.57 46612 T Anoscopy, remove lesions 0428 19.9022 $1,181.06 $236.21 46614 T Anoscopy, control bleeding 0146 4.6374 $275.20 $64.40 $55.04 46615 T Anoscopy 0428 19.9022 $1,181.06 $236.21 46700 T Repair of anal stricture 0150 23.8654 $1,416.24 $437.12 $283.25 46705 C Repair of anal stricture 46706 T Repr of anal fistula w/glue 0150 23.8654 $1,416.24 $437.12 $283.25 46715 C Repair of anovaginal fistula 46716 C Repair of anovaginal fistula 46730 C Construction of absent anus 46735 C Construction of absent anus 46740 C Construction of absent anus 46742 C Repair of imperforated anus 46744 C Repair of cloacal anomaly 46746 C Repair of cloacal anomaly 46748 C Repair of cloacal anomaly 46750 T Repair of anal sphincter 0150 23.8654 $1,416.24 $437.12 $283.25 46751 C Repair of anal sphincter Start Printed Page 50754 46753 T Reconstruction of anus 0150 23.8654 $1,416.24 $437.12 $283.25 46754 T Removal of suture from anus 0149 18.0726 $1,072.48 $293.06 $214.50 46760 T Repair of anal sphincter 0150 23.8654 $1,416.24 $437.12 $283.25 46761 T Repair of anal sphincter 0150 23.8654 $1,416.24 $437.12 $283.25 46762 T Implant artificial sphincter 0150 23.8654 $1,416.24 $437.12 $283.25 46900 T Destruction, anal lesion(s) 0016 2.5834 $153.31 $33.57 $30.66 46910 T Destruction, anal lesion(s) 0017 18.4211 $1,093.16 $227.84 $218.63 46916 T Cryosurgery, anal lesion(s) 0013 1.1078 $65.74 $14.20 $13.15 46917 T Laser surgery, anal lesions 0695 20.3164 $1,205.64 $266.59 $241.13 46922 T Excision of anal lesion(s) 0695 20.3164 $1,205.64 $266.59 $241.13 46924 T Destruction, anal lesion(s) 0695 20.3164 $1,205.64 $266.59 $241.13 46934 T Destruction of hemorrhoids 0155 16.2546 $964.60 $192.92 46935 T Destruction of hemorrhoids 0155 16.2546 $964.60 $192.92 46936 T Destruction of hemorrhoids 0149 18.0726 $1,072.48 $293.06 $214.50 46937 T Cryotherapy of rectal lesion 0149 18.0726 $1,072.48 $293.06 $214.50 46938 T Cryotherapy of rectal lesion 0150 23.8654 $1,416.24 $437.12 $283.25 46940 T Treatment of anal fissure 0149 18.0726 $1,072.48 $293.06 $214.50 46942 T Treatment of anal fissure 0148 3.7383 $221.84 $57.21 $44.37 46945 T Ligation of hemorrhoids 0155 16.2546 $964.60 $192.92 46946 T Ligation of hemorrhoids 0155 16.2546 $964.60 $192.92 46947 T Hemorrhoidopexy by stapling 0150 23.8654 $1,416.24 $437.12 $283.25 46999 T Anus surgery procedure 0148 3.7383 $221.84 $57.21 $44.37 47000 T Needle biopsy of liver 0685 6.0174 $357.09 $115.47 $71.42 47001 N Needle biopsy, liver add-on 47010 C Open drainage, liver lesion 47011 T Percut drain, liver lesion 0037 9.4751 $562.28 $224.91 $112.46 47015 C Inject/aspirate liver cyst 47100 C Wedge biopsy of liver 47120 C Partial removal of liver 47122 C Extensive removal of liver 47125 C Partial removal of liver 47130 C Partial removal of liver 47133 C Removal of donor liver 47135 C Transplantation of liver 47136 C Transplantation of liver 47140 C Partial removal, donor liver 47141 C Partial removal, donor liver 47142 C Partial removal, donor liver 47143 C Prep donor liver, whole 47144 C Prep donor liver, 3-segment 47145 C Prep donor liver, lobe split 47146 C Prep donor liver/venous 47147 C Prep donor liver/arterial 47300 C Surgery for liver lesion 47350 C Repair liver wound 47360 C Repair liver wound 47361 C Repair liver wound 47362 C Repair liver wound 47370 T Laparo ablate liver tumor rf 0131 43.3389 $2,571.86 $1,001.89 $514.37 47371 T Laparo ablate liver cryosurg 0131 43.3389 $2,571.86 $1,001.89 $514.37 47379 T Laparoscope procedure, liver 0130 31.9271 $1,894.65 $659.53 $378.93 47380 C Open ablate liver tumor rf 47381 C Open ablate liver tumor cryo 47382 T Percut ablate liver rf 0423 40.2866 $2,390.73 $478.15 47399 T Liver surgery procedure 0002 0.9559 $56.73 $11.35 47400 C Incision of liver duct 47420 C Incision of bile duct 47425 C Incision of bile duct 47460 C Incise bile duct sphincter 47480 C Incision of gallbladder 47490 T Incision of gallbladder 0152 12.2833 $728.93 $145.79 47500 N Injection for liver x-rays 47505 N Injection for liver x-rays 47510 T Insert catheter, bile duct 0152 12.2833 $728.93 $145.79 47511 T Insert bile duct drain 0152 12.2833 $728.93 $145.79 47525 T Change bile duct catheter 0427 10.1977 $605.16 $124.11 $121.03 Start Printed Page 50755 47530 T Revise/reinsert bile tube 0427 10.1977 $605.16 $124.11 $121.03 47550 C Bile duct endoscopy add-on 47552 T Biliary endoscopy thru skin 0152 12.2833 $728.93 $145.79 47553 T Biliary endoscopy thru skin 0152 12.2833 $728.93 $145.79 47554 T Biliary endoscopy thru skin 0152 12.2833 $728.93 $145.79 47555 T Biliary endoscopy thru skin 0152 12.2833 $728.93 $145.79 47556 T Biliary endoscopy thru skin 0152 12.2833 $728.93 $145.79 47560 T Laparoscopy w/cholangio 0130 31.9271 $1,894.65 $659.53 $378.93 47561 T Laparo w/cholangio/biopsy 0130 31.9271 $1,894.65 $659.53 $378.93 47562 T Laparoscopic cholecystectomy 0131 43.3389 $2,571.86 $1,001.89 $514.37 47563 T Laparo cholecystectomy/graph 0131 43.3389 $2,571.86 $1,001.89 $514.37 47564 T Laparo cholecystectomy/explr 0131 43.3389 $2,571.86 $1,001.89 $514.37 47570 C Laparo cholecystoenterostomy 47579 T Laparoscope proc, biliary 0130 31.9271 $1,894.65 $659.53 $378.93 47600 C Removal of gallbladder 47605 C Removal of gallbladder 47610 C Removal of gallbladder 47612 C Removal of gallbladder 47620 C Removal of gallbladder 47630 T Remove bile duct stone 0152 12.2833 $728.93 $145.79 47700 C Exploration of bile ducts 47701 C Bile duct revision 47711 C Excision of bile duct tumor 47712 C Excision of bile duct tumor 47715 C Excision of bile duct cyst 47716 C Fusion of bile duct cyst 47720 C Fuse gallbladder & bowel 47721 C Fuse upper gi structures 47740 C Fuse gallbladder & bowel 47741 C Fuse gallbladder & bowel 47760 C Fuse bile ducts and bowel 47765 C Fuse liver ducts & bowel 47780 C Fuse bile ducts and bowel 47785 C Fuse bile ducts and bowel 47800 C Reconstruction of bile ducts 47801 C Placement, bile duct support 47802 C Fuse liver duct & intestine 47900 C Suture bile duct injury 47999 T Bile tract surgery procedure 0152 12.2833 $728.93 $145.79 48000 C Drainage of abdomen 48001 C Placement of drain, pancreas 48005 C Resect/debride pancreas 48020 C Removal of pancreatic stone 48100 C Biopsy of pancreas, open 48102 T Needle biopsy, pancreas 0685 6.0174 $357.09 $115.47 $71.42 48120 C Removal of pancreas lesion 48140 C Partial removal of pancreas 48145 C Partial removal of pancreas 48146 C Pancreatectomy 48148 C Removal of pancreatic duct 48150 C Partial removal of pancreas 48152 C Pancreatectomy 48153 C Pancreatectomy 48154 C Pancreatectomy 48155 C Removal of pancreas 48160 E Pancreas removal/transplant 48180 C Fuse pancreas and bowel 48400 C Injection, intraop add-on 48500 C Surgery of pancreatic cyst 48510 C Drain pancreatic pseudocyst 48511 T Drain pancreatic pseudocyst 0037 9.4751 $562.28 $224.91 $112.46 48520 C Fuse pancreas cyst and bowel 48540 C Fuse pancreas cyst and bowel 48545 C Pancreatorrhaphy 48547 C Duodenal exclusion 48550 E Donor pancreatectomy Start Printed Page 50756 48551 C Prep donor pancreas 48552 C Prep donor pancreas/venous 48554 E Transpl allograft pancreas 48556 C Removal, allograft pancreas 48999 T Pancreas surgery procedure 0004 1.7646 $104.72 $22.36 $20.94 49000 C Exploration of abdomen 49002 C Reopening of abdomen 49010 C Exploration behind abdomen 49020 C Drain abdominal abscess 49021 T Drain abdominal abscess 0037 9.4751 $562.28 $224.91 $112.46 49040 C Drain, open, abdom abscess 49041 T Drain, percut, abdom abscess 0037 9.4751 $562.28 $224.91 $112.46 49060 C Drain, open, retrop abscess 49061 T Drain, percut, retroper absc 0037 9.4751 $562.28 $224.91 $112.46 49062 C Drain to peritoneal cavity 49080 T Puncture, peritoneal cavity 0070 3.2101 $190.50 $38.10 49081 T Removal of abdominal fluid 0070 3.2101 $190.50 $38.10 49085 T Remove abdomen foreign body 0153 21.6961 $1,287.51 $382.75 $257.50 49180 T Biopsy, abdominal mass 0685 6.0174 $357.09 $115.47 $71.42 49200 T Removal of abdominal lesion 0130 31.9271 $1,894.65 $659.53 $378.93 49201 C Remove abdom lesion, complex 49215 C Excise sacral spine tumor 49220 C Multiple surgery, abdomen 49250 T Excision of umbilicus 0153 21.6961 $1,287.51 $382.75 $257.50 49255 C Removal of omentum 49320 T Diag laparo separate proc 0130 31.9271 $1,894.65 $659.53 $378.93 49321 T Laparoscopy, biopsy 0130 31.9271 $1,894.65 $659.53 $378.93 49322 T Laparoscopy, aspiration 0130 31.9271 $1,894.65 $659.53 $378.93 49323 T Laparo drain lymphocele 0130 31.9271 $1,894.65 $659.53 $378.93 49329 T Laparo proc, abdm/per/oment 0130 31.9271 $1,894.65 $659.53 $378.93 49400 N Air injection into abdomen 49419 T Insrt abdom cath for chemotx 0115 31.4727 $1,867.68 $459.35 $373.54 49420 T Insert abdom drain, temp 0652 28.8948 $1,714.70 $342.94 49421 T Insert abdom drain, perm 0652 28.8948 $1,714.70 $342.94 49422 T Remove perm cannula/catheter 0105 22.3685 $1,327.41 $370.40 $265.48 49423 T Exchange drainage catheter 0152 12.2833 $728.93 $145.79 49424 N Assess cyst, contrast inject 49425 C Insert abdomen-venous drain 49426 T Revise abdomen-venous shunt 0153 21.6961 $1,287.51 $382.75 $257.50 49427 N Injection, abdominal shunt 49428 C Ligation of shunt 49429 T Removal of shunt 0105 22.3685 $1,327.41 $370.40 $265.48 49491 T Rpr hern preemie reduc 0154 28.7847 $1,708.17 $464.85 $341.63 49492 T Rpr ing hern premie, blocked 0154 28.7847 $1,708.17 $464.85 $341.63 49495 T Rpr ing hernia baby, reduc 0154 28.7847 $1,708.17 $464.85 $341.63 49496 T Rpr ing hernia baby, blocked 0154 28.7847 $1,708.17 $464.85 $341.63 49500 T Rpr ing hernia, init, reduce 0154 28.7847 $1,708.17 $464.85 $341.63 49501 T Rpr ing hernia, init blocked 0154 28.7847 $1,708.17 $464.85 $341.63 49505 T Prp i/hern init reduc>5 yr 0154 28.7847 $1,708.17 $464.85 $341.63 49507 T Prp i/hern init block>5 yr 0154 28.7847 $1,708.17 $464.85 $341.63 49520 T Rerepair ing hernia, reduce 0154 28.7847 $1,708.17 $464.85 $341.63 49521 T Rerepair ing hernia, blocked 0154 28.7847 $1,708.17 $464.85 $341.63 49525 T Repair ing hernia, sliding 0154 28.7847 $1,708.17 $464.85 $341.63 49540 T Repair lumbar hernia 0154 28.7847 $1,708.17 $464.85 $341.63 49550 T Rpr rem hernia, init, reduce 0154 28.7847 $1,708.17 $464.85 $341.63 49553 T Rpr fem hernia, init blocked 0154 28.7847 $1,708.17 $464.85 $341.63 49555 T Rerepair fem hernia, reduce 0154 28.7847 $1,708.17 $464.85 $341.63 49557 T Rerepair fem hernia, blocked 0154 28.7847 $1,708.17 $464.85 $341.63 49560 T Rpr ventral hern init, reduc 0154 28.7847 $1,708.17 $464.85 $341.63 49561 T Rpr ventral hern init, block 0154 28.7847 $1,708.17 $464.85 $341.63 49565 T Rerepair ventrl hern, reduce 0154 28.7847 $1,708.17 $464.85 $341.63 49566 T Rerepair ventrl hern, block 0154 28.7847 $1,708.17 $464.85 $341.63 49568 T Hernia repair w/mesh 0154 28.7847 $1,708.17 $464.85 $341.63 49570 T Rpr epigastric hern, reduce 0154 28.7847 $1,708.17 $464.85 $341.63 49572 T Rpr epigastric hern, blocked 0154 28.7847 $1,708.17 $464.85 $341.63 49580 T Rpr umbil hern, reduc < 5 yr 0154 28.7847 $1,708.17 $464.85 $341.63 Start Printed Page 50757 49582 T Rpr umbil hern, block < 5 yr 0154 28.7847 $1,708.17 $464.85 $341.63 49585 T Rpr umbil hern, reduc > 5 yr 0154 28.7847 $1,708.17 $464.85 $341.63 49587 T Rpr umbil hern, block > 5 yr 0154 28.7847 $1,708.17 $464.85 $341.63 49590 T Repair spigilian hernia 0154 28.7847 $1,708.17 $464.85 $341.63 49600 T Repair umbilical lesion 0154 28.7847 $1,708.17 $464.85 $341.63 49605 C Repair umbilical lesion 49606 C Repair umbilical lesion 49610 C Repair umbilical lesion 49611 C Repair umbilical lesion 49650 T Laparo hernia repair initial 0131 43.3389 $2,571.86 $1,001.89 $514.37 49651 T Laparo hernia repair recur 0131 43.3389 $2,571.86 $1,001.89 $514.37 49659 T Laparo proc, hernia repair 0130 31.9271 $1,894.65 $659.53 $378.93 49900 C Repair of abdominal wall 49904 C Omental flap, extra-abdom 49905 C Omental flap 49906 C Free omental flap, microvasc 49999 T Abdomen surgery procedure 0153 21.6961 $1,287.51 $382.75 $257.50 50010 C Exploration of kidney 50020 T Renal abscess, open drain 0162 23.3918 $1,388.14 $277.63 50021 T Renal abscess, percut drain 0037 9.4751 $562.28 $224.91 $112.46 50040 C Drainage of kidney 50045 C Exploration of kidney 50060 C Removal of kidney stone 50065 C Incision of kidney 50070 C Incision of kidney 50075 C Removal of kidney stone 50080 T Removal of kidney stone 0429 42.3147 $2,511.08 $502.22 50081 T Removal of kidney stone 0429 42.3147 $2,511.08 $502.22 50100 C Revise kidney blood vessels 50120 C Exploration of kidney 50125 C Explore and drain kidney 50130 C Removal of kidney stone 50135 C Exploration of kidney 50200 T Biopsy of kidney 0685 6.0174 $357.09 $115.47 $71.42 50205 C Biopsy of kidney 50220 C Remove kidney, open 50225 C Removal kidney open, complex 50230 C Removal kidney open, radical 50234 C Removal of kidney & ureter 50236 C Removal of kidney & ureter 50240 C Partial removal of kidney 50280 C Removal of kidney lesion 50290 C Removal of kidney lesion 50300 C Removal of donor kidney 50320 C Removal of donor kidney 50323 C Prep cadaver renal allograft 50325 C Prep donor renal graft 50327 C Prep renal graft/venous 50328 C Prep renal graft/arterial 50329 C Prep renal graft/ureteral 50340 C Removal of kidney 50360 C Transplantation of kidney 50365 C Transplantation of kidney 50370 C Remove transplanted kidney 50380 C Reimplantation of kidney 50390 T Drainage of kidney lesion 0685 6.0174 $357.09 $115.47 $71.42 50391 T Instll rx agnt into rnal tub 0156 2.5751 $152.81 $40.52 $30.56 50392 T Insert kidney drain 0161 18.5576 $1,101.26 $249.36 $220.25 50393 T Insert ureteral tube 0161 18.5576 $1,101.26 $249.36 $220.25 50394 N Injection for kidney x-ray 50395 T Create passage to kidney 0161 18.5576 $1,101.26 $249.36 $220.25 50396 T Measure kidney pressure 0164 1.1855 $70.35 $17.29 $14.07 50398 T Change kidney tube 0122 6.9721 $413.75 $84.85 $82.75 50400 C Revision of kidney/ureter 50405 C Revision of kidney/ureter 50500 C Repair of kidney wound Start Printed Page 50758 50520 C Close kidney-skin fistula 50525 C Repair renal-abdomen fistula 50526 C Repair renal-abdomen fistula 50540 C Revision of horseshoe kidney 50541 T Laparo ablate renal cyst 0130 31.9271 $1,894.65 $659.53 $378.93 50542 T Laparo ablate renal mass 0131 43.3389 $2,571.86 $1,001.89 $514.37 50543 T Laparo partial nephrectomy 0131 43.3389 $2,571.86 $1,001.89 $514.37 50544 T Laparoscopy, pyeloplasty 0130 31.9271 $1,894.65 $659.53 $378.93 50545 C Laparo radical nephrectomy 50546 C Laparoscopic nephrectomy 50547 C Laparo removal donor kidney 50548 C Laparo remove w/ ureter 50549 T Laparoscope proc, renal 0130 31.9271 $1,894.65 $659.53 $378.93 50551 T Kidney endoscopy 0160 6.6753 $396.13 $105.06 $79.23 50553 T Kidney endoscopy 0161 18.5576 $1,101.26 $249.36 $220.25 50555 T Kidney endoscopy & biopsy 0160 6.6753 $396.13 $105.06 $79.23 50557 T Kidney endoscopy & treatment 0162 23.3918 $1,388.14 $277.63 50561 T Kidney endoscopy & treatment 0161 18.5576 $1,101.26 $249.36 $220.25 50562 T Renal scope w/tumor resect 0160 6.6753 $396.13 $105.06 $79.23 50570 T Kidney endoscopy 0160 6.6753 $396.13 $105.06 $79.23 50572 T Kidney endoscopy 0160 6.6753 $396.13 $105.06 $79.23 50574 T Kidney endoscopy & biopsy 0160 6.6753 $396.13 $105.06 $79.23 50575 T Kidney endoscopy 0163 33.7354 $2,001.96 $400.39 50576 T Kidney endoscopy & treatment 0161 18.5576 $1,101.26 $249.36 $220.25 50580 C Kidney endoscopy & treatment 50590 T Fragmenting of kidney stone 0169 43.0133 $2,552.54 $1,021.01 $510.51 50600 C Exploration of ureter 50605 C Insert ureteral support 50610 C Removal of ureter stone 50620 C Removal of ureter stone 50630 C Removal of ureter stone 50650 C Removal of ureter 50660 C Removal of ureter 50684 N Injection for ureter x-ray 50686 T Measure ureter pressure 0164 1.1855 $70.35 $17.29 $14.07 50688 T Change of ureter tube 0122 6.9721 $413.75 $84.85 $82.75 50690 N Injection for ureter x-ray 50700 C Revision of ureter 50715 C Release of ureter 50722 C Release of ureter 50725 C Release/revise ureter 50727 C Revise ureter 50728 C Revise ureter 50740 C Fusion of ureter & kidney 50750 C Fusion of ureter & kidney 50760 C Fusion of ureters 50770 C Splicing of ureters 50780 C Reimplant ureter in bladder 50782 C Reimplant ureter in bladder 50783 C Reimplant ureter in bladder 50785 C Reimplant ureter in bladder 50800 C Implant ureter in bowel 50810 C Fusion of ureter & bowel 50815 C Urine shunt to intestine 50820 C Construct bowel bladder 50825 C Construct bowel bladder 50830 C Revise urine flow 50840 C Replace ureter by bowel 50845 C Appendico-vesicostomy 50860 C Transplant ureter to skin 50900 C Repair of ureter 50920 C Closure ureter/skin fistula 50930 C Closure ureter/bowel fistula 50940 C Release of ureter 50945 T Laparoscopy ureterolithotomy 0131 43.3389 $2,571.86 $1,001.89 $514.37 50947 T Laparo new ureter/bladder 0131 43.3389 $2,571.86 $1,001.89 $514.37 Start Printed Page 50759 50948 T Laparo new ureter/bladder 0131 43.3389 $2,571.86 $1,001.89 $514.37 50949 T Laparoscope proc, ureter 0130 31.9271 $1,894.65 $659.53 $378.93 50951 T Endoscopy of ureter 0160 6.6753 $396.13 $105.06 $79.23 50953 T Endoscopy of ureter 0160 6.6753 $396.13 $105.06 $79.23 50955 T Ureter endoscopy & biopsy 0161 18.5576 $1,101.26 $249.36 $220.25 50957 T Ureter endoscopy & treatment 0161 18.5576 $1,101.26 $249.36 $220.25 50961 T Ureter endoscopy & treatment 0161 18.5576 $1,101.26 $249.36 $220.25 50970 T Ureter endoscopy 0160 6.6753 $396.13 $105.06 $79.23 50972 T Ureter endoscopy & catheter 0160 6.6753 $396.13 $105.06 $79.23 50974 T Ureter endoscopy & biopsy 0161 18.5576 $1,101.26 $249.36 $220.25 50976 T Ureter endoscopy & treatment 0161 18.5576 $1,101.26 $249.36 $220.25 50980 T Ureter endoscopy & treatment 0161 18.5576 $1,101.26 $249.36 $220.25 51000 T Drainage of bladder 0164 1.1855 $70.35 $17.29 $14.07 51005 T Drainage of bladder 0164 1.1855 $70.35 $17.29 $14.07 51010 T Drainage of bladder 0165 16.6689 $989.18 $197.84 51020 T Incise & treat bladder 0162 23.3918 $1,388.14 $277.63 51030 T Incise & treat bladder 0162 23.3918 $1,388.14 $277.63 51040 T Incise & drain bladder 0162 23.3918 $1,388.14 $277.63 51045 T Incise bladder/drain ureter 0160 6.6753 $396.13 $105.06 $79.23 51050 T Removal of bladder stone 0162 23.3918 $1,388.14 $277.63 51060 C Removal of ureter stone 51065 T Remove ureter calculus 0162 23.3918 $1,388.14 $277.63 51080 T Drainage of bladder abscess 0008 16.4989 $979.09 $195.82 51500 T Removal of bladder cyst 0154 28.7847 $1,708.17 $464.85 $341.63 51520 T Removal of bladder lesion 0162 23.3918 $1,388.14 $277.63 51525 C Removal of bladder lesion 51530 C Removal of bladder lesion 51535 C Repair of ureter lesion 51550 C Partial removal of bladder 51555 C Partial removal of bladder 51565 C Revise bladder & ureter(s) 51570 C Removal of bladder 51575 C Removal of bladder & nodes 51580 C Remove bladder/revise tract 51585 C Removal of bladder & nodes 51590 C Remove bladder/revise tract 51595 C Remove bladder/revise tract 51596 C Remove bladder/create pouch 51597 C Removal of pelvic structures 51600 N Injection for bladder x-ray 51605 N Preparation for bladder xray 51610 N Injection for bladder x-ray 51700 T Irrigation of bladder 0164 1.1855 $70.35 $17.29 $14.07 51701 X Insert bladder catheter 0340 0.6384 $37.88 $7.58 51702 X Insert temp bladder cath 0340 0.6384 $37.88 $7.58 51703 T Insert bladder cath, complex 0164 1.1855 $70.35 $17.29 $14.07 51705 T Change of bladder tube 0121 2.2766 $135.10 $43.80 $27.02 51710 T Change of bladder tube 0122 6.9721 $413.75 $84.85 $82.75 51715 T Endoscopic injection/implant 0168 28.2685 $1,677.54 $388.03 $335.51 51720 T Treatment of bladder lesion 0156 2.5751 $152.81 $40.52 $30.56 51725 T Simple cystometrogram 0156 2.5751 $152.81 $40.52 $30.56 51726 T Complex cystometrogram 0156 2.5751 $152.81 $40.52 $30.56 51736 T Urine flow measurement 0164 1.1855 $70.35 $17.29 $14.07 51741 T Electro-uroflowmetry, first 0164 1.1855 $70.35 $17.29 $14.07 51772 T Urethra pressure profile 0156 2.5751 $152.81 $40.52 $30.56 51784 T Anal/urinary muscle study 0164 1.1855 $70.35 $17.29 $14.07 51785 T Anal/urinary muscle study 0164 1.1855 $70.35 $17.29 $14.07 51792 T Urinary reflex study 0164 1.1855 $70.35 $17.29 $14.07 51795 T Urine voiding pressure study 0164 1.1855 $70.35 $17.29 $14.07 51797 T Intraabdominal pressure test 0164 1.1855 $70.35 $17.29 $14.07 51798 X Us urine capacity measure 0340 0.6384 $37.88 $7.58 51800 C Revision of bladder/urethra 51820 C Revision of urinary tract 51840 C Attach bladder/urethra 51841 C Attach bladder/urethra 51845 C Repair bladder neck Start Printed Page 50760 51860 C Repair of bladder wound 51865 C Repair of bladder wound 51880 T Repair of bladder opening 0162 23.3918 $1,388.14 $277.63 51900 C Repair bladder/vagina lesion 51920 C Close bladder-uterus fistula 51925 C Hysterectomy/bladder repair 51940 C Correction of bladder defect 51960 C Revision of bladder & bowel 51980 C Construct bladder opening 51990 T Laparo urethral suspension 0131 43.3389 $2,571.86 $1,001.89 $514.37 51992 T Laparo sling operation 0132 62.9914 $3,738.10 $1,239.22 $747.62 52000 T Cystoscopy 0160 6.6753 $396.13 $105.06 $79.23 52001 T Cystoscopy, removal of clots 0160 6.6753 $396.13 $105.06 $79.23 52005 T Cystoscopy & ureter catheter 0161 18.5576 $1,101.26 $249.36 $220.25 52007 T Cystoscopy and biopsy 0161 18.5576 $1,101.26 $249.36 $220.25 52010 T Cystoscopy & duct catheter 0160 6.6753 $396.13 $105.06 $79.23 52204 T Cystoscopy 0161 18.5576 $1,101.26 $249.36 $220.25 52214 T Cystoscopy and treatment 0162 23.3918 $1,388.14 $277.63 52224 T Cystoscopy and treatment 0162 23.3918 $1,388.14 $277.63 52234 T Cystoscopy and treatment 0162 23.3918 $1,388.14 $277.63 52235 T Cystoscopy and treatment 0162 23.3918 $1,388.14 $277.63 52240 T Cystoscopy and treatment 0162 23.3918 $1,388.14 $277.63 52250 T Cystoscopy and radiotracer 0162 23.3918 $1,388.14 $277.63 52260 T Cystoscopy and treatment 0161 18.5576 $1,101.26 $249.36 $220.25 52265 T Cystoscopy and treatment 0160 6.6753 $396.13 $105.06 $79.23 52270 T Cystoscopy & revise urethra 0161 18.5576 $1,101.26 $249.36 $220.25 52275 T Cystoscopy & revise urethra 0161 18.5576 $1,101.26 $249.36 $220.25 52276 T Cystoscopy and treatment 0161 18.5576 $1,101.26 $249.36 $220.25 52277 T Cystoscopy and treatment 0162 23.3918 $1,388.14 $277.63 52281 T Cystoscopy and treatment 0161 18.5576 $1,101.26 $249.36 $220.25 52282 T Cystoscopy, implant stent 0163 33.7354 $2,001.96 $400.39 52283 T Cystoscopy and treatment 0161 18.5576 $1,101.26 $249.36 $220.25 52285 T Cystoscopy and treatment 0161 18.5576 $1,101.26 $249.36 $220.25 52290 T Cystoscopy and treatment 0161 18.5576 $1,101.26 $249.36 $220.25 52300 T Cystoscopy and treatment 0161 18.5576 $1,101.26 $249.36 $220.25 52301 T Cystoscopy and treatment 0161 18.5576 $1,101.26 $249.36 $220.25 52305 T Cystoscopy and treatment 0161 18.5576 $1,101.26 $249.36 $220.25 52310 T Cystoscopy and treatment 0160 6.6753 $396.13 $105.06 $79.23 52315 T Cystoscopy and treatment 0161 18.5576 $1,101.26 $249.36 $220.25 52317 T Remove bladder stone 0162 23.3918 $1,388.14 $277.63 52318 T Remove bladder stone 0162 23.3918 $1,388.14 $277.63 52320 T Cystoscopy and treatment 0162 23.3918 $1,388.14 $277.63 52325 T Cystoscopy, stone removal 0162 23.3918 $1,388.14 $277.63 52327 T Cystoscopy, inject material 0162 23.3918 $1,388.14 $277.63 52330 T Cystoscopy and treatment 0162 23.3918 $1,388.14 $277.63 52332 T Cystoscopy and treatment 0162 23.3918 $1,388.14 $277.63 52334 T Create passage to kidney 0162 23.3918 $1,388.14 $277.63 52341 T Cysto w/ureter stricture tx 0162 23.3918 $1,388.14 $277.63 52342 T Cysto w/up stricture tx 0162 23.3918 $1,388.14 $277.63 52343 T Cysto w/renal stricture tx 0162 23.3918 $1,388.14 $277.63 52344 T Cysto/uretero, stone remove 0162 23.3918 $1,388.14 $277.63 52345 T Cysto/uretero w/up stricture 0162 23.3918 $1,388.14 $277.63 52346 T Cystouretero w/renal strict 0162 23.3918 $1,388.14 $277.63 52351 T Cystouretero & or pyeloscope 0161 18.5576 $1,101.26 $249.36 $220.25 52352 T Cystouretero w/stone remove 0162 23.3918 $1,388.14 $277.63 52353 T Cystouretero w/lithotripsy 0163 33.7354 $2,001.96 $400.39 52354 T Cystouretero w/biopsy 0162 23.3918 $1,388.14 $277.63 52355 T Cystouretero w/excise tumor 0162 23.3918 $1,388.14 $277.63 52400 T Cystouretero w/congen repr 0162 23.3918 $1,388.14 $277.63 52402 T Cystourethro cut ejacul duct 0162 23.3918 $1,388.14 $277.63 52450 T Incision of prostate 0162 23.3918 $1,388.14 $277.63 52500 T Revision of bladder neck 0162 23.3918 $1,388.14 $277.63 52510 T Dilation prostatic urethra 0161 18.5576 $1,101.26 $249.36 $220.25 52601 T Prostatectomy (TURP) 0163 33.7354 $2,001.96 $400.39 52606 T Control postop bleeding 0162 23.3918 $1,388.14 $277.63 52612 T Prostatectomy, first stage 0163 33.7354 $2,001.96 $400.39 Start Printed Page 50761 52614 T Prostatectomy, second stage 0163 33.7354 $2,001.96 $400.39 52620 T Remove residual prostate 0163 33.7354 $2,001.96 $400.39 52630 T Remove prostate regrowth 0163 33.7354 $2,001.96 $400.39 52640 T Relieve bladder contracture 0162 23.3918 $1,388.14 $277.63 52647 T Laser surgery of prostate 0429 42.3147 $2,511.08 $502.22 52648 T Laser surgery of prostate 0429 42.3147 $2,511.08 $502.22 52700 T Drainage of prostate abscess 0162 23.3918 $1,388.14 $277.63 53000 T Incision of urethra 0166 17.6743 $1,048.85 $218.73 $209.77 53010 T Incision of urethra 0166 17.6743 $1,048.85 $218.73 $209.77 53020 T Incision of urethra 0166 17.6743 $1,048.85 $218.73 $209.77 53025 T Incision of urethra 0166 17.6743 $1,048.85 $218.73 $209.77 53040 T Drainage of urethra abscess 0166 17.6743 $1,048.85 $218.73 $209.77 53060 T Drainage of urethra abscess 0166 17.6743 $1,048.85 $218.73 $209.77 53080 T Drainage of urinary leakage 0166 17.6743 $1,048.85 $218.73 $209.77 53085 T Drainage of urinary leakage 0166 17.6743 $1,048.85 $218.73 $209.77 53200 T Biopsy of urethra 0166 17.6743 $1,048.85 $218.73 $209.77 53210 T Removal of urethra 0168 28.2685 $1,677.54 $388.03 $335.51 53215 T Removal of urethra 0166 17.6743 $1,048.85 $218.73 $209.77 53220 T Treatment of urethra lesion 0168 28.2685 $1,677.54 $388.03 $335.51 53230 T Removal of urethra lesion 0168 28.2685 $1,677.54 $388.03 $335.51 53235 T Removal of urethra lesion 0166 17.6743 $1,048.85 $218.73 $209.77 53240 T Surgery for urethra pouch 0168 28.2685 $1,677.54 $388.03 $335.51 53250 T Removal of urethra gland 0166 17.6743 $1,048.85 $218.73 $209.77 53260 T Treatment of urethra lesion 0166 17.6743 $1,048.85 $218.73 $209.77 53265 T Treatment of urethra lesion 0166 17.6743 $1,048.85 $218.73 $209.77 53270 T Removal of urethra gland 0166 17.6743 $1,048.85 $218.73 $209.77 53275 T Repair of urethra defect 0166 17.6743 $1,048.85 $218.73 $209.77 53400 T Revise urethra, stage 1 0168 28.2685 $1,677.54 $388.03 $335.51 53405 T Revise urethra, stage 2 0168 128.2685 $1,677.54 $388.03 $335.51 53410 T Reconstruction of urethra 0168 28.2685 $1,677.54 $388.03 $335.51 53415 C Reconstruction of urethra 53420 T Reconstruct urethra, stage 1 0168 28.2685 $1,677.54 $388.03 $335.51 53425 T Reconstruct urethra, stage 2 0168 28.2685 $1,677.54 $388.03 $335.51 53430 T Reconstruction of urethra 0168 28.2685 $1,677.54 $388.03 $335.51 53431 T Reconstruct urethra/bladder 0168 28.2685 $1,677.54 $388.03 $335.51 53440 S Correct bladder function 0385 75.6446 $4,488.98 $897.80 53442 T Remove perineal prosthesis 0168 28.2685 $1,677.54 $388.03 $335.51 53444 S Insert tandem cuff 0385 75.6446 $4,488.98 $897.80 53445 S Insert uro/ves nck sphincter 0386 120.1694 $7,131.21 $1,426.24 53446 T Remove uro sphincter 0168 28.2685 $1,677.54 $388.03 $335.51 53447 S Remove/replace ur sphincter 0386 120.1694 $7,131.21 $1,426.24 53448 C Remov/replc ur sphinctr comp 53449 T Repair uro sphincter 0168 28.2685 $1,677.54 $388.03 $335.51 53450 T Revision of urethra 0168 28.2685 $1,677.54 $388.03 $335.51 53460 T Revision of urethra 0166 17.6743 $1,048.85 $218.73 $209.77 53500 T Urethrlys, transvag w/ scope 0168 28.2685 $1,677.54 $388.03 $335.51 53502 T Repair of urethra injury 0166 17.6743 $1,048.85 $218.73 $209.77 53505 T Repair of urethra injury 0168 28.2685 $1,677.54 $388.03 $335.51 53510 T Repair of urethra injury 0166 17.6743 $1,048.85 $218.73 $209.77 53515 T Repair of urethra injury 0168 28.2685 $1,677.54 $388.03 $335.51 53520 T Repair of urethra defect 0168 28.2685 $1,677.54 $388.03 $335.51 53600 T Dilate urethra stricture 0156 2.5751 $152.81 $40.52 $30.56 53601 T Dilate urethra stricture 0164 1.1855 $70.35 $17.29 $14.07 53605 T Dilate urethra stricture 0161 18.5576 $1,101.26 $249.36 $220.25 53620 T Dilate urethra stricture 0165 16.6689 $989.18 $197.84 53621 T Dilate urethra stricture 0164 1.1855 $70.35 $17.29 $14.07 53660 T Dilation of urethra 0164 1.1855 $70.35 $17.29 $14.07 53661 T Dilation of urethra 0164 1.1855 $70.35 $17.29 $14.07 53665 T Dilation of urethra 0166 17.6743 $1,048.85 $218.73 $209.77 53850 T Prostatic microwave thermotx 0675 43.7329 $2,595.24 $519.05 53852 T Prostatic rf thermotx 0675 43.7329 $2,595.24 $519.05 53853 T Prostatic water thermother 0162 23.3918 $1,388.14 $277.63 53899 T Urology surgery procedure 0164 1.1855 $70.35 $17.29 $14.07 54000 T Slitting of prepuce 0166 17.6743 $1,048.85 $218.73 $209.77 54001 T Slitting of prepuce 0166 17.6743 $1,048.85 $218.73 $209.77 54015 T Drain penis lesion 0008 16.4989 $979.09 $195.82 Start Printed Page 50762 54050 T Destruction, penis lesion(s) 0013 1.1078 $65.74 $14.20 $13.15 54055 T Destruction, penis lesion(s) 0017 18.4211 $1,093.16 $227.84 $218.63 54056 T Cryosurgery, penis lesion(s) 0012 0.8497 $50.42 $11.18 $10.08 54057 T Laser surg, penis lesion(s) 0017 18.4211 $1,093.16 $227.84 $218.63 54060 T Excision of penis lesion(s) 0017 18.4211 $1,093.16 $227.84 $218.63 54065 T Destruction, penis lesion(s) 0695 20.3164 $1,205.64 $266.59 $241.13 54100 T Biopsy of penis 0021 14.9776 $888.82 $219.48 $177.76 54105 T Biopsy of penis 0022 19.6472 $1,165.92 $354.45 $233.18 54110 T Treatment of penis lesion 0181 30.8663 $1,831.70 $621.82 $366.34 54111 T Treat penis lesion, graft 0181 30.8663 $1,831.70 $621.82 $366.34 54112 T Treat penis lesion, graft 0181 30.8663 $1,831.70 $621.82 $366.34 54115 T Treatment of penis lesion 0008 16.4989 $979.09 $195.82 54120 T Partial removal of penis 0181 30.8663 $1,831.70 $621.82 $366.34 54125 C Removal of penis 54130 C Remove penis & nodes 54135 C Remove penis & nodes 54150 T Circumcision 0180 19.8827 $1,179.90 $304.87 $235.98 54152 T Circumcision 0180 19.8827 $1,179.90 $304.87 $235.98 54160 T Circumcision 0180 19.8827 $1,179.90 $304.87 $235.98 54161 T Circumcision 0180 19.8827 $1,179.90 $304.87 $235.98 54162 T Lysis penil circumic lesion 0180 19.8827 $1,179.90 $304.87 $235.98 54163 T Repair of circumcision 0180 19.8827 $1,179.90 $304.87 $235.98 54164 T Frenulotomy of penis 0180 19.8827 $1,179.90 $304.87 $235.98 54200 T Treatment of penis lesion 0156 2.5751 $152.81 $40.52 $30.56 54205 T Treatment of penis lesion 0181 30.8663 $1,831.70 $621.82 $366.34 54220 T Treatment of penis lesion 0156 2.5751 $152.81 $40.52 $30.56 54230 N Prepare penis study 54231 T Dynamic cavernosometry 0165 16.6689 $989.18 $197.84 54235 T Penile injection 0164 1.1855 $70.35 $17.29 $14.07 54240 T Penis study 0164 1.1855 $70.35 $17.29 $14.07 54250 T Penis study 0164 1.1855 $70.35 $17.29 $14.07 54300 T Revision of penis 0181 30.8663 $1,831.70 $621.82 $366.34 54304 T Revision of penis 0181 30.8663 $1,831.70 $621.82 $366.34 54308 T Reconstruction of urethra 0181 30.8663 $1,831.70 $621.82 $366.34 54312 T Reconstruction of urethra 0181 30.8663 $1,831.70 $621.82 $366.34 54316 T Reconstruction of urethra 0181 30.8663 $1,831.70 $621.82 $366.34 54318 T Reconstruction of urethra 0181 30.8663 $1,831.70 $621.82 $366.34 54322 T Reconstruction of urethra 0181 30.8663 $1,831.70 $621.82 $366.34 54324 T Reconstruction of urethra 0181 30.8663 $1,831.70 $621.82 $366.34 54326 T Reconstruction of urethra 0181 30.8663 $1,831.70 $621.82 $366.34 54328 T Revise penis/urethra 0181 30.8663 $1,831.70 $621.82 $366.34 54332 C Revise penis/urethra 54336 C Revise penis/urethra 54340 T Secondary urethral surgery 0181 30.8663 $1,831.70 $621.82 $366.34 54344 T Secondary urethral surgery 0181 30.8663 $1,831.70 $621.82 $366.34 54348 T Secondary urethral surgery 0181 30.8663 $1,831.70 $621.82 $366.34 54352 T Reconstruct urethra/penis 0181 30.8663 $1,831.70 $621.82 $366.34 54360 T Penis plastic surgery 0181 30.8663 $1,831.70 $621.82 $366.34 54380 T Repair penis 0181 30.8663 $1,831.70 $621.82 $366.34 54385 T Repair penis 0181 30.8663 $1,831.70 $621.82 $366.34 54390 C Repair penis and bladder 54400 S Insert semi-rigid prosthesis 0385 75.6446 $4,488.98 $897.80 54401 S Insert self-contd prosthesis 0386 120.1694 $7,131.21 $1,426.24 54405 S Insert multi-comp penis pros 0386 120.1694 $7,131.21 $1,426.24 54406 T Remove muti-comp penis pros 0181 30.8663 $1,831.70 $621.82 $366.34 54408 T Repair multi-comp penis pros 0181 30.8663 $1,831.70 $621.82 $366.34 54410 S Remove/replace penis prosth 0386 120.1694 $7,131.21 $1,426.24 54411 C Remov/replc penis pros, comp 54415 T Remove self-contd penis pros 0181 30.8663 $1,831.70 $621.82 $366.34 54416 S Remv/repl penis contain pros 0386 120.1694 $7,131.21 $1,426.24 54417 C Remv/replc penis pros, compl 54420 T Revision of penis 0181 30.8663 $1,831.70 $621.82 $366.34 54430 C Revision of penis 54435 T Revision of penis 0181 30.8663 $1,831.70 $621.82 $366.34 54440 T Repair of penis 0181 30.8663 $1,831.70 $621.82 $366.34 54450 T Preputial stretching 0156 2.5751 $152.81 $40.52 $30.56 Start Printed Page 50763 54500 T Biopsy of testis 0037 9.4751 $562.28 $224.91 $112.46 54505 T Biopsy of testis 0183 23.6415 $1,402.96 $280.59 54512 T Excise lesion testis 0183 23.6415 $1,402.96 $280.59 54520 T Removal of testis 0183 23.6415 $1,402.96 $280.59 54522 T Orchiectomy, partial 0183 23.6415 $1,402.96 $280.59 54530 T Removal of testis 0154 28.7847 $1,708.17 $464.85 $341.63 54535 C Extensive testis surgery 54550 T Exploration for testis 0154 28.7847 $1,708.17 $464.85 $341.63 54560 T Exploration for testis 0183 23.6415 $1,402.96 $280.59 54600 T Reduce testis torsion 0183 23.6415 $1,402.96 $280.59 54620 T Suspension of testis 0183 23.6415 $1,402.96 $280.59 54640 T Suspension of testis 0154 28.7847 $1,708.17 $464.85 $341.63 54650 C Orchiopexy (Fowler-Stephens) 54660 T Revision of testis 0183 23.6415 $1,402.96 $280.59 54670 T Repair testis injury 0183 23.6415 $1,402.96 $280.59 54680 T Relocation of testis(es) 0183 23.6415 $1,402.96 $280.59 54690 T Laparoscopy, orchiectomy 0131 43.3389 $2,571.86 $1,001.89 $514.37 54692 T Laparoscopy, orchiopexy 0132 62.9914 $3,738.10 $1,239.22 $747.62 54699 T Laparoscope proc, testis 0130 31.9271 $1,894.65 $659.53 $378.93 54700 T Drainage of scrotum 0183 23.6415 $1,402.96 $280.59 54800 T Biopsy of epididymis 0004 1.7646 $104.72 $22.36 $20.94 54820 T Exploration of epididymis 0183 23.6415 $1,402.96 $280.59 54830 T Remove epididymis lesion 0183 23.6415 $1,402.96 $280.59 54840 T Remove epididymis lesion 0183 23.6415 $1,402.96 $280.59 54860 T Removal of epididymis 0183 23.6415 $1,402.96 $280.59 54861 T Removal of epididymis 0183 23.6415 $1,402.96 $280.59 54900 T Fusion of spermatic ducts 0183 23.6415 $1,402.96 $280.59 54901 T Fusion of spermatic ducts 0183 23.6415 $1,402.96 $280.59 55000 T Drainage of hydrocele 0004 1.7646 $104.72 $22.36 $20.94 55040 T Removal of hydrocele 0154 28.7847 $1,708.17 $464.85 $341.63 55041 T Removal of hydroceles 0154 28.7847 $1,708.17 $464.85 $341.63 55060 T Repair of hydrocele 0183 23.6415 $1,402.96 $280.59 55100 T Drainage of scrotum abscess 0008 16.4989 $979.09 $195.82 55110 T Explore scrotum 0183 23.6415 $1,402.96 $280.59 55120 T Removal of scrotum lesion 0183 23.6415 $1,402.96 $280.59 55150 T Removal of scrotum 0183 23.6415 $1,402.96 $280.59 55175 T Revision of scrotum 0183 23.6415 $1,402.96 $280.59 55180 T Revision of scrotum 0183 23.6415 $1,402.96 $280.59 55200 T Incision of sperm duct 0183 23.6415 $1,402.96 $280.59 55250 T Removal of sperm duct(s) 0183 23.6415 $1,402.96 $280.59 55300 N Prepare, sperm duct x-ray 55400 T Repair of sperm duct 0183 23.6415 $1,402.96 $280.59 55450 T Ligation of sperm duct 0183 23.6415 $1,402.96 $280.59 55500 T Removal of hydrocele 0183 23.6415 $1,402.96 $280.59 55520 T Removal of sperm cord lesion 0183 23.6415 $1,402.96 $280.59 55530 T Revise spermatic cord veins 0183 23.6415 $1,402.96 $280.59 55535 T Revise spermatic cord veins 0154 28.7847 $1,708.17 $464.85 $341.63 55540 T Revise hernia & sperm veins 0154 28.7847 $1,708.17 $464.85 $341.63 55550 T Laparo ligate spermatic vein 0131 43.3389 $2,571.86 $1,001.89 $514.37 55559 T Laparo proc, spermatic cord 0130 31.9271 $1,894.65 $659.53 $378.93 55600 T Incise sperm duct pouch 0183 23.6415 $1,402.96 $280.59 55605 C Incise sperm duct pouch 55650 C Remove sperm duct pouch 55680 T Remove sperm pouch lesion 0183 23.6415 $1,402.96 $280.59 55700 T Biopsy of prostate 0184 4.3566 $258.53 $96.27 $51.71 55705 T Biopsy of prostate 0184 4.3566 $258.53 $96.27 $51.71 55720 T Drainage of prostate abscess 0162 23.3918 $1,388.14 $277.63 55725 T Drainage of prostate abscess 0162 23.3918 $1,388.14 $277.63 55801 C Removal of prostate 55810 C Extensive prostate surgery 55812 C Extensive prostate surgery 55815 C Extensive prostate surgery 55821 C Removal of prostate 55831 C Removal of prostate 55840 C Extensive prostate surgery 55842 C Extensive prostate surgery Start Printed Page 50764 55845 C Extensive prostate surgery 55859 T Percut/needle insert, pros 0163 33.7354 $2,001.96 $400.39 55860 T Surgical exposure, prostate 0165 16.6689 $989.18 $197.84 55862 C Extensive prostate surgery 55865 C Extensive prostate surgery 55866 C Laparo radical prostatectomy 55870 T Electroejaculation 0197 2.3572 $139.88 $27.98 55873 T Cryoablate prostate 0674 95.7856 $5,684.20 $1,136.84 55899 T Genital surgery procedure 0164 1.1855 $70.35 $17.29 $14.07 55970 E Sex transformation, M to F 55980 E Sex transformation, F to M 56405 T I & D of vulva/perineum 0189 2.371 $140.70 $28.14 56420 T Drainage of gland abscess 0189 2.371 $140.70 $28.14 56440 T Surgery for vulva lesion 0194 20.7525 $1,231.52 $397.84 $246.30 56441 T Lysis of labial lesion(s) 0193 14.5843 $865.48 $173.10 56501 T Destroy, vulva lesions, sim 0017 18.4211 $1,093.16 $227.84 $218.63 56515 T Destroy vulva lesion/s compl 0695 20.3164 $1,205.64 $266.59 $241.13 56605 T Biopsy of vulva/perineum 0019 4.0547 $240.62 $71.87 $48.12 56606 T Biopsy of vulva/perineum 0019 4.0547 $240.62 $71.87 $48.12 56620 T Partial removal of vulva 0195 26.6791 $1,583.22 $483.80 $316.64 56625 T Complete removal of vulva 0195 26.6791 $1,583.22 $483.80 $316.64 56630 C Extensive vulva surgery 56631 C Extensive vulva surgery 56632 C Extensive vulva surgery 56633 C Extensive vulva surgery 56634 C Extensive vulva surgery 56637 C Extensive vulva surgery 56640 C Extensive vulva surgery 56700 T Partial removal of hymen 0194 20.7525 $1,231.52 $397.84 $246.30 56720 T Incision of hymen 0193 14.5843 $865.48 $173.10 56740 T Remove vagina gland lesion 0194 20.7525 $1,231.52 $397.84 $246.30 56800 T Repair of vagina 0194 20.7525 $1,231.52 $397.84 $246.30 56805 T Repair clitoris 0193 14.5843 $865.48 $173.10 56810 T Repair of perineum 0194 20.7525 $1,231.52 $397.84 $246.30 56820 T Exam of vulva w/scope 0188 1.14 $67.65 $13.53 56821 T Exam/biopsy of vulva w/scope 0189 2.371 $140.70 $28.14 57000 T Exploration of vagina 0193 14.5843 $865.48 $173.10 57010 T Drainage of pelvic abscess 0193 14.5843 $865.48 $173.10 57020 T Drainage of pelvic fluid 0192 4.3082 $255.66 $51.13 57022 T I & d vaginal hematoma, pp 0007 11.4501 $679.48 $135.90 57023 T I & d vag hematoma, non-ob 0008 16.4989 $979.09 $195.82 57061 T Destroy vag lesions, simple 0194 20.7525 $1,231.52 $397.84 $246.30 57065 T Destroy vag lesions, complex 0194 20.7525 $1,231.52 $397.84 $246.30 57100 T Biopsy of vagina 0192 4.3082 $255.66 $51.13 57105 T Biopsy of vagina 0194 20.7525 $1,231.52 $397.84 $246.30 57106 T Remove vagina wall, partial 0194 20.7525 $1,231.52 $397.84 $246.30 57107 T Remove vagina tissue, part 0195 26.6791 $1,583.22 $483.80 $316.64 57109 T Vaginectomy partial w/nodes 0195 26.6791 $1,583.22 $483.80 $316.64 57110 C Remove vagina wall, complete 57111 C Remove vagina tissue, compl 57112 C Vaginectomy w/nodes, compl 57120 T Closure of vagina 0195 26.6791 $1,583.22 $483.80 $316.64 57130 T Remove vagina lesion 0194 20.7525 $1,231.52 $397.84 $246.30 57135 T Remove vagina lesion 0194 20.7525 $1,231.52 $397.84 $246.30 57150 T Treat vagina infection 0191 0.167 $9.91 $2.78 $1.98 57155 T Insert uteri tandems/ovoids 0192 4.3082 $255.66 $51.13 57160 T Insert pessary/other device 0188 1.14 $67.65 $13.53 57170 T Fitting of diaphragm/cap 0191 0.167 $9.91 $2.78 $1.98 57180 T Treat vaginal bleeding 0189 2.371 $140.70 $28.14 57200 T Repair of vagina 0194 20.7525 $1,231.52 $397.84 $246.30 57210 T Repair vagina/perineum 0194 20.7525 $1,231.52 $397.84 $246.30 57220 T Revision of urethra 0202 40.3866 $2,396.66 $958.66 $479.33 57230 T Repair of urethral lesion 0195 26.6791 $1,583.22 $483.80 $316.64 57240 T Repair bladder & vagina 0195 26.6791 $1,583.22 $483.80 $316.64 57250 T Repair rectum & vagina 0195 26.6791 $1,583.22 $483.80 $316.64 57260 T Repair of vagina 0195 26.6791 $1,583.22 $483.80 $316.64 Start Printed Page 50765 57265 T Extensive repair of vagina 0202 40.3866 $2,396.66 $958.66 $479.33 57267 T Insert mesh/pelvic flr addon 0154 28.7847 $1,708.17 $464.85 $341.63 57268 T Repair of bowel bulge 0195 26.6791 $1,583.22 $483.80 $316.64 57270 C Repair of bowel pouch 57280 C Suspension of vagina 57282 C Repair of vaginal prolapse 57283 C Colpopexy, intraperitoneal 57284 T Repair paravaginal defect 0202 40.3866 $2,396.66 $958.66 $479.33 57287 T Revise/remove sling repair 0202 40.3866 $2,396.66 $958.66 $479.33 57288 T Repair bladder defect 0202 40.3866 $2,396.66 $958.66 $479.33 57289 T Repair bladder & vagina 0195 26.6791 $1,583.22 $483.80 $316.64 57291 T Construction of vagina 0195 26.6791 $1,583.22 $483.80 $316.64 57292 C Construct vagina with graft 57300 T Repair rectum-vagina fistula 0195 26.6791 $1,583.22 $483.80 $316.64 57305 C Repair rectum-vagina fistula 57307 C Fistula repair & colostomy 57308 C Fistula repair, transperine 57310 T Repair urethrovaginal lesion 0202 40.3866 $2,396.66 $958.66 $479.33 57311 C Repair urethrovaginal lesion 57320 T Repair bladder-vagina lesion 0195 26.6791 $1,583.22 $483.80 $316.64 57330 T Repair bladder-vagina lesion 0195 26.6791 $1,583.22 $483.80 $316.64 57335 C Repair vagina 57400 T Dilation of vagina 0194 20.7525 $1,231.52 $397.84 $246.30 57410 T Pelvic examination 0193 14.5843 $865.48 $173.10 57415 T Remove vaginal foreign body 0194 20.7525 $1,231.52 $397.84 $246.30 57420 T Exam of vagina w/scope 0189 2.371 $140.70 $28.14 57421 T Exam/biopsy of vag w/scope 0189 2.371 $140.70 $28.14 57425 T Laparoscopy, surg, colpopexy 0130 31.9271 $1,894.65 $659.53 $378.93 57452 T Examination of vagina 0189 2.371 $140.70 $28.14 57454 T Vagina examination & biopsy 0189 2.371 $140.70 $28.14 57455 T Biopsy of cervix w/scope 0189 2.371 $140.70 $28.14 57456 T Endocerv curettage w/scope 0189 2.371 $140.70 $28.14 57460 T Cervix excision 0193 14.5843 $865.48 $173.10 57461 T Conz of cervix w/scope, leep 0194 20.7525 $1,231.52 $397.84 $246.30 57500 T Biopsy of cervix 0192 4.3082 $255.66 $51.13 57505 T Endocervical curettage 0189 2.371 $140.70 $28.14 57510 T Cauterization of cervix 0193 14.5843 $865.48 $173.10 57511 T Cryocautery of cervix 0189 2.371 $140.70 $28.14 57513 T Laser surgery of cervix 0193 14.5843 $865.48 $173.10 57520 T Conization of cervix 0194 20.7525 $1,231.52 $397.84 $246.30 57522 T Conization of cervix 0195 26.6791 $1,583.22 $483.80 $316.64 57530 T Removal of cervix 0195 26.6791 $1,583.22 $483.80 $316.64 57531 C Removal of cervix, radical 57540 C Removal of residual cervix 57545 C Remove cervix/repair pelvis 57550 T Removal of residual cervix 0195 26.6791 $1,583.22 $483.80 $316.64 57555 T Remove cervix/repair vagina 0195 26.6791 $1,583.22 $483.80 $316.64 57556 T Remove cervix, repair bowel 0202 40.3866 $2,396.66 $958.66 $479.33 57700 T Revision of cervix 0194 20.7525 $1,231.52 $397.84 $246.30 57720 T Revision of cervix 0194 20.7525 $1,231.52 $397.84 $246.30 57800 T Dilation of cervical canal 0193 14.5843 $865.48 $173.10 57820 T D & c of residual cervix 0196 17.0974 $1,014.61 $338.23 $202.92 58100 T Biopsy of uterus lining 0188 1.14 $67.65 $13.53 58120 T Dilation and curettage 0196 17.0974 $1,014.61 $338.23 $202.92 58140 C Removal of uterus lesion 58145 T Myomectomy vag method 0195 26.6791 $1,583.22 $483.80 $316.64 58146 C Myomectomy abdom complex 58150 C Total hysterectomy 58152 C Total hysterectomy 58180 C Partial hysterectomy 58200 C Extensive hysterectomy 58210 C Extensive hysterectomy 58240 C Removal of pelvis contents 58260 C Vaginal hysterectomy 58262 C Vag hyst including t/o 58263 C Vag hyst w/t/o & vag repair Start Printed Page 50766 58267 C Vag hyst w/urinary repair 58270 C Vag hyst w/enterocele repair 58275 C Hysterectomy/revise vagina 58280 C Hysterectomy/revise vagina 58285 C Extensive hysterectomy 58290 C Vag hyst complex 58291 C Vag hyst incl t/o, complex 58292 C Vag hyst t/o & repair, compl 58293 C Vag hyst w/uro repair, compl 58294 C Vag hyst w/enterocele, compl 58300 E Insert intrauterine device 58301 T Remove intrauterine device 0189 2.371 $140.70 $28.14 58321 T Artificial insemination 0197 2.3572 $139.88 $27.98 58322 T Artificial insemination 0197 2.3572 $139.88 $27.98 58323 T Sperm washing 0197 2.3572 $139.88 $27.98 58340 N Catheter for hysterography 58345 T Reopen fallopian tube 0193 14.5843 $865.48 $173.10 58346 T Insert heyman uteri capsule 0193 14.5843 $865.48 $173.10 58350 T Reopen fallopian tube 0195 26.6791 $1,583.22 $483.80 $316.64 58353 T Endometr ablate, thermal 0195 26.6791 $1,583.22 $483.80 $316.64 58356 T Endometrial cryoablation 0202 40.3866 $2,396.66 $958.66 $479.33 58400 C Suspension of uterus 58410 C Suspension of uterus 58520 C Repair of ruptured uterus 58540 C Revision of uterus 58545 T Laparoscopic myomectomy 0130 31.9271 $1,894.65 $659.53 $378.93 58546 T Laparo-myomectomy, complex 0131 43.3389 $2,571.86 $1,001.89 $514.37 58550 T Laparo-asst vag hysterectomy 0132 62.9914 $3,738.10 $1,239.22 $747.62 58552 T Laparo-vag hyst incl t/o 0131 43.3389 $2,571.86 $1,001.89 $514.37 58553 T Laparo-vag hyst, complex 0131 43.3389 $2,571.86 $1,001.89 $514.37 58554 T Laparo-vag hyst w/t/o, compl 0131 43.3389 $2,571.86 $1,001.89 $514.37 58555 T Hysteroscopy, dx, sep proc 0190 21.0653 $1,250.08 $424.28 $250.02 58558 T Hysteroscopy, biopsy 0190 21.0653 $1,250.08 $424.28 $250.02 58559 T Hysteroscopy, lysis 0190 21.0653 $1,250.08 $424.28 $250.02 58560 T Hysteroscopy, resect septum 0387 32.5445 $1,931.29 $655.55 $386.26 58561 T Hysteroscopy, remove myoma 0387 32.5445 $1,931.29 $655.55 $386.26 58562 T Hysteroscopy, remove fb 0190 21.0653 $1,250.08 $424.28 $250.02 58563 T Hysteroscopy, ablation 0387 32.5445 $1,931.29 $655.55 $386.26 58565 T Hysteroscopy, sterilization 0202 40.3866 $2,396.66 $958.66 $479.33 58578 T Laparo proc, uterus 0130 31.9271 $1,894.65 $659.53 $378.93 58579 T Hysteroscope procedure 0190 21.0653 $1,250.08 $424.28 $250.02 58600 T Division of fallopian tube 0195 26.6791 $1,583.22 $483.80 $316.64 58605 C Division of fallopian tube 58611 C Ligate oviduct(s) add-on 58615 T Occlude fallopian tube(s) 0194 20.7525 $1,231.52 $397.84 $246.30 58660 T Laparoscopy, lysis 0131 43.3389 $2,571.86 $1,001.89 $514.37 58661 T Laparoscopy, remove adnexa 0131 43.3389 $2,571.86 $1,001.89 $514.37 58662 T Laparoscopy, excise lesions 0131 43.3389 $2,571.86 $1,001.89 $514.37 58670 T Laparoscopy, tubal cautery 0131 43.3389 $2,571.86 $1,001.89 $514.37 58671 T Laparoscopy, tubal block 0131 43.3389 $2,571.86 $1,001.89 $514.37 58672 T Laparoscopy, fimbrioplasty 0131 43.3389 $2,571.86 $1,001.89 $514.37 58673 T Laparoscopy, salpingostomy 0131 43.3389 $2,571.86 $1,001.89 $514.37 58679 T Laparo proc, oviduct-ovary 0130 31.9271 $1,894.65 $659.53 $378.93 58700 C Removal of fallopian tube 58720 C Removal of ovary/tube(s) 58740 C Revise fallopian tube(s) 58750 C Repair oviduct 58752 C Revise ovarian tube(s) 58760 C Remove tubal obstruction 58770 T Create new tubal opening 0195 26.6791 $1,583.22 $483.80 $316.64 58800 T Drainage of ovarian cyst(s) 0193 14.5843 $865.48 $173.10 58805 C Drainage of ovarian cyst(s) 58820 T Drain ovary abscess, open 0195 26.6791 $1,583.22 $483.80 $316.64 58822 C Drain ovary abscess, percut 58823 T Drain pelvic abscess, percut 0193 14.5843 $865.48 $173.10 58825 C Transposition, ovary(s) Start Printed Page 50767 58900 T Biopsy of ovary(s) 0193 14.5843 $865.48 $173.10 58920 T Partial removal of ovary(s) 0195 26.6791 $1,583.22 $483.80 $316.64 58925 T Removal of ovarian cyst(s) 0195 26.6791 $1,583.22 $483.80 $316.64 58940 C Removal of ovary(s) 58943 C Removal of ovary(s) 58950 C Resect ovarian malignancy 58951 C Resect ovarian malignancy 58952 C Resect ovarian malignancy 58953 C Tah, rad dissect for debulk 58954 C Tah rad debulk/lymph remove 58956 C Bso, omentectomy w/tah 58960 C Exploration of abdomen 58970 T Retrieval of oocyte 0197 2.3572 $139.88 $27.98 58974 T Transfer of embryo 0197 2.3572 $139.88 $27.98 58976 T Transfer of embryo 0197 2.3572 $139.88 $27.98 58999 T Genital surgery procedure 0191 0.167 $9.91 $2.78 $1.98 59000 T Amniocentesis, diagnostic 0198 1.3683 $81.20 $32.19 $16.24 59001 T Amniocentesis, therapeutic 0192 4.3082 $255.66 $51.13 59012 T Fetal cord puncture,prenatal 0198 1.3683 $81.20 $32.19 $16.24 59015 T Chorion biopsy 0198 1.3683 $81.20 $32.19 $16.24 59020 T Fetal contract stress test 0192 4.3082 $255.66 $51.13 59025 T Fetal non-stress test 0198 1.3683 $81.20 $32.19 $16.24 59030 T Fetal scalp blood sample 0198 1.3683 $81.20 $32.19 $16.24 59050 E Fetal monitor w/report 59051 B Fetal monitor/interpret only 59070 T Transabdom amnioinfus w/ us 0198 1.3683 $81.20 $32.19 $16.24 59072 T Umbilical cord occlud w/ us 0198 1.3683 $81.20 $32.19 $16.24 59074 T Fetal fluid drainage w/ us 0198 1.3683 $81.20 $32.19 $16.24 59076 T Fetal shunt placement, w/ us 0198 1.3683 $81.20 $32.19 $16.24 59100 T Remove uterus lesion 0195 26.6791 $1,583.22 $483.80 $316.64 59120 C Treat ectopic pregnancy 59121 C Treat ectopic pregnancy 59130 C Treat ectopic pregnancy 59135 C Treat ectopic pregnancy 59136 C Treat ectopic pregnancy 59140 C Treat ectopic pregnancy 59150 T Treat ectopic pregnancy 0131 43.3389 $2,571.86 $1,001.89 $514.37 59151 T Treat ectopic pregnancy 0131 43.3389 $2,571.86 $1,001.89 $514.37 59160 T D & c after delivery 0196 17.0974 $1,014.61 $338.23 $202.92 59200 T Insert cervical dilator 0189 2.371 $140.70 $28.14 59300 T Episiotomy or vaginal repair 0193 14.5843 $865.48 $173.10 59320 T Revision of cervix 0194 20.7525 $1,231.52 $397.84 $246.30 59325 C Revision of cervix 59350 C Repair of uterus 59400 B Obstetrical care 59409 T Obstetrical care 0194 20.7525 $1,231.52 $397.84 $246.30 59410 B Obstetrical care 59412 T Antepartum manipulation 0700 5.3614 $318.16 $63.63 59414 T Deliver placenta 0193 14.5843 $865.48 $173.10 59425 B Antepartum care only 59426 B Antepartum care only 59430 B Care after delivery 59510 E Cesarean delivery 59514 C Cesarean delivery only 59515 E Cesarean delivery 59525 C Remove uterus after cesarean 59610 E Vbac delivery 59612 T Vbac delivery only 0194 20.7525 $1,231.52 $397.84 $246.30 59614 E Vbac care after delivery 59618 E Attempted vbac delivery 59620 C Attempted vbac delivery only 59622 E Attempted vbac after care 59812 T Treatment of miscarriage 0201 17.6047 $1,044.72 $329.65 $208.94 59820 T Care of miscarriage 0201 17.6047 $1,044.72 $329.65 $208.94 59821 T Treatment of miscarriage 0201 17.6047 $1,044.72 $329.65 $208.94 59830 C Treat uterus infection Start Printed Page 50768 59840 T Abortion 0200 17.8728 $1,060.63 $263.69 $212.13 59841 T Abortion 0200 17.8728 $1,060.63 $263.69 $212.13 59850 C Abortion 59851 C Abortion 59852 C Abortion 59855 C Abortion 59856 C Abortion 59857 C Abortion 59866 T Abortion (mpr) 0198 1.3683 $81.20 $32.19 $16.24 59870 T Evacuate mole of uterus 0201 17.6047 $1,044.72 $329.65 $208.94 59871 T Remove cerclage suture 0194 20.7525 $1,231.52 $397.84 $246.30 59897 T Fetal invas px w/ us 0198 1.3683 $81.20 $32.19 $16.24 59898 T Laparo proc, ob care/deliver 0130 31.9271 $1,894.65 $659.53 $378.93 59899 T Maternity care procedure 0198 1.3683 $81.20 $32.19 $16.24 60000 T Drain thyroid/tongue cyst 0252 7.8673 $466.87 $113.41 $93.37 60001 T Aspirate/inject thyriod cyst 0004 1.7646 $104.72 $22.36 $20.94 60100 T Biopsy of thyroid 0004 1.7646 $104.72 $22.36 $20.94 60200 T Remove thyroid lesion 0114 40.7652 $2,419.13 $485.91 $483.83 60210 T Partial thyroid excision 0114 40.7652 $2,419.13 $485.91 $483.83 60212 T Partial thyroid excision 0114 40.7652 $2,419.13 $485.91 $483.83 60220 T Partial removal of thyroid 0114 40.7652 $2,419.13 $485.91 $483.83 60225 T Partial removal of thyroid 0114 40.7652 $2,419.13 $485.91 $483.83 60240 T Removal of thyroid 0114 40.7652 $2,419.13 $485.91 $483.83 60252 T Removal of thyroid 0256 37.3204 $2,214.70 $442.94 60254 C Extensive thyroid surgery 60260 T Repeat thyroid surgery 0256 37.3204 $2,214.70 $442.94 60270 C Removal of thyroid 60271 C Removal of thyroid 60280 T Remove thyroid duct lesion 0114 40.7652 $2,419.13 $485.91 $483.83 60281 T Remove thyroid duct lesion 0114 40.7652 $2,419.13 $485.91 $483.83 60500 T Explore parathyroid glands 0256 37.3204 $2,214.70 $442.94 60502 C Re-explore parathyroids 60505 C Explore parathyroid glands 60512 T Autotransplant parathyroid 0022 19.6472 $1,165.92 $354.45 $233.18 60520 C Removal of thymus gland 60521 C Removal of thymus gland 60522 C Removal of thymus gland 60540 C Explore adrenal gland 60545 C Explore adrenal gland 60600 C Remove carotid body lesion 60605 C Remove carotid body lesion 60650 C Laparoscopy adrenalectomy 60659 T Laparo proc, endocrine 0130 31.9271 $1,894.65 $659.53 $378.93 60699 T Endocrine surgery procedure 0114 40.7652 $2,419.13 $485.91 $483.83 61000 T Remove cranial cavity fluid 0212 2.974 $176.49 $70.59 $35.30 61001 T Remove cranial cavity fluid 0212 2.974 $176.49 $70.59 $35.30 61020 T Remove brain cavity fluid 0212 2.974 $176.49 $70.59 $35.30 61026 T Injection into brain canal 0212 2.974 $176.49 $70.59 $35.30 61050 T Remove brain canal fluid 0212 2.974 $176.49 $70.59 $35.30 61055 T Injection into brain canal 0212 2.974 $176.49 $70.59 $35.30 61070 T Brain canal shunt procedure 0212 2.974 $176.49 $70.59 $35.30 61105 C Twist drill hole 61107 C Drill skull for implantation 61108 C Drill skull for drainage 61120 C Burr hole for puncture 61140 C Pierce skull for biopsy 61150 C Pierce skull for drainage 61151 C Pierce skull for drainage 61154 C Pierce skull & remove clot 61156 C Pierce skull for drainage 61210 C Pierce skull, implant device 61215 T Insert brain-fluid device 0224 40.6455 $2,412.03 $482.41 61250 C Pierce skull & explore 61253 C Pierce skull & explore 61304 C Open skull for exploration 61305 C Open skull for exploration Start Printed Page 50769 61312 C Open skull for drainage 61313 C Open skull for drainage 61314 C Open skull for drainage 61315 C Open skull for drainage 61316 C Implt cran bone flap to abdo 61320 C Open skull for drainage 61321 C Open skull for drainage 61322 C Decompressive craniotomy 61323 C Decompressive lobectomy 61330 T Decompress eye socket 0256 37.3204 $2,214.70 $442.94 61332 C Explore/biopsy eye socket 61333 C Explore orbit/remove lesion 61334 T Explore orbit/remove object 0256 37.3204 $2,214.70 $442.94 61340 C Relieve cranial pressure 61343 C Incise skull (press relief) 61345 C Relieve cranial pressure 61440 C Incise skull for surgery 61450 C Incise skull for surgery 61458 C Incise skull for brain wound 61460 C Incise skull for surgery 61470 C Incise skull for surgery 61480 C Incise skull for surgery 61490 C Incise skull for surgery 61500 C Removal of skull lesion 61501 C Remove infected skull bone 61510 C Removal of brain lesion 61512 C Remove brain lining lesion 61514 C Removal of brain abscess 61516 C Removal of brain lesion 61517 C Implt brain chemotx add-on 61518 C Removal of brain lesion 61519 C Remove brain lining lesion 61520 C Removal of brain lesion 61521 C Removal of brain lesion 61522 C Removal of brain abscess 61524 C Removal of brain lesion 61526 C Removal of brain lesion 61530 C Removal of brain lesion 61531 C Implant brain electrodes 61533 C Implant brain electrodes 61534 C Removal of brain lesion 61535 C Remove brain electrodes 61536 C Removal of brain lesion 61537 C Removal of brain tissue 61538 C Removal of brain tissue 61539 C Removal of brain tissue 61540 C Removal of brain tissue 61541 C Incision of brain tissue 61542 C Removal of brain tissue 61543 C Removal of brain tissue 61544 C Remove & treat brain lesion 61545 C Excision of brain tumor 61546 C Removal of pituitary gland 61548 C Removal of pituitary gland 61550 C Release of skull seams 61552 C Release of skull seams 61556 C Incise skull/sutures 61557 C Incise skull/sutures 61558 C Excision of skull/sutures 61559 C Excision of skull/sutures 61563 C Excision of skull tumor 61564 C Excision of skull tumor 61566 C Removal of brain tissue 61567 C Incision of brain tissue 61570 C Remove foreign body, brain 61571 C Incise skull for brain wound Start Printed Page 50770 61575 C Skull base/brainstem surgery 61576 C Skull base/brainstem surgery 61580 C Craniofacial approach, skull 61581 C Craniofacial approach, skull 61582 C Craniofacial approach, skull 61583 C Craniofacial approach, skull 61584 C Orbitocranial approach/skull 61585 C Orbitocranial approach/skull 61586 C Resect nasopharynx, skull 61590 C Infratemporal approach/skull 61591 C Infratemporal approach/skull 61592 C Orbitocranial approach/skull 61595 C Transtemporal approach/skull 61596 C Transcochlear approach/skull 61597 C Transcondylar approach/skull 61598 C Transpetrosal approach/skull 61600 C Resect/excise cranial lesion 61601 C Resect/excise cranial lesion 61605 C Resect/excise cranial lesion 61606 C Resect/excise cranial lesion 61607 C Resect/excise cranial lesion 61608 C Resect/excise cranial lesion 61609 C Transect artery, sinus 61610 C Transect artery, sinus 61611 C Transect artery, sinus 61612 C Transect artery, sinus 61613 C Remove aneurysm, sinus 61615 C Resect/excise lesion, skull 61616 C Resect/excise lesion, skull 61618 C Repair dura 61619 C Repair dura 61623 T Endovasc tempory vessel occl 0081 34.4473 $2,044.21 $408.84 61624 C Occlusion/embolization cath 61626 T Transcath occlusion, non-cns 0081 34.4473 $2,044.21 $408.84 61680 C Intracranial vessel surgery 61682 C Intracranial vessel surgery 61684 C Intracranial vessel surgery 61686 C Intracranial vessel surgery 61690 C Intracranial vessel surgery 61692 C Intracranial vessel surgery 61697 C Brain aneurysm repr, complx 61698 C Brain aneurysm repr, complx 61700 C Brain aneurysm repr, simple 61702 C Inner skull vessel surgery 61703 C Clamp neck artery 61705 C Revise circulation to head 61708 C Revise circulation to head 61710 C Revise circulation to head 61711 C Fusion of skull arteries 61720 C Incise skull/brain surgery 61735 C Incise skull/brain surgery 61750 C Incise skull/brain biopsy 61751 C Brain biopsy w/ ct/mr guide 61760 C Implant brain electrodes 61770 C Incise skull for treatment 61790 T Treat trigeminal nerve 0220 17.3586 $1,030.11 $206.02 61791 T Treat trigeminal tract 0206 5.492 $325.91 $75.55 $65.18 61793 E Focus radiation beam 61795 S Brain surgery using computer 0302 4.6145 $273.84 $103.74 $54.77 61850 C Implant neuroelectrodes 61860 C Implant neuroelectrodes 61863 C Implant neuroelectrode 61864 C Implant neuroelectrde, add'l 61867 C Implant neuroelectrode 61868 C Implant neuroelectrde, add'l 61870 C Implant neuroelectrodes Start Printed Page 50771 61875 C Implant neuroelectrodes 61880 T Revise/remove neuroelectrode 0687 19.2347 $1,141.44 $456.57 $228.29 61885 S Implant neurostim one array 0039 181.4 $10,764.82 $2,152.96 61886 T Implant neurostim arrays 0315 290.647 $17,247.86 $3,449.57 61888 T Revise/remove neuroreceiver 0688 43.0444 $2,554.38 $1,021.75 $510.88 62000 C Treat skull fracture 62005 C Treat skull fracture 62010 C Treatment of head injury 62100 C Repair brain fluid leakage 62115 C Reduction of skull defect 62116 C Reduction of skull defect 62117 C Reduction of skull defect 62120 C Repair skull cavity lesion 62121 C Incise skull repair 62140 C Repair of skull defect 62141 C Repair of skull defect 62142 C Remove skull plate/flap 62143 C Replace skull plate/flap 62145 C Repair of skull & brain 62146 C Repair of skull with graft 62147 C Repair of skull with graft 62148 C Retr bone flap to fix skull 62160 T Neuroendoscopy add-on 0122 6.9721 $413.75 $84.85 $82.75 62161 C Dissect brain w/scope 62162 C Remove colloid cyst w/scope 62163 C Neuroendoscopy w/fb removal 62164 C Remove brain tumor w/scope 62165 C Remove pituit tumor w/scope 62180 C Establish brain cavity shunt 62190 C Establish brain cavity shunt 62192 C Establish brain cavity shunt 62194 T Replace/irrigate catheter 0427 10.1977 $605.16 $124.11 $121.03 62200 C Establish brain cavity shunt 62201 C Establish brain cavity shunt 62220 C Establish brain cavity shunt 62223 C Establish brain cavity shunt 62225 T Replace/irrigate catheter 0427 10.1977 $605.16 $124.11 $121.03 62230 T Replace/revise brain shunt 0224 40.6455 $2,412.03 $482.41 62252 S Csf shunt reprogram 0691 2.5252 $149.85 $59.94 $29.97 62256 C Remove brain cavity shunt 62258 C Replace brain cavity shunt 62263 T Lysis epidural adhesions 0203 10.4015 $617.26 $246.90 $123.45 62264 T Epidural lysis on single day 0203 10.4015 $617.26 $246.90 $123.45 62268 T Drain spinal cord cyst 0212 2.974 $176.49 $70.59 $35.30 62269 T Needle biopsy, spinal cord 0685 6.0174 $357.09 $115.47 $71.42 62270 T Spinal fluid tap, diagnostic 0204 2.191 $130.02 $40.13 $26.00 62272 T Drain cerebro spinal fluid 0204 2.191 $130.02 $40.13 $26.00 62273 T Treat epidural spine lesion 0206 5.492 $325.91 $75.55 $65.18 62280 T Treat spinal cord lesion 0207 6.0109 $356.70 $86.92 $71.34 62281 T Treat spinal cord lesion 0207 6.0109 $356.70 $86.92 $71.34 62282 T Treat spinal canal lesion 0207 6.0109 $356.70 $86.92 $71.34 62284 N Injection for myelogram 62287 T Percutaneous diskectomy 0221 29.9209 $1,775.60 $463.62 $355.12 62290 N Inject for spine disk x-ray 62291 N Inject for spine disk x-ray 62292 T Injection into disk lesion 0212 2.974 $176.49 $70.59 $35.30 62294 T Injection into spinal artery 0212 2.974 $176.49 $70.59 $35.30 62310 T Inject spine c/t 0207 6.0109 $356.70 $86.92 $71.34 62311 T Inject spine l/s (cd) 0207 6.0109 $356.70 $86.92 $71.34 62318 T Inject spine w/cath, c/t 0207 6.0109 $356.70 $86.92 $71.34 62319 T Inject spine w/cath l/s (cd) 0207 6.0109 $356.70 $86.92 $71.34 62350 T Implant spinal canal cath 0223 28.123 $1,668.90 $333.78 62351 T Implant spinal canal cath 0208 42.3409 $2,512.64 $502.53 62355 T Remove spinal canal catheter 0203 10.4015 $617.26 $246.90 $123.45 62360 T Insert spine infusion device 0226 138.8695 $8,240.93 $1,648.19 62361 T Implant spine infusion pump 0227 136.4922 $8,099.86 $1,619.97 Start Printed Page 50772 62362 T Implant spine infusion pump 0227 136.4922 $8,099.86 $1,619.97 62365 T Remove spine infusion device 0221 29.9209 $1,775.60 $463.62 $355.12 62367 S Analyze spine infusion pump 0691 2.5252 $149.85 $59.94 $29.97 62368 S Analyze spine infusion pump 0691 2.5252 $149.85 $59.94 $29.97 63001 T Removal of spinal lamina 0208 42.3409 $2,512.64 $502.53 63003 T Removal of spinal lamina 0208 42.3409 $2,512.64 $502.53 63005 T Removal of spinal lamina 0208 42.3409 $2,512.64 $502.53 63011 T Removal of spinal lamina 0208 42.3409 $2,512.64 $502.53 63012 T Removal of spinal lamina 0208 42.3409 $2,512.64 $502.53 63015 T Removal of spinal lamina 0208 42.3409 $2,512.64 $502.53 63016 T Removal of spinal lamina 0208 42.3409 $2,512.64 $502.53 63017 T Removal of spinal lamina 0208 42.3409 $2,512.64 $502.53 63020 T Neck spine disk surgery 0208 42.3409 $2,512.64 $502.53 63030 T Low back disk surgery 0208 42.3409 $2,512.64 $502.53 63035 T Spinal disk surgery add-on 0208 42.3409 $2,512.64 $502.53 63040 T Laminotomy, single cervical 0208 42.3409 $2,512.64 $502.53 63042 T Laminotomy, single lumbar 0208 42.3409 $2,512.64 $502.53 63043 C Laminotomy, add'l cervical 63044 C Laminotomy, add'l lumbar 63045 T Removal of spinal lamina 0208 42.3409 $2,512.64 $502.53 63046 T Removal of spinal lamina 0208 42.3409 $2,512.64 $502.53 63047 T Removal of spinal lamina 0208 42.3409 $2,512.64 $502.53 63048 T Remove spinal lamina add-on 0208 42.3409 $2,512.64 $502.53 63050 C Cervical laminoplasty 63051 C C-laminoplasty w/graft/plate 63055 T Decompress spinal cord 0208 42.3409 $2,512.64 $502.53 63056 T Decompress spinal cord 0208 42.3409 $2,512.64 $502.53 63057 T Decompress spine cord add-on 0208 42.3409 $2,512.64 $502.53 63064 T Decompress spinal cord 0208 42.3409 $2,512.64 $502.53 63066 T Decompress spine cord add-on 0208 42.3409 $2,512.64 $502.53 63075 C Neck spine disk surgery 63076 C Neck spine disk surgery 63077 C Spine disk surgery, thorax 63078 C Spine disk surgery, thorax 63081 C Removal of vertebral body 63082 C Remove vertebral body add-on 63085 C Removal of vertebral body 63086 C Remove vertebral body add-on 63087 C Removal of vertebral body 63088 C Remove vertebral body add-on 63090 C Removal of vertebral body 63091 C Remove vertebral body add-on 63101 C Removal of vertebral body 63102 C Removal of vertebral body 63103 C Remove vertebral body add-on 63170 C Incise spinal cord tract(s) 63172 C Drainage of spinal cyst 63173 C Drainage of spinal cyst 63180 C Revise spinal cord ligaments 63182 C Revise spinal cord ligaments 63185 C Incise spinal column/nerves 63190 C Incise spinal column/nerves 63191 C Incise spinal column/nerves 63194 C Incise spinal column & cord 63195 C Incise spinal column & cord 63196 C Incise spinal column & cord 63197 C Incise spinal column & cord 63198 C Incise spinal column & cord 63199 C Incise spinal column & cord 63200 C Release of spinal cord 63250 C Revise spinal cord vessels 63251 C Revise spinal cord vessels 63252 C Revise spinal cord vessels 63265 C Excise intraspinal lesion 63266 C Excise intraspinal lesion 63267 C Excise intraspinal lesion Start Printed Page 50773 63268 C Excise intraspinal lesion 63270 C Excise intraspinal lesion 63271 C Excise intraspinal lesion 63272 C Excise intraspinal lesion 63273 C Excise intraspinal lesion 63275 C Biopsy/excise spinal tumor 63276 C Biopsy/excise spinal tumor 63277 C Biopsy/excise spinal tumor 63278 C Biopsy/excise spinal tumor 63280 C Biopsy/excise spinal tumor 63281 C Biopsy/excise spinal tumor 63282 C Biopsy/excise spinal tumor 63283 C Biopsy/excise spinal tumor 63285 C Biopsy/excise spinal tumor 63286 C Biopsy/excise spinal tumor 63287 C Biopsy/excise spinal tumor 63290 C Biopsy/excise spinal tumor 63295 C Repair of laminectomy defect 63300 C Removal of vertebral body 63301 C Removal of vertebral body 63302 C Removal of vertebral body 63303 C Removal of vertebral body 63304 C Removal of vertebral body 63305 C Removal of vertebral body 63306 C Removal of vertebral body 63307 C Removal of vertebral body 63308 C Remove vertebral body add-on 63600 T Remove spinal cord lesion 0220 17.3586 $1,030.11 $206.02 63610 T Stimulation of spinal cord 0220 17.3586 $1,030.11 $206.02 63615 T Remove lesion of spinal cord 0220 17.3586 $1,030.11 $206.02 63650 S Implant neuroelectrodes 0040 55.3297 $3,283.43 $656.69 63655 S Implant neuroelectrodes 0040 55.3297 $3,283.43 $656.69 63660 T Revise/remove neuroelectrode 0687 19.2347 $1,141.44 $456.57 $228.29 63685 T Implant neuroreceiver 0222 179.0982 $10,628.22 $2,125.64 63688 T Revise/remove neuroreceiver 0688 43.0444 $2,554.38 $1,021.75 $510.88 63700 C Repair of spinal herniation 63702 C Repair of spinal herniation 63704 C Repair of spinal herniation 63706 C Repair of spinal herniation 63707 C Repair spinal fluid leakage 63709 C Repair spinal fluid leakage 63710 C Graft repair of spine defect 63740 C Install spinal shunt 63741 T Install spinal shunt 0228 51.7258 $3,069.56 $613.91 63744 T Revision of spinal shunt 0228 51.7258 $3,069.56 $613.91 63746 T Removal of spinal shunt 0109 11.0433 $655.34 $131.49 $131.07 64400 T N block inj, trigeminal 0204 2.191 $130.02 $40.13 $26.00 64402 T N block inj, facial 0204 2.191 $130.02 $40.13 $26.00 64405 T N block inj, occipital 0204 2.191 $130.02 $40.13 $26.00 64408 T N block inj, vagus 0204 2.191 $130.02 $40.13 $26.00 64410 T N block inj, phrenic 0206 5.492 $325.91 $75.55 $65.18 64412 T N block inj, spinal accessor 0206 5.492 $325.91 $75.55 $65.18 64413 T N block inj, cervical plexus 0204 2.191 $130.02 $40.13 $26.00 64415 T Injection for nerve block 0204 2.191 $130.02 $40.13 $26.00 64416 T N block cont infuse, b plex 0204 2.191 $130.02 $40.13 $26.00 64417 T N block inj, axillary 0204 2.191 $130.02 $40.13 $26.00 64418 T N block inj, suprascapular 0204 2.191 $130.02 $40.13 $26.00 64420 T N block inj, intercost, sng 0204 2.191 $130.02 $40.13 $26.00 64421 T N block inj, intercost, mlt 0206 5.492 $325.91 $75.55 $65.18 64425 T N block inj ilio-ing/hypogi 0204 2.191 $130.02 $40.13 $26.00 64430 T N block inj, pudendal 0204 2.191 $130.02 $40.13 $26.00 64435 T N block inj, paracervical 0204 2.191 $130.02 $40.13 $26.00 64445 T Injection for nerve block 0204 2.191 $130.02 $40.13 $26.00 64446 T N blk inj, sciatic, cont inf 0206 5.492 $325.91 $75.55 $65.18 64447 T N block inj fem, single 0204 2.191 $130.02 $40.13 $26.00 64448 T N block inj fem, cont inf 0204 2.191 $130.02 $40.13 $26.00 Start Printed Page 50774 64449 T N block inj, lumbar plexus 0204 2.191 $130.02 $40.13 $26.00 64450 T N block, other peripheral 0204 2.191 $130.02 $40.13 $26.00 64470 T Inj paravertebral c/t 0207 6.0109 $356.70 $86.92 $71.34 64472 T Inj paravertebral c/t add-on 0206 5.492 $325.91 $75.55 $65.18 64475 T Inj paravertebral l/s 0207 6.0109 $356.70 $86.92 $71.34 64476 T Inj paravertebral l/s add-on 0206 5.492 $325.91 $75.55 $65.18 64479 T Inj foramen epidural c/t 0207 6.0109 $356.70 $86.92 $71.34 64480 T Inj foramen epidural add-on 0207 6.0109 $356.70 $86.92 $71.34 64483 T Inj foramen epidural l/s 0207 6.0109 $356.70 $86.92 $71.34 64484 T Inj foramen epidural add-on 0207 6.0109 $356.70 $86.92 $71.34 64505 T N block, spenopalatine gangl 0204 2.191 $130.02 $40.13 $26.00 64508 T N block, carotid sinus s/p 0204 2.191 $130.02 $40.13 $26.00 64510 T N block, stellate ganglion 0207 6.0109 $356.70 $86.92 $71.34 64517 T N block inj, hypogas plxs 0204 2.191 $130.02 $40.13 $26.00 64520 T N block, lumbar/thoracic 0207 6.0109 $356.70 $86.92 $71.34 64530 T N block inj, celiac pelus 0207 6.0109 $356.70 $86.92 $71.34 64550 A Apply neurostimulator 64553 S Implant neuroelectrodes 0225 234.6925 $13,927.36 $2,785.47 64555 S Implant neuroelectrodes 0040 55.3297 $3,283.43 $656.69 64560 S Implant neuroelectrodes 0040 55.3297 $3,283.43 $656.69 64561 S Implant neuroelectrodes 0040 55.3297 $3,283.43 $656.69 64565 S Implant neuroelectrodes 0040 55.3297 $3,283.43 $656.69 64573 S Implant neuroelectrodes 0225 234.6925 $13,927.36 $2,785.47 64575 S Implant neuroelectrodes 0040 55.3297 $3,283.43 $656.69 64577 S Implant neuroelectrodes 0225 234.6925 $13,927.36 $2,785.47 64580 S Implant neuroelectrodes 0040 55.3297 $3,283.43 $656.69 64581 S Implant neuroelectrodes 0040 55.3297 $3,283.43 $656.69 64585 T Revise/remove neuroelectrode 0687 19.2347 $1,141.44 $456.57 $228.29 64590 T Implant neuroreceiver 0222 179.0982 $10,628.22 $2,125.64 64595 T Revise/remove neuroreceiver 0688 43.0444 $2,554.38 $1,021.75 $510.88 64600 T Injection treatment of nerve 0203 10.4015 $617.26 $246.90 $123.45 64605 T Injection treatment of nerve 0203 10.4015 $617.26 $246.90 $123.45 64610 T Injection treatment of nerve 0203 10.4015 $617.26 $246.90 $123.45 64612 T Destroy nerve, face muscle 0204 2.191 $130.02 $40.13 $26.00 64613 T Destroy nerve, spine muscle 0204 2.191 $130.02 $40.13 $26.00 64614 T Destroy nerve, extrem musc 0204 2.191 $130.02 $40.13 $26.00 64620 T Injection treatment of nerve 0203 10.4015 $617.26 $246.90 $123.45 64622 T Destr paravertebrl nerve l/s 0203 10.4015 $617.26 $246.90 $123.45 64623 T Destr paravertebral n add-on 0207 6.0109 $356.70 $86.92 $71.34 64626 T Destr paravertebrl nerve c/t 0203 10.4015 $617.26 $246.90 $123.45 64627 T Destr paravertebral n add-on 0207 6.0109 $356.70 $86.92 $71.34 64630 T Injection treatment of nerve 0206 5.492 $325.91 $75.55 $65.18 64640 T Injection treatment of nerve 0206 5.492 $325.91 $75.55 $65.18 64680 T Injection treatment of nerve 0207 6.0109 $356.70 $86.92 $71.34 64681 T Injection treatment of nerve 0203 10.4015 $617.26 $246.90 $123.45 64702 T Revise finger/toe nerve 0220 17.3586 $1,030.11 $206.02 64704 T Revise hand/foot nerve 0220 17.3586 $1,030.11 $206.02 64708 T Revise arm/leg nerve 0220 17.3586 $1,030.11 $206.02 64712 T Revision of sciatic nerve 0220 17.3586 $1,030.11 $206.02 64713 T Revision of arm nerve(s) 0220 17.3586 $1,030.11 $206.02 64714 T Revise low back nerve(s) 0220 17.3586 $1,030.11 $206.02 64716 T Revision of cranial nerve 0220 17.3586 $1,030.11 $206.02 64718 T Revise ulnar nerve at elbow 0220 17.3586 $1,030.11 $206.02 64719 T Revise ulnar nerve at wrist 0220 17.3586 $1,030.11 $206.02 64721 T Carpal tunnel surgery 0220 17.3586 $1,030.11 $206.02 64722 T Relieve pressure on nerve(s) 0220 17.3586 $1,030.11 $206.02 64726 T Release foot/toe nerve 0220 17.3586 $1,030.11 $206.02 64727 T Internal nerve revision 0220 17.3586 $1,030.11 $206.02 64732 T Incision of brow nerve 0220 17.3586 $1,030.11 $206.02 64734 T Incision of cheek nerve 0220 17.3586 $1,030.11 $206.02 64736 T Incision of chin nerve 0220 17.3586 $1,030.11 $206.02 64738 T Incision of jaw nerve 0220 17.3586 $1,030.11 $206.02 64740 T Incision of tongue nerve 0220 17.3586 $1,030.11 $206.02 64742 T Incision of facial nerve 0220 17.3586 $1,030.11 $206.02 64744 T Incise nerve, back of head 0220 17.3586 $1,030.11 $206.02 64746 T Incise diaphragm nerve 0220 17.3586 $1,030.11 $206.02 Start Printed Page 50775 64752 C Incision of vagus nerve 64755 C Incision of stomach nerves 64760 C Incision of vagus nerve 64761 T Incision of pelvis nerve 0220 17.3586 $1,030.11 $206.02 64763 T Incise hip/thigh nerve 0220 17.3586 $1,030.11 $206.02 64766 T Incise hip/thigh nerve 0221 29.9209 $1,775.60 $463.62 $355.12 64771 T Sever cranial nerve 0220 17.3586 $1,030.11 $206.02 64772 T Incision of spinal nerve 0220 17.3586 $1,030.11 $206.02 64774 T Remove skin nerve lesion 0220 17.3586 $1,030.11 $206.02 64776 T Remove digit nerve lesion 0220 17.3586 $1,030.11 $206.02 64778 T Digit nerve surgery add-on 0220 17.3586 $1,030.11 $206.02 64782 T Remove limb nerve lesion 0220 17.3586 $1,030.11 $206.02 64783 T Limb nerve surgery add-on 0220 17.3586 $1,030.11 $206.02 64784 T Remove nerve lesion 0220 17.3586 $1,030.11 $206.02 64786 T Remove sciatic nerve lesion 0221 29.9209 $1,775.60 $463.62 $355.12 64787 T Implant nerve end 0220 17.3586 $1,030.11 $206.02 64788 T Remove skin nerve lesion 0220 17.3586 $1,030.11 $206.02 64790 T Removal of nerve lesion 0220 17.3586 $1,030.11 $206.02 64792 T Removal of nerve lesion 0221 29.9209 $1,775.60 $463.62 $355.12 64795 T Biopsy of nerve 0220 17.3586 $1,030.11 $206.02 64802 T Remove sympathetic nerves 0220 17.3586 $1,030.11 $206.02 64804 C Remove sympathetic nerves 64809 C Remove sympathetic nerves 64818 C Remove sympathetic nerves 64820 T Remove sympathetic nerves 0220 17.3586 $1,030.11 $206.02 64821 T Remove sympathetic nerves 0054 25.3711 $1,505.60 $301.12 64822 T Remove sympathetic nerves 0054 25.3711 $1,505.60 $301.12 64823 T Remove sympathetic nerves 0054 25.3711 $1,505.60 $301.12 64831 T Repair of digit nerve 0221 29.9209 $1,775.60 $463.62 $355.12 64832 T Repair nerve add-on 0221 29.9209 $1,775.60 $463.62 $355.12 64834 T Repair of hand or foot nerve 0221 29.9209 $1,775.60 $463.62 $355.12 64835 T Repair of hand or foot nerve 0221 29.9209 $1,775.60 $463.62 $355.12 64836 T Repair of hand or foot nerve 0221 29.9209 $1,775.60 $463.62 $355.12 64837 T Repair nerve add-on 0221 29.9209 $1,775.60 $463.62 $355.12 64840 T Repair of leg nerve 0221 29.9209 $1,775.60 $463.62 $355.12 64856 T Repair/transpose nerve 0221 29.9209 $1,775.60 $463.62 $355.12 64857 T Repair arm/leg nerve 0221 29.9209 $1,775.60 $463.62 $355.12 64858 T Repair sciatic nerve 0221 29.9209 $1,775.60 $463.62 $355.12 64859 T Nerve surgery 0221 29.9209 $1,775.60 $463.62 $355.12 64861 T Repair of arm nerves 0221 29.9209 $1,775.60 $463.62 $355.12 64862 T Repair of low back nerves 0221 29.9209 $1,775.60 $463.62 $355.12 64864 T Repair of facial nerve 0221 29.9209 $1,775.60 $463.62 $355.12 64865 T Repair of facial nerve 0221 29.9209 $1,775.60 $463.62 $355.12 64866 C Fusion of facial/other nerve 64868 C Fusion of facial/other nerve 64870 T Fusion of facial/other nerve 0221 29.9209 $1,775.60 $463.62 $355.12 64872 T Subsequent repair of nerve 0221 29.9209 $1,775.60 $463.62 $355.12 64874 T Repair & revise nerve add-on 0221 29.9209 $1,775.60 $463.62 $355.12 64876 T Repair nerve/shorten bone 0221 29.9209 $1,775.60 $463.62 $355.12 64885 T Nerve graft, head or neck 0221 29.9209 $1,775.60 $463.62 $355.12 64886 T Nerve graft, head or neck 0221 29.9209 $1,775.60 $463.62 $355.12 64890 T Nerve graft, hand or foot 0221 29.9209 $1,775.60 $463.62 $355.12 64891 T Nerve graft, hand or foot 0221 29.9209 $1,775.60 $463.62 $355.12 64892 T Nerve graft, arm or leg 0221 29.9209 $1,775.60 $463.62 $355.12 64893 T Nerve graft, arm or leg 0221 29.9209 $1,775.60 $463.62 $355.12 64895 T Nerve graft, hand or foot 0221 29.9209 $1,775.60 $463.62 $355.12 64896 T Nerve graft, hand or foot 0221 29.9209 $1,775.60 $463.62 $355.12 64897 T Nerve graft, arm or leg 0221 29.9209 $1,775.60 $463.62 $355.12 64898 T Nerve graft, arm or leg 0221 29.9209 $1,775.60 $463.62 $355.12 64901 T Nerve graft add-on 0221 29.9209 $1,775.60 $463.62 $355.12 64902 T Nerve graft add-on 0221 29.9209 $1,775.60 $463.62 $355.12 64905 T Nerve pedicle transfer 0221 29.9209 $1,775.60 $463.62 $355.12 64907 T Nerve pedicle transfer 0221 29.9209 $1,775.60 $463.62 $355.12 64999 T Nervous system surgery 0204 2.191 $130.02 $40.13 $26.00 65091 T Revise eye 0242 30.5464 $1,812.72 $597.36 $362.54 65093 T Revise eye with implant 0241 23.3036 $1,382.91 $384.47 $276.58 Start Printed Page 50776 65101 T Removal of eye 0242 30.5464 $1,812.72 $597.36 $362.54 65103 T Remove eye/insert implant 0242 30.5464 $1,812.72 $597.36 $362.54 65105 T Remove eye/attach implant 0242 30.5464 $1,812.72 $597.36 $362.54 65110 T Removal of eye 0242 30.5464 $1,812.72 $597.36 $362.54 65112 T Remove eye/revise socket 0242 30.5464 $1,812.72 $597.36 $362.54 65114 T Remove eye/revise socket 0242 30.5464 $1,812.72 $597.36 $362.54 65125 T Revise ocular implant 0240 18.1508 $1,077.12 $315.31 $215.42 65130 T Insert ocular implant 0241 23.3036 $1,382.91 $384.47 $276.58 65135 T Insert ocular implant 0241 23.3036 $1,382.91 $384.47 $276.58 65140 T Attach ocular implant 0242 30.5464 $1,812.72 $597.36 $362.54 65150 T Revise ocular implant 0241 23.3036 $1,382.91 $384.47 $276.58 65155 T Reinsert ocular implant 0242 30.5464 $1,812.72 $597.36 $362.54 65175 T Removal of ocular implant 0240 18.1508 $1,077.12 $315.31 $215.42 65205 S Remove foreign body from eye 0698 1.2438 $73.81 $16.55 $14.76 65210 S Remove foreign body from eye 0698 1.2438 $73.81 $16.55 $14.76 65220 S Remove foreign body from eye 0698 1.2438 $73.81 $16.55 $14.76 65222 S Remove foreign body from eye 0698 1.2438 $73.81 $16.55 $14.76 65235 T Remove foreign body from eye 0233 14.9673 $888.20 $266.33 $177.64 65260 T Remove foreign body from eye 0236 17.0229 $1,010.19 $202.04 65265 T Remove foreign body from eye 0237 28.9401 $1,717.39 $343.48 65270 T Repair of eye wound 0240 18.1508 $1,077.12 $315.31 $215.42 65272 T Repair of eye wound 0234 21.9741 $1,304.01 $511.31 $260.80 65273 C Repair of eye wound 65275 T Repair of eye wound 0234 21.9741 $1,304.01 $511.31 $260.80 65280 T Repair of eye wound 0236 17.0229 $1,010.19 $202.04 65285 T Repair of eye wound 0672 36.9284 $2,191.44 $438.29 65286 T Repair of eye wound 0232 6.6732 $396.01 $103.17 $79.20 65290 T Repair of eye socket wound 0243 22.1671 $1,315.46 $431.39 $263.09 65400 T Removal of eye lesion 0233 14.9673 $888.20 $266.33 $177.64 65410 T Biopsy of cornea 0233 14.9673 $888.20 $266.33 $177.64 65420 T Removal of eye lesion 0233 14.9673 $888.20 $266.33 $177.64 65426 T Removal of eye lesion 0234 21.9741 $1,304.01 $511.31 $260.80 65430 S Corneal smear 0698 1.2438 $73.81 $16.55 $14.76 65435 T Curette/treat cornea 0239 6.9097 $410.04 $82.01 65436 T Curette/treat cornea 0233 14.9673 $888.20 $266.33 $177.64 65450 S Treatment of corneal lesion 0231 1.9278 $114.40 $44.61 $22.88 65600 T Revision of cornea 0240 18.1508 $1,077.12 $315.31 $215.42 65710 T Corneal transplant 0244 38.3723 $2,277.13 $803.26 $455.43 65730 T Corneal transplant 0244 38.3723 $2,277.13 $803.26 $455.43 65750 T Corneal transplant 0244 38.3723 $2,277.13 $803.26 $455.43 65755 T Corneal transplant 0244 38.3723 $2,277.13 $803.26 $455.43 65760 E Revision of cornea 65765 E Revision of cornea 65767 E Corneal tissue transplant 65770 T Revise cornea with implant 0244 38.3723 $2,277.13 $803.26 $455.43 65771 E Radial keratotomy 65772 T Correction of astigmatism 0233 14.9673 $888.20 $266.33 $177.64 65775 T Correction of astigmatism 0233 14.9673 $888.20 $266.33 $177.64 65780 T Ocular reconst, transplant 0244 38.3723 $2,277.13 $803.26 $455.43 65781 T Ocular reconst, transplant 0244 38.3723 $2,277.13 $803.26 $455.43 65782 T Ocular reconst, transplant 0244 38.3723 $2,277.13 $803.26 $455.43 65800 T Drainage of eye 0233 14.9673 $888.20 $266.33 $177.64 65805 T Drainage of eye 0233 14.9673 $888.20 $266.33 $177.64 65810 T Drainage of eye 0234 21.9741 $1,304.01 $511.31 $260.80 65815 T Drainage of eye 0234 21.9741 $1,304.01 $511.31 $260.80 65820 T Relieve inner eye pressure 0232 6.6732 $396.01 $103.17 $79.20 65850 T Incision of eye 0234 21.9741 $1,304.01 $511.31 $260.80 65855 T Laser surgery of eye 0247 5.033 $298.67 $104.31 $59.73 65860 T Incise inner eye adhesions 0247 5.033 $298.67 $104.31 $59.73 65865 T Incise inner eye adhesions 0233 14.9673 $888.20 $266.33 $177.64 65870 T Incise inner eye adhesions 0234 21.9741 $1,304.01 $511.31 $260.80 65875 T Incise inner eye adhesions 0234 21.9741 $1,304.01 $511.31 $260.80 65880 T Incise inner eye adhesions 0233 14.9673 $888.20 $266.33 $177.64 65900 T Remove eye lesion 0233 14.9673 $888.20 $266.33 $177.64 65920 T Remove implant of eye 0234 21.9741 $1,304.01 $511.31 $260.80 65930 T Remove blood clot from eye 0234 21.9741 $1,304.01 $511.31 $260.80 Start Printed Page 50777 66020 T Injection treatment of eye 0233 14.9673 $888.20 $266.33 $177.64 66030 T Injection treatment of eye 0232 6.6732 $396.01 $103.17 $79.20 66130 T Remove eye lesion 0234 21.9741 $1,304.01 $511.31 $260.80 66150 T Glaucoma surgery 0234 21.9741 $1,304.01 $511.31 $260.80 66155 T Glaucoma surgery 0234 21.9741 $1,304.01 $511.31 $260.80 66160 T Glaucoma surgery 0234 21.9741 $1,304.01 $511.31 $260.80 66165 T Glaucoma surgery 0234 21.9741 $1,304.01 $511.31 $260.80 66170 T Glaucoma surgery 0234 21.9741 $1,304.01 $511.31 $260.80 66172 T Incision of eye 0673 29.2582 $1,736.27 $649.56 $347.25 66180 T Implant eye shunt 0673 29.2582 $1,736.27 $649.56 $347.25 66185 T Revise eye shunt 0673 29.2582 $1,736.27 $649.56 $347.25 66220 T Repair eye lesion 0672 36.9284 $2,191.44 $438.29 66225 T Repair/graft eye lesion 0673 29.2582 $1,736.27 $649.56 $347.25 66250 T Follow-up surgery of eye 0233 14.9673 $888.20 $266.33 $177.64 66500 T Incision of iris 0232 6.6732 $396.01 $103.17 $79.20 66505 T Incision of iris 0232 6.6732 $396.01 $103.17 $79.20 66600 T Remove iris and lesion 0234 21.9741 $1,304.01 $511.31 $260.80 66605 T Removal of iris 0234 21.9741 $1,304.01 $511.31 $260.80 66625 T Removal of iris 0232 6.6732 $396.01 $103.17 $79.20 66630 T Removal of iris 0234 21.9741 $1,304.01 $511.31 $260.80 66635 T Removal of iris 0234 21.9741 $1,304.01 $511.31 $260.80 66680 T Repair iris & ciliary body 0234 21.9741 $1,304.01 $511.31 $260.80 66682 T Repair iris & ciliary body 0234 21.9741 $1,304.01 $511.31 $260.80 66700 T Destruction, ciliary body 0233 14.9673 $888.20 $266.33 $177.64 66710 T Destruction, ciliary body 0233 14.9673 $888.20 $266.33 $177.64 66711 T Ciliary endoscopic ablation 0233 14.9673 $888.20 $266.33 $177.64 66720 T Destruction, ciliary body 0233 14.9673 $888.20 $266.33 $177.64 66740 T Destruction, ciliary body 0234 21.9741 $1,304.01 $511.31 $260.80 66761 T Revision of iris 0247 5.033 $298.67 $104.31 $59.73 66762 T Revision of iris 0247 5.033 $298.67 $104.31 $59.73 66770 T Removal of inner eye lesion 0247 5.033 $298.67 $104.31 $59.73 66820 T Incision, secondary cataract 0232 6.6732 $396.01 $103.17 $79.20 66821 T After cataract laser surgery 0247 5.033 $298.67 $104.31 $59.73 66825 T Reposition intraocular lens 0234 21.9741 $1,304.01 $511.31 $260.80 66830 T Removal of lens lesion 0232 6.6732 $396.01 $103.17 $79.20 66840 T Removal of lens material 0245 13.3625 $792.97 $221.89 $158.59 66850 T Removal of lens material 0249 27.9369 $1,657.86 $524.67 $331.57 66852 T Removal of lens material 0249 27.9369 $1,657.86 $524.67 $331.57 66920 T Extraction of lens 0249 27.9369 $1,657.86 $524.67 $331.57 66930 T Extraction of lens 0249 27.9369 $1,657.86 $524.67 $331.57 66940 T Extraction of lens 0245 13.3625 $792.97 $221.89 $158.59 66982 T Cataract surgery, complex 0246 23.4597 $1,392.17 $495.96 $278.43 66983 T Cataract surg w/iol, 1 stage 0246 23.4597 $1,392.17 $495.96 $278.43 66984 T Cataract surg w/iol, 1 stage 0246 23.4597 $1,392.17 $495.96 $278.43 66985 T Insert lens prosthesis 0246 23.4597 $1,392.17 $495.96 $278.43 66986 T Exchange lens prosthesis 0246 23.4597 $1,392.17 $495.96 $278.43 66990 N Ophthalmic endoscope add-on 66999 T Eye surgery procedure 0232 6.6732 $396.01 $103.17 $79.20 67005 T Partial removal of eye fluid 0237 28.9401 $1,717.39 $343.48 67010 T Partial removal of eye fluid 0237 28.9401 $1,717.39 $343.48 67015 T Release of eye fluid 0237 28.9401 $1,717.39 $343.48 67025 T Replace eye fluid 0237 28.9401 $1,717.39 $343.48 67027 T Implant eye drug system 0672 36.9284 $2,191.44 $438.29 67028 T Injection eye drug 0235 4.6593 $276.50 $67.40 $55.30 67030 T Incise inner eye strands 0236 17.0229 $1,010.19 $202.04 67031 T Laser surgery, eye strands 0247 5.033 $298.67 $104.31 $59.73 67036 T Removal of inner eye fluid 0672 36.9284 $2,191.44 $438.29 67038 T Strip retinal membrane 0672 36.9284 $2,191.44 $438.29 67039 T Laser treatment of retina 0672 36.9284 $2,191.44 $438.29 67040 T Laser treatment of retina 0672 36.9284 $2,191.44 $438.29 67101 T Repair detached retina 0236 17.0229 $1,010.19 $202.04 67105 T Repair detached retina 0248 4.6769 $277.54 $93.98 $55.51 67107 T Repair detached retina 0672 36.9284 $2,191.44 $438.29 67108 T Repair detached retina 0672 36.9284 $2,191.44 $438.29 67110 T Repair detached retina 0236 17.0229 $1,010.19 $202.04 67112 T Rerepair detached retina 0672 36.9284 $2,191.44 $438.29 Start Printed Page 50778 67115 T Release encircling material 0236 17.0229 $1,010.19 $202.04 67120 T Remove eye implant material 0236 17.0229 $1,010.19 $202.04 67121 T Remove eye implant material 0237 28.9401 $1,717.39 $343.48 67141 T Treatment of retina 0235 4.6593 $276.50 $67.40 $55.30 67145 T Treatment of retina 0248 4.6769 $277.54 $93.98 $55.51 67208 T Treatment of retinal lesion 0236 17.0229 $1,010.19 $202.04 67210 T Treatment of retinal lesion 0248 4.6769 $277.54 $93.98 $55.51 67218 T Treatment of retinal lesion 0236 17.0229 $1,010.19 $202.04 67220 T Treatment of choroid lesion 0235 4.6593 $276.50 $67.40 $55.30 67221 T Ocular photodynamic ther 0235 4.6593 $276.50 $67.40 $55.30 67225 T Eye photodynamic ther add-on 0235 4.6593 $276.50 $67.40 $55.30 67227 T Treatment of retinal lesion 0236 17.0229 $1,010.19 $202.04 67228 T Treatment of retinal lesion 0248 4.6769 $277.54 $93.98 $55.51 67250 T Reinforce eye wall 0240 18.1508 $1,077.12 $315.31 $215.42 67255 T Reinforce/graft eye wall 0237 28.9401 $1,717.39 $343.48 67299 T Eye surgery procedure 0235 4.6593 $276.50 $67.40 $55.30 67311 T Revise eye muscle 0243 22.1671 $1,315.46 $431.39 $263.09 67312 T Revise two eye muscles 0243 22.1671 $1,315.46 $431.39 $263.09 67314 T Revise eye muscle 0243 22.1671 $1,315.46 $431.39 $263.09 67316 T Revise two eye muscles 0243 22.1671 $1,315.46 $431.39 $263.09 67318 T Revise eye muscle(s) 0243 22.1671 $1,315.46 $431.39 $263.09 67320 T Revise eye muscle(s) add-on 0243 22.1671 $1,315.46 $431.39 $263.09 67331 T Eye surgery follow-up add-on 0243 22.1671 $1,315.46 $431.39 $263.09 67332 T Rerevise eye muscles add-on 0243 22.1671 $1,315.46 $431.39 $263.09 67334 T Revise eye muscle w/suture 0243 22.1671 $1,315.46 $431.39 $263.09 67335 T Eye suture during surgery 0243 22.1671 $1,315.46 $431.39 $263.09 67340 T Revise eye muscle add-on 0243 22.1671 $1,315.46 $431.39 $263.09 67343 T Release eye tissue 0243 22.1671 $1,315.46 $431.39 $263.09 67345 T Destroy nerve of eye muscle 0238 2.5933 $153.89 $30.78 67350 T Biopsy eye muscle 0699 10.0177 $594.48 $118.90 67399 T Eye muscle surgery procedure 0243 22.1671 $1,315.46 $431.39 $263.09 67400 T Explore/biopsy eye socket 0241 23.3036 $1,382.91 $384.47 $276.58 67405 T Explore/drain eye socket 0241 23.3036 $1,382.91 $384.47 $276.58 67412 T Explore/treat eye socket 0241 23.3036 $1,382.91 $384.47 $276.58 67413 T Explore/treat eye socket 0241 23.3036 $1,382.91 $384.47 $276.58 67414 T Explr/decompress eye socket 0242 30.5464 $1,812.72 $597.36 $362.54 67415 T Aspiration, orbital contents 0240 18.1508 $1,077.12 $315.31 $215.42 67420 T Explore/treat eye socket 0242 30.5464 $1,812.72 $597.36 $362.54 67430 T Explore/treat eye socket 0242 30.5464 $1,812.72 $597.36 $362.54 67440 T Explore/drain eye socket 0242 30.5464 $1,812.72 $597.36 $362.54 67445 T Explr/decompress eye socket 0242 30.5464 $1,812.72 $597.36 $362.54 67450 T Explore/biopsy eye socket 0242 30.5464 $1,812.72 $597.36 $362.54 67500 S Inject/treat eye socket 0231 1.9278 $114.40 $44.61 $22.88 67505 T Inject/treat eye socket 0238 2.5933 $153.89 $30.78 67515 T Inject/treat eye socket 0238 2.5933 $153.89 $30.78 67550 T Insert eye socket implant 0242 30.5464 $1,812.72 $597.36 $362.54 67560 T Revise eye socket implant 0241 23.3036 $1,382.91 $384.47 $276.58 67570 T Decompress optic nerve 0242 30.5464 $1,812.72 $597.36 $362.54 67599 T Orbit surgery procedure 0238 2.5933 $153.89 $30.78 67700 T Drainage of eyelid abscess 0238 2.5933 $153.89 $30.78 67710 T Incision of eyelid 0239 6.9097 $410.04 $82.01 67715 T Incision of eyelid fold 0240 18.1508 $1,077.12 $315.31 $215.42 67800 T Remove eyelid lesion 0238 2.5933 $153.89 $30.78 67801 T Remove eyelid lesions 0239 6.9097 $410.04 $82.01 67805 T Remove eyelid lesions 0238 2.5933 $153.89 $30.78 67808 T Remove eyelid lesion(s) 0240 18.1508 $1,077.12 $315.31 $215.42 67810 T Biopsy of eyelid 0238 2.5933 $153.89 $30.78 67820 S Revise eyelashes 0698 1.2438 $73.81 $16.55 $14.76 67825 T Revise eyelashes 0238 2.5933 $153.89 $30.78 67830 T Revise eyelashes 0239 6.9097 $410.04 $82.01 67835 T Revise eyelashes 0240 18.1508 $1,077.12 $315.31 $215.42 67840 T Remove eyelid lesion 0239 6.9097 $410.04 $82.01 67850 T Treat eyelid lesion 0239 6.9097 $410.04 $82.01 67875 T Closure of eyelid by suture 0239 6.9097 $410.04 $82.01 67880 T Revision of eyelid 0233 14.9673 $888.20 $266.33 $177.64 67882 T Revision of eyelid 0240 18.1508 $1,077.12 $315.31 $215.42 Start Printed Page 50779 67900 T Repair brow defect 0240 18.1508 $1,077.12 $315.31 $215.42 67901 T Repair eyelid defect 0240 18.1508 $1,077.12 $315.31 $215.42 67902 T Repair eyelid defect 0240 18.1508 $1,077.12 $315.31 $215.42 67903 T Repair eyelid defect 0240 18.1508 $1,077.12 $315.31 $215.42 67904 T Repair eyelid defect 0240 18.1508 $1,077.12 $315.31 $215.42 67906 T Repair eyelid defect 0240 18.1508 $1,077.12 $315.31 $215.42 67908 T Repair eyelid defect 0240 18.1508 $1,077.12 $315.31 $215.42 67909 T Revise eyelid defect 0240 18.1508 $1,077.12 $315.31 $215.42 67911 T Revise eyelid defect 0240 18.1508 $1,077.12 $315.31 $215.42 67912 T Correction eyelid w/ implant 0240 18.1508 $1,077.12 $315.31 $215.42 67914 T Repair eyelid defect 0240 18.1508 $1,077.12 $315.31 $215.42 67915 T Repair eyelid defect 0240 18.1508 $1,077.12 $315.31 $215.42 67916 T Repair eyelid defect 0240 18.1508 $1,077.12 $315.31 $215.42 67917 T Repair eyelid defect 0240 18.1508 $1,077.12 $315.31 $215.42 67921 T Repair eyelid defect 0240 18.1508 $1,077.12 $315.31 $215.42 67922 T Repair eyelid defect 0240 18.1508 $1,077.12 $315.31 $215.42 67923 T Repair eyelid defect 0240 18.1508 $1,077.12 $315.31 $215.42 67924 T Repair eyelid defect 0240 18.1508 $1,077.12 $315.31 $215.42 67930 T Repair eyelid wound 0240 18.1508 $1,077.12 $315.31 $215.42 67935 T Repair eyelid wound 0240 18.1508 $1,077.12 $315.31 $215.42 67938 S Remove eyelid foreign body 0698 1.2438 $73.81 $16.55 $14.76 67950 T Revision of eyelid 0240 18.1508 $1,077.12 $315.31 $215.42 67961 T Revision of eyelid 0240 18.1508 $1,077.12 $315.31 $215.42 67966 T Revision of eyelid 0240 18.1508 $1,077.12 $315.31 $215.42 67971 T Reconstruction of eyelid 0241 23.3036 $1,382.91 $384.47 $276.58 67973 T Reconstruction of eyelid 0241 23.3036 $1,382.91 $384.47 $276.58 67974 T Reconstruction of eyelid 0241 23.3036 $1,382.91 $384.47 $276.58 67975 T Reconstruction of eyelid 0240 18.1508 $1,077.12 $315.31 $215.42 67999 T Revision of eyelid 0238 2.5933 $153.89 $30.78 68020 T Incise/drain eyelid lining 0240 18.1508 $1,077.12 $315.31 $215.42 68040 S Treatment of eyelid lesions 0698 1.2438 $73.81 $16.55 $14.76 68100 T Biopsy of eyelid lining 0232 6.6732 $396.01 $103.17 $79.20 68110 T Remove eyelid lining lesion 0699 10.0177 $594.48 $118.90 68115 T Remove eyelid lining lesion 0240 18.1508 $1,077.12 $315.31 $215.42 68130 T Remove eyelid lining lesion 0233 14.9673 $888.20 $266.33 $177.64 68135 T Remove eyelid lining lesion 0239 6.9097 $410.04 $82.01 68200 S Treat eyelid by injection 0230 0.7858 $46.63 $14.97 $9.33 68320 T Revise/graft eyelid lining 0240 18.1508 $1,077.12 $315.31 $215.42 68325 T Revise/graft eyelid lining 0242 30.5464 $1,812.72 $597.36 $362.54 68326 T Revise/graft eyelid lining 0241 23.3036 $1,382.91 $384.47 $276.58 68328 T Revise/graft eyelid lining 0241 23.3036 $1,382.91 $384.47 $276.58 68330 T Revise eyelid lining 0234 21.9741 $1,304.01 $511.31 $260.80 68335 T Revise/graft eyelid lining 0241 23.3036 $1,382.91 $384.47 $276.58 68340 T Separate eyelid adhesions 0240 18.1508 $1,077.12 $315.31 $215.42 68360 T Revise eyelid lining 0234 21.9741 $1,304.01 $511.31 $260.80 68362 T Revise eyelid lining 0234 21.9741 $1,304.01 $511.31 $260.80 68371 T Harvest eye tissue, alograft 0233 14.9673 $888.20 $266.33 $177.64 68399 T Eyelid lining surgery 0238 2.5933 $153.89 $30.78 68400 T Incise/drain tear gland 0238 2.5933 $153.89 $30.78 68420 T Incise/drain tear sac 0240 18.1508 $1,077.12 $315.31 $215.42 68440 T Incise tear duct opening 0238 2.5933 $153.89 $30.78 68500 T Removal of tear gland 0241 23.3036 $1,382.91 $384.47 $276.58 68505 T Partial removal, tear gland 0241 23.3036 $1,382.91 $384.47 $276.58 68510 T Biopsy of tear gland 0240 18.1508 $1,077.12 $315.31 $215.42 68520 T Removal of tear sac 0241 23.3036 $1,382.91 $384.47 $276.58 68525 T Biopsy of tear sac 0240 18.1508 $1,077.12 $315.31 $215.42 68530 T Clearance of tear duct 0240 18.1508 $1,077.12 $315.31 $215.42 68540 T Remove tear gland lesion 0241 23.3036 $1,382.91 $384.47 $276.58 68550 T Remove tear gland lesion 0242 30.5464 $1,812.72 $597.36 $362.54 68700 T Repair tear ducts 0241 23.3036 $1,382.91 $384.47 $276.58 68705 T Revise tear duct opening 0238 2.5933 $153.89 $30.78 68720 T Create tear sac drain 0242 30.5464 $1,812.72 $597.36 $362.54 68745 T Create tear duct drain 0241 23.3036 $1,382.91 $384.47 $276.58 68750 T Create tear duct drain 0242 30.5464 $1,812.72 $597.36 $362.54 68760 S Close tear duct opening 0698 1.2438 $73.81 $16.55 $14.76 68761 S Close tear duct opening 0231 1.9278 $114.40 $44.61 $22.88 Start Printed Page 50780 68770 T Close tear system fistula 0240 18.1508 $1,077.12 $315.31 $215.42 68801 S Dilate tear duct opening 0698 1.2438 $73.81 $16.55 $14.76 68810 S Probe nasolacrimal duct 0231 1.9278 $114.40 $44.61 $22.88 68811 T Probe nasolacrimal duct 0240 18.1508 $1,077.12 $315.31 $215.42 68815 T Probe nasolacrimal duct 0240 18.1508 $1,077.12 $315.31 $215.42 68840 S Explore/irrigate tear ducts 0231 1.9278 $114.40 $44.61 $22.88 68850 N Injection for tear sac x-ray 68899 S Tear duct system surgery 0230 0.7858 $46.63 $14.97 $9.33 69000 T Drain external ear lesion 0006 1.55 $91.98 $22.28 $18.40 69005 T Drain external ear lesion 0008 16.4989 $979.09 $195.82 69020 T Drain outer ear canal lesion 0006 1.55 $91.98 $22.28 $18.40 69090 E Pierce earlobes 69100 T Biopsy of external ear 0019 4.0547 $240.62 $71.87 $48.12 69105 T Biopsy of external ear canal 0253 16.1357 $957.54 $282.29 $191.51 69110 T Remove external ear, partial 0021 14.9776 $888.82 $219.48 $177.76 69120 T Removal of external ear 0254 23.404 $1,388.86 $321.35 $277.77 69140 T Remove ear canal lesion(s) 0254 23.404 $1,388.86 $321.35 $277.77 69145 T Remove ear canal lesion(s) 0021 14.9776 $888.82 $219.48 $177.76 69150 T Extensive ear canal surgery 0252 7.8673 $466.87 $113.41 $93.37 69155 C Extensive ear/neck surgery 69200 X Clear outer ear canal 0340 0.6384 $37.88 $7.58 69205 T Clear outer ear canal 0022 19.6472 $1,165.92 $354.45 $233.18 69210 X Remove impacted ear wax 0340 0.6384 $37.88 $7.58 69220 T Clean out mastoid cavity 0012 0.8497 $50.42 $11.18 $10.08 69222 T Clean out mastoid cavity 0253 16.1357 $957.54 $282.29 $191.51 69300 T Revise external ear 0254 23.404 $1,388.86 $321.35 $277.77 69310 T Rebuild outer ear canal 0256 37.3204 $2,214.70 $442.94 69320 T Rebuild outer ear canal 0256 37.3204 $2,214.70 $442.94 69399 T Outer ear surgery procedure 0251 2.0101 $119.29 $23.86 69400 T Inflate middle ear canal 0251 2.0101 $119.29 $23.86 69401 T Inflate middle ear canal 0251 2.0101 $119.29 $23.86 69405 T Catheterize middle ear canal 0252 7.8673 $466.87 $113.41 $93.37 69410 T Inset middle ear (baffle) 0251 2.0101 $119.29 $23.86 69420 T Incision of eardrum 0251 2.0101 $119.29 $23.86 69421 T Incision of eardrum 0253 16.1357 $957.54 $282.29 $191.51 69424 T Remove ventilating tube 0252 7.8673 $466.87 $113.41 $93.37 69433 T Create eardrum opening 0252 7.8673 $466.87 $113.41 $93.37 69436 T Create eardrum opening 0253 16.1357 $957.54 $282.29 $191.51 69440 T Exploration of middle ear 0254 23.404 $1,388.86 $321.35 $277.77 69450 T Eardrum revision 0256 37.3204 $2,214.70 $442.94 69501 T Mastoidectomy 0256 37.3204 $2,214.70 $442.94 69502 T Mastoidectomy 0254 23.404 $1,388.86 $321.35 $277.77 69505 T Remove mastoid structures 0256 37.3204 $2,214.70 $442.94 69511 T Extensive mastoid surgery 0256 37.3204 $2,214.70 $442.94 69530 T Extensive mastoid surgery 0256 37.3204 $2,214.70 $442.94 69535 C Remove part of temporal bone 69540 T Remove ear lesion 0253 16.1357 $957.54 $282.29 $191.51 69550 T Remove ear lesion 0256 37.3204 $2,214.70 $442.94 69552 T Remove ear lesion 0256 37.3204 $2,214.70 $442.94 69554 C Remove ear lesion 69601 T Mastoid surgery revision 0256 37.3204 $2,214.70 $442.94 69602 T Mastoid surgery revision 0256 37.3204 $2,214.70 $442.94 69603 T Mastoid surgery revision 0256 37.3204 $2,214.70 $442.94 69604 T Mastoid surgery revision 0256 37.3204 $2,214.70 $442.94 69605 T Mastoid surgery revision 0256 37.3204 $2,214.70 $442.94 69610 T Repair of eardrum 0254 23.404 $1,388.86 $321.35 $277.77 69620 T Repair of eardrum 0254 23.404 $1,388.86 $321.35 $277.77 69631 T Repair eardrum structures 0256 37.3204 $2,214.70 $442.94 69632 T Rebuild eardrum structures 0256 37.3204 $2,214.70 $442.94 69633 T Rebuild eardrum structures 0256 37.3204 $2,214.70 $442.94 69635 T Repair eardrum structures 0256 37.3204 $2,214.70 $442.94 69636 T Rebuild eardrum structures 0256 37.3204 $2,214.70 $442.94 69637 T Rebuild eardrum structures 0256 37.3204 $2,214.70 $442.94 69641 T Revise middle ear & mastoid 0256 37.3204 $2,214.70 $442.94 69642 T Revise middle ear & mastoid 0256 37.3204 $2,214.70 $442.94 69643 T Revise middle ear & mastoid 0256 37.3204 $2,214.70 $442.94 Start Printed Page 50781 69644 T Revise middle ear & mastoid 0256 37.3204 $2,214.70 $442.94 69645 T Revise middle ear & mastoid 0256 37.3204 $2,214.70 $442.94 69646 T Revise middle ear & mastoid 0256 37.3204 $2,214.70 $442.94 69650 T Release middle ear bone 0254 23.404 $1,388.86 $321.35 $277.77 69660 T Revise middle ear bone 0256 37.3204 $2,214.70 $442.94 69661 T Revise middle ear bone 0256 37.3204 $2,214.70 $442.94 69662 T Revise middle ear bone 0256 37.3204 $2,214.70 $442.94 69666 T Repair middle ear structures 0256 37.3204 $2,214.70 $442.94 69667 T Repair middle ear structures 0256 37.3204 $2,214.70 $442.94 69670 T Remove mastoid air cells 0256 37.3204 $2,214.70 $442.94 69676 T Remove middle ear nerve 0256 37.3204 $2,214.70 $442.94 69700 T Close mastoid fistula 0256 37.3204 $2,214.70 $442.94 69710 E Implant/replace hearing aid 69711 T Remove/repair hearing aid 0256 37.3204 $2,214.70 $442.94 69714 T Implant temple bone w/stimul 0256 37.3204 $2,214.70 $442.94 69715 T Temple bne implnt w/stimulat 0256 37.3204 $2,214.70 $442.94 69717 T Temple bone implant revision 0256 37.3204 $2,214.70 $442.94 69718 T Revise temple bone implant 0256 37.3204 $2,214.70 $442.94 69720 T Release facial nerve 0256 37.3204 $2,214.70 $442.94 69725 T Release facial nerve 0256 37.3204 $2,214.70 $442.94 69740 T Repair facial nerve 0256 37.3204 $2,214.70 $442.94 69745 T Repair facial nerve 0256 37.3204 $2,214.70 $442.94 69799 T Middle ear surgery procedure 0251 2.0101 $119.29 $23.86 69801 T Incise inner ear 0256 37.3204 $2,214.70 $442.94 69802 T Incise inner ear 0256 37.3204 $2,214.70 $442.94 69805 T Explore inner ear 0256 37.3204 $2,214.70 $442.94 69806 T Explore inner ear 0256 37.3204 $2,214.70 $442.94 69820 T Establish inner ear window 0256 37.3204 $2,214.70 $442.94 69840 T Revise inner ear window 0256 37.3204 $2,214.70 $442.94 69905 T Remove inner ear 0256 37.3204 $2,214.70 $442.94 69910 T Remove inner ear & mastoid 0256 37.3204 $2,214.70 $442.94 69915 T Incise inner ear nerve 0256 37.3204 $2,214.70 $442.94 69930 T Implant cochlear device 0259 366.3317 $21,739.22 $8,070.21 $4,347.84 69949 T Inner ear surgery procedure 0251 2.0101 $119.29 $23.86 69950 C Incise inner ear nerve 69955 T Release facial nerve 0256 37.3204 $2,214.70 $442.94 69960 T Release inner ear canal 0256 37.3204 $2,214.70 $442.94 69970 C Remove inner ear lesion 69979 T Temporal bone surgery 0251 2.0101 $119.29 $23.86 69990 N Microsurgery add-on 70010 S Contrast x-ray of brain 0274 3.0413 $180.48 $72.19 $36.10 70015 S Contrast x-ray of brain 0274 3.0413 $180.48 $72.19 $36.10 70030 X X-ray eye for foreign body 0260 0.7555 $44.83 $17.93 $8.97 70100 X X-ray exam of jaw 0260 0.7555 $44.83 $17.93 $8.97 70110 X X-ray exam of jaw 0260 0.7555 $44.83 $17.93 $8.97 70120 X X-ray exam of mastoids 0260 0.7555 $44.83 $17.93 $8.97 70130 X X-ray exam of mastoids 0260 0.7555 $44.83 $17.93 $8.97 70134 X X-ray exam of middle ear 0261 1.2901 $76.56 $15.31 70140 X X-ray exam of facial bones 0260 0.7555 $44.83 $17.93 $8.97 70150 X X-ray exam of facial bones 0260 0.7555 $44.83 $17.93 $8.97 70160 X X-ray exam of nasal bones 0260 0.7555 $44.83 $17.93 $8.97 70170 X X-ray exam of tear duct 0264 3.524 $209.12 $79.41 $41.82 70190 X X-ray exam of eye sockets 0260 0.7555 $44.83 $17.93 $8.97 70200 X X-ray exam of eye sockets 0260 0.7555 $44.83 $17.93 $8.97 70210 X X-ray exam of sinuses 0260 0.7555 $44.83 $17.93 $8.97 70220 X X-ray exam of sinuses 0260 0.7555 $44.83 $17.93 $8.97 70240 X X-ray exam, pituitary saddle 0260 0.7555 $44.83 $17.93 $8.97 70250 X X-ray exam of skull 0260 0.7555 $44.83 $17.93 $8.97 70260 X X-ray exam of skull 0261 1.2901 $76.56 $15.31 70300 X X-ray exam of teeth 0262 0.9228 $54.76 $10.95 70310 X X-ray exam of teeth 0262 0.9228 $54.76 $10.95 70320 X Full mouth x-ray of teeth 0262 0.9228 $54.76 $10.95 70328 X X-ray exam of jaw joint 0260 0.7555 $44.83 $17.93 $8.97 70330 X X-ray exam of jaw joints 0260 0.7555 $44.83 $17.93 $8.97 70332 S X-ray exam of jaw joint 0275 3.5779 $212.32 $69.09 $42.46 70336 S Magnetic image, jaw joint 0335 5.1581 $306.10 $122.43 $61.22 Start Printed Page 50782 70350 X X-ray head for orthodontia 0260 0.7555 $44.83 $17.93 $8.97 70355 X Panoramic x-ray of jaws 0260 0.7555 $44.83 $17.93 $8.97 70360 X X-ray exam of neck 0260 0.7555 $44.83 $17.93 $8.97 70370 X Throat x-ray & fluoroscopy 0272 1.3801 $81.90 $32.76 $16.38 70371 X Speech evaluation, complex 0272 1.3801 $81.90 $32.76 $16.38 70373 X Contrast x-ray of larynx 0263 1.7476 $103.71 $24.40 $20.74 70380 X X-ray exam of salivary gland 0260 0.7555 $44.83 $17.93 $8.97 70390 X X-ray exam of salivary duct 0263 1.7476 $103.71 $24.40 $20.74 70450* S Ct head/brain w/o dye 0332 3.2694 $194.02 $77.60 $38.80 70460* S Ct head/brain w/dye 0283 4.4253 $262.61 $105.04 $52.52 70470* S Ct head/brain w/o & w/ dye 0333 5.2836 $313.54 $125.41 $62.71 70480* S Ct orbit/ear/fossa w/o dye 0332 3.2694 $194.02 $77.60 $38.80 70481* S Ct orbit/ear/fossa w/dye 0283 4.4253 $262.61 $105.04 $52.52 70482* S Ct orbit/ear/fossa w/o&w dye 0333 5.2836 $313.54 $125.41 $62.71 70486* S Ct maxillofacial w/o dye 0332 3.2694 $194.02 $77.60 $38.80 70487* S Ct maxillofacial w/dye 0283 4.4253 $262.61 $105.04 $52.52 70488* S Ct maxillofacial w/o & w dye 0333 5.2836 $313.54 $125.41 $62.71 70490* S Ct soft tissue neck w/o dye 0332 3.2694 $194.02 $77.60 $38.80 70491* S Ct soft tissue neck w/dye 0283 4.4253 $262.61 $105.04 $52.52 70492* S Ct sft tsue nck w/o & w/dye 0333 5.2836 $313.54 $125.41 $62.71 70496* S Ct angiography, head 0662 5.1621 $306.33 $122.53 $61.27 70498* S Ct angiography, neck 0662 5.1621 $306.33 $122.53 $61.27 70540* S Mri orbit/face/neck w/o dye 0336 6.0742 $360.46 $144.18 $72.09 70542* S Mri orbit/face/neck w/dye 0284 6.4201 $380.99 $152.39 $76.20 70543* S Mri orbt/fac/nck w/o & w dye 0337 8.7945 $521.89 $208.75 $104.38 70544* S Mr angiography head w/o dye 0336 6.0742 $360.46 $144.18 $72.09 70545* S Mr angiography head w/dye 0284 6.4201 $380.99 $152.39 $76.20 70546* S Mr angiograph head w/o&w dye 0337 8.7945 $521.89 $208.75 $104.38 70547* S Mr angiography neck w/o dye 0336 6.0742 $360.46 $144.18 $72.09 70548* S Mr angiography neck w/dye 0284 6.4201 $380.99 $152.39 $76.20 70549* S Mr angiograph neck w/o&w dye 0337 8.7945 $521.89 $208.75 $104.38 70551* S Mri brain w/o dye 0336 6.0742 $360.46 $144.18 $72.09 70552* S Mri brain w/ dye 0284 6.4201 $380.99 $152.39 $76.20 70553* S Mri brain w/o & w/ dye 0337 8.7945 $521.89 $208.75 $104.38 70557 S Mri brain w/o dye 0336 6.0742 $360.46 $144.18 $72.09 70558 S Mri brain w/ dye 0284 6.4201 $380.99 $152.39 $76.20 70559 S Mri brain w/o & w/ dye 0337 8.7945 $521.89 $208.75 $104.38 71010 X Chest x-ray 0260 0.7555 $44.83 $17.93 $8.97 71015 X Chest x-ray 0260 0.7555 $44.83 $17.93 $8.97 71020 X Chest x-ray 0260 0.7555 $44.83 $17.93 $8.97 71021 X Chest x-ray 0260 0.7555 $44.83 $17.93 $8.97 71022 X Chest x-ray 0260 0.7555 $44.83 $17.93 $8.97 71023 X Chest x-ray and fluoroscopy 0272 1.3801 $81.90 $32.76 $16.38 71030 X Chest x-ray 0260 0.7555 $44.83 $17.93 $8.97 71034 X Chest x-ray and fluoroscopy 0272 1.3801 $81.90 $32.76 $16.38 71035 X Chest x-ray 0260 0.7555 $44.83 $17.93 $8.97 71040 X Contrast x-ray of bronchi 0263 1.7476 $103.71 $24.40 $20.74 71060 X Contrast x-ray of bronchi 0263 1.7476 $103.71 $24.40 $20.74 71090 X X-ray & pacemaker insertion 0272 1.3801 $81.90 $32.76 $16.38 71100 X X-ray exam of ribs 0260 0.7555 $44.83 $17.93 $8.97 71101 X X-ray exam of ribs/chest 0260 0.7555 $44.83 $17.93 $8.97 71110 X X-ray exam of ribs 0260 0.7555 $44.83 $17.93 $8.97 71111 X X-ray exam of ribs/ chest 0261 1.2901 $76.56 $15.31 71120 X X-ray exam of breastbone 0260 0.7555 $44.83 $17.93 $8.97 71130 X X-ray exam of breastbone 0260 0.7555 $44.83 $17.93 $8.97 71250* S Ct thorax w/o dye 0332 3.2694 $194.02 $77.60 $38.80 71260* S Ct thorax w/dye 0283 4.4253 $262.61 $105.04 $52.52 71270* S Ct thorax w/o & w/ dye 0333 5.2836 $313.54 $125.41 $62.71 71275* S Ct angiography, chest 0662 5.1621 $306.33 $122.53 $61.27 71550* S Mri chest w/o dye 0336 6.0742 $360.46 $144.18 $72.09 71551* S Mri chest w/dye 0284 6.4201 $380.99 $152.39 $76.20 71552* S Mri chest w/o & w/dye 0337 8.7945 $521.89 $208.75 $104.38 71555 B Mri angio chest w or w/o dye 72010 X X-ray exam of spine 0260 0.7555 $44.83 $17.93 $8.97 72020 X X-ray exam of spine 0260 0.7555 $44.83 $17.93 $8.97 72040 X X-ray exam of neck spine 0260 0.7555 $44.83 $17.93 $8.97 Start Printed Page 50783 72050 X X-ray exam of neck spine 0261 1.2901 $76.56 $15.31 72052 X X-ray exam of neck spine 0261 1.2901 $76.56 $15.31 72069 X X-ray exam of trunk spine 0260 0.7555 $44.83 $17.93 $8.97 72070 X X-ray exam of thoracic spine 0260 0.7555 $44.83 $17.93 $8.97 72072 X X-ray exam of thoracic spine 0260 0.7555 $44.83 $17.93 $8.97 72074 X X-ray exam of thoracic spine 0260 0.7555 $44.83 $17.93 $8.97 72080 X X-ray exam of trunk spine 0260 0.7555 $44.83 $17.93 $8.97 72090 X X-ray exam of trunk spine 0261 1.2901 $76.56 $15.31 72100 X X-ray exam of lower spine 0260 0.7555 $44.83 $17.93 $8.97 72110 X X-ray exam of lower spine 0261 1.2901 $76.56 $15.31 72114 X X-ray exam of lower spine 0261 1.2901 $76.56 $15.31 72120 X X-ray exam of lower spine 0261 1.2901 $76.56 $15.31 72125* S Ct neck spine w/o dye 0332 3.2694 $194.02 $77.60 $38.80 72126* S Ct neck spine w/dye 0283 4.4253 $262.61 $105.04 $52.52 72127* S Ct neck spine w/o & w/dye 0333 5.2836 $313.54 $125.41 $62.71 72128* S Ct chest spine w/o dye 0332 3.2694 $194.02 $77.60 $38.80 72129* S Ct chest spine w/dye 0283 4.4253 $262.61 $105.04 $52.52 72130* S Ct chest spine w/o & w/dye 0333 5.2836 $313.54 $125.41 $62.71 72131* S Ct lumbar spine w/o dye 0332 3.2694 $194.02 $77.60 $38.80 72132* S Ct lumbar spine w/dye 0283 4.4253 $262.61 $105.04 $52.52 72133* S Ct lumbar spine w/o & w/dye 0333 5.2836 $313.54 $125.41 $62.71 72141* S Mri neck spine w/o dye 0336 6.0742 $360.46 $144.18 $72.09 72142* S Mri neck spine w/dye 0284 6.4201 $380.99 $152.39 $76.20 72146* S Mri chest spine w/o dye 0336 6.0742 $360.46 $144.18 $72.09 72147* S Mri chest spine w/dye 0284 6.4201 $380.99 $152.39 $76.20 72148* S Mri lumbar spine w/o dye 0336 6.0742 $360.46 $144.18 $72.09 72149* S Mri lumbar spine w/dye 0284 6.4201 $380.99 $152.39 $76.20 72156* S Mri neck spine w/o & w/dye 0337 8.7945 $521.89 $208.75 $104.38 72157* S Mri chest spine w/o & w/dye 0337 8.7945 $521.89 $208.75 $104.38 72158* S Mri lumbar spine w/o & w/dye 0337 8.7945 $521.89 $208.75 $104.38 72159 E Mr angio spine w/o&w/dye 72170 X X-ray exam of pelvis 0260 0.7555 $44.83 $17.93 $8.97 72190 X X-ray exam of pelvis 0260 0.7555 $44.83 $17.93 $8.97 72191* S Ct angiograph pelv w/o&w/dye 0662 5.1621 $306.33 $122.53 $61.27 72192* S Ct pelvis w/o dye 0332 3.2694 $194.02 $77.60 $38.80 72193* S Ct pelvis w/dye 0283 4.4253 $262.61 $105.04 $52.52 72194* S Ct pelvis w/o & w/dye 0333 5.2836 $313.54 $125.41 $62.71 72195* S Mri pelvis w/o dye 0336 6.0742 $360.46 $144.18 $72.09 72196* S Mri pelvis w/dye 0284 6.4201 $380.99 $152.39 $76.20 72197* S Mri pelvis w/o & w/dye 0337 8.7945 $521.89 $208.75 $104.38 72198 B Mr angio pelvis w/o & w/dye 72200 X X-ray exam sacroiliac joints 0260 0.7555 $44.83 $17.93 $8.97 72202 X X-ray exam sacroiliac joints 0260 0.7555 $44.83 $17.93 $8.97 72220 X X-ray exam of tailbone 0260 0.7555 $44.83 $17.93 $8.97 72240 S Contrast x-ray of neck spine 0274 3.0413 $180.48 $72.19 $36.10 72255 S Contrast x-ray, thorax spine 0274 3.0413 $180.48 $72.19 $36.10 72265 S Contrast x-ray, lower spine 0274 3.0413 $180.48 $72.19 $36.10 72270 S Contrast x-ray, spine 0274 3.0413 $180.48 $72.19 $36.10 72275 S Epidurography 0274 3.0413 $180.48 $72.19 $36.10 72285 S X-ray c/t spine disk 0388 12.3294 $731.66 $292.66 $146.33 72295 S X-ray of lower spine disk 0388 12.3294 $731.66 $292.66 $146.33 73000 X X-ray exam of collar bone 0260 0.7555 $44.83 $17.93 $8.97 73010 X X-ray exam of shoulder blade 0260 0.7555 $44.83 $17.93 $8.97 73020 X X-ray exam of shoulder 0260 0.7555 $44.83 $17.93 $8.97 73030 X X-ray exam of shoulder 0260 0.7555 $44.83 $17.93 $8.97 73040 S Contrast x-ray of shoulder 0275 3.5779 $212.32 $69.09 $42.46 73050 X X-ray exam of shoulders 0260 0.7555 $44.83 $17.93 $8.97 73060 X X-ray exam of humerus 0260 0.7555 $44.83 $17.93 $8.97 73070 X X-ray exam of elbow 0260 0.7555 $44.83 $17.93 $8.97 73080 X X-ray exam of elbow 0260 0.7555 $44.83 $17.93 $8.97 73085 S Contrast x-ray of elbow 0275 3.5779 $212.32 $69.09 $42.46 73090 X X-ray exam of forearm 0260 0.7555 $44.83 $17.93 $8.97 73092 X X-ray exam of arm, infant 0260 0.7555 $44.83 $17.93 $8.97 73100 X X-ray exam of wrist 0260 0.7555 $44.83 $17.93 $8.97 73110 X X-ray exam of wrist 0260 0.7555 $44.83 $17.93 $8.97 73115 S Contrast x-ray of wrist 0275 3.5779 $212.32 $69.09 $42.46 Start Printed Page 50784 73120 X X-ray exam of hand 0260 0.7555 $44.83 $17.93 $8.97 73130 X X-ray exam of hand 0260 0.7555 $44.83 $17.93 $8.97 73140 X X-ray exam of finger(s) 0260 0.7555 $44.83 $17.93 $8.97 73200* S Ct upper extremity w/o dye 0332 3.2694 $194.02 $77.60 $38.80 73201* S Ct upper extremity w/dye 0283 4.4253 $262.61 $105.04 $52.52 73202* S Ct uppr extremity w/o&w/dye 0333 5.2836 $313.54 $125.41 $62.71 73206* S Ct angio upr extrm w/o&w/dye 0662 5.1621 $306.33 $122.53 $61.27 73218* S Mri upper extremity w/o dye 0336 6.0742 $360.46 $144.18 $72.09 73219* S Mri upper extremity w/dye 0284 6.4201 $380.99 $152.39 $76.20 73220* S Mri uppr extremity w/o&w/dye 0337 8.7945 $521.89 $208.75 $104.38 73221* S Mri joint upr extrem w/o dye 0336 6.0742 $360.46 $144.18 $72.09 73222* S Mri joint upr extrem w/dye 0284 6.4201 $380.99 $152.39 $76.20 73223* S Mri joint upr extr w/o&w/dye 0337 8.7945 $521.89 $208.75 $104.38 73225 E Mr angio upr extr w/o&w/dye 73500 X X-ray exam of hip 0260 0.7555 $44.83 $17.93 $8.97 73510 X X-ray exam of hip 0260 0.7555 $44.83 $17.93 $8.97 73520 X X-ray exam of hips 0261 1.2901 $76.56 $15.31 73525 S Contrast x-ray of hip 0275 3.5779 $212.32 $69.09 $42.46 73530 X X-ray exam of hip 0261 1.2901 $76.56 $15.31 73540 X X-ray exam of pelvis & hips 0260 0.7555 $44.83 $17.93 $8.97 73542 S X-ray exam, sacroiliac joint 0275 3.5779 $212.32 $69.09 $42.46 73550 X X-ray exam of thigh 0260 0.7555 $44.83 $17.93 $8.97 73560 X X-ray exam of knee, 1 or 2 0260 0.7555 $44.83 $17.93 $8.97 73562 X X-ray exam of knee, 3 0260 0.7555 $44.83 $17.93 $8.97 73564 X X-ray exam, knee, 4 or more 0260 0.7555 $44.83 $17.93 $8.97 73565 X X-ray exam of knees 0260 0.7555 $44.83 $17.93 $8.97 73580 S Contrast x-ray of knee joint 0275 3.5779 $212.32 $69.09 $42.46 73590 X X-ray exam of lower leg 0260 0.7555 $44.83 $17.93 $8.97 73592 X X-ray exam of leg, infant 0260 0.7555 $44.83 $17.93 $8.97 73600 X X-ray exam of ankle 0260 0.7555 $44.83 $17.93 $8.97 73610 X X-ray exam of ankle 0260 0.7555 $44.83 $17.93 $8.97 73615 S Contrast x-ray of ankle 0275 3.5779 $212.32 $69.09 $42.46 73620 X X-ray exam of foot 0260 0.7555 $44.83 $17.93 $8.97 73630 X X-ray exam of foot 0260 0.7555 $44.83 $17.93 $8.97 73650 X X-ray exam of heel 0260 0.7555 $44.83 $17.93 $8.97 73660 X X-ray exam of toe(s) 0260 0.7555 $44.83 $17.93 $8.97 73700* S Ct lower extremity w/o dye 0332 3.2694 $194.02 $77.60 $38.80 73701* S Ct lower extremity w/dye 0283 4.4253 $262.61 $105.04 $52.52 73702* S Ct lwr extremity w/o&w/dye 0333 5.2836 $313.54 $125.41 $62.71 73706* S Ct angio lwr extr w/o&w/dye 0662 5.1621 $306.33 $122.53 $61.27 73718* S Mri lower extremity w/o dye 0336 6.0742 $360.46 $144.18 $72.09 73719* S Mri lower extremity w/dye 0284 6.4201 $380.99 $152.39 $76.20 73720* S Mri lwr extremity w/o&w/dye 0337 8.7945 $521.89 $208.75 $104.38 73721* S Mri jnt of lwr extre w/o dye 0336 6.0742 $360.46 $144.18 $72.09 73722* S Mri joint of lwr extr w/dye 0284 6.4201 $380.99 $152.39 $76.20 73723* S Mri joint lwr extr w/o&w/dye 0337 8.7945 $521.89 $208.75 $104.38 73725 B Mr ang lwr ext w or w/o dye 74000 X X-ray exam of abdomen 0260 0.7555 $44.83 $17.93 $8.97 74010 X X-ray exam of abdomen 0260 0.7555 $44.83 $17.93 $8.97 74020 X X-ray exam of abdomen 0260 0.7555 $44.83 $17.93 $8.97 74022 X X-ray exam series, abdomen 0261 1.2901 $76.56 $15.31 74150* S Ct abdomen w/o dye 0332 3.2694 $194.02 $77.60 $38.80 74160* S Ct abdomen w/dye 0283 4.4253 $262.61 $105.04 $52.52 74170* S Ct abdomen w/o &w /dye 0333 5.2836 $313.54 $125.41 $62.71 74175* S Ct angio abdom w/o & w/dye 0662 5.1621 $306.33 $122.53 $61.27 74181* S Mri abdomen w/o dye 0336 6.0742 $360.46 $144.18 $72.09 74182* S Mri abdomen w/dye 0284 6.4201 $380.99 $152.39 $76.20 74183* S Mri abdomen w/o & w/dye 0337 8.7945 $521.89 $208.75 $104.38 74185 B Mri angio, abdom w orw/o dye 74190 X X-ray exam of peritoneum 0264 3.524 $209.12 $79.41 $41.82 74210 S Contrst x-ray exam of throat 0276 1.5319 $90.91 $36.36 $18.18 74220 S Contrast x-ray, esophagus 0276 1.5319 $90.91 $36.36 $18.18 74230 S Cine/vid x-ray, throat/esoph 0276 1.5319 $90.91 $36.36 $18.18 74235 S Remove esophagus obstruction 0296 2.2452 $133.24 $53.29 $26.65 74240 S X-ray exam, upper gi tract 0276 1.5319 $90.91 $36.36 $18.18 74241 S X-ray exam, upper gi tract 0276 1.5319 $90.91 $36.36 $18.18 Start Printed Page 50785 74245 S X-ray exam, upper gi tract 0277 2.3852 $141.54 $56.61 $28.31 74246 S Contrst x-ray uppr gi tract 0276 1.5319 $90.91 $36.36 $18.18 74247 S Contrst x-ray uppr gi tract 0276 1.5319 $90.91 $36.36 $18.18 74249 S Contrst x-ray uppr gi tract 0277 2.3852 $141.54 $56.61 $28.31 74250 S X-ray exam of small bowel 0276 1.5319 $90.91 $36.36 $18.18 74251 S X-ray exam of small bowel 0277 2.3852 $141.54 $56.61 $28.31 74260 S X-ray exam of small bowel 0277 2.3852 $141.54 $56.61 $28.31 74270 S Contrast x-ray exam of colon 0276 1.5319 $90.91 $36.36 $18.18 74280 S Contrast x-ray exam of colon 0277 2.3852 $141.54 $56.61 $28.31 74283 S Contrast x-ray exam of colon 0276 1.5319 $90.91 $36.36 $18.18 74290 S Contrast x-ray, gallbladder 0276 1.5319 $90.91 $36.36 $18.18 74291 S Contrast x-rays, gallbladder 0276 1.5319 $90.91 $36.36 $18.18 74300 X X-ray bile ducts/pancreas 0263 1.7476 $103.71 $24.40 $20.74 74301 X X-rays at surgery add-on 0263 1.7476 $103.71 $24.40 $20.74 74305 X X-ray bile ducts/pancreas 0263 1.7476 $103.71 $24.40 $20.74 74320 X Contrast x-ray of bile ducts 0264 3.524 $209.12 $79.41 $41.82 74327 S X-ray bile stone removal 0296 2.2452 $133.24 $53.29 $26.65 74328 N X-ray bile duct endoscopy 74329 N X-ray for pancreas endoscopy 74330 N X-ray bile/panc endoscopy 74340 X X-ray guide for GI tube 0272 1.3801 $81.90 $32.76 $16.38 74350 X X-ray guide, stomach tube 0263 1.7476 $103.71 $24.40 $20.74 74355 X X-ray guide, intestinal tube 0263 1.7476 $103.71 $24.40 $20.74 74360 S X-ray guide, GI dilation 0296 2.2452 $133.24 $53.29 $26.65 74363 S X-ray, bile duct dilation 0297 5.253 $311.73 $122.13 $62.35 74400 S Contrst x-ray, urinary tract 0278 2.6434 $156.87 $62.74 $31.37 74410 S Contrst x-ray, urinary tract 0278 2.6434 $156.87 $62.74 $31.37 74415 S Contrst x-ray, urinary tract 0278 2.6434 $156.87 $62.74 $31.37 74420 S Contrst x-ray, urinary tract 0278 2.6434 $156.87 $62.74 $31.37 74425 S Contrst x-ray, urinary tract 0278 2.6434 $156.87 $62.74 $31.37 74430 S Contrast x-ray, bladder 0278 2.6434 $156.87 $62.74 $31.37 74440 S X-ray, male genital tract 0278 2.6434 $156.87 $62.74 $31.37 74445 S X-ray exam of penis 0278 2.6434 $156.87 $62.74 $31.37 74450 S X-ray, urethra/bladder 0278 2.6434 $156.87 $62.74 $31.37 74455 S X-ray, urethra/bladder 0278 2.6434 $156.87 $62.74 $31.37 74470 X X-ray exam of kidney lesion 0263 1.7476 $103.71 $24.40 $20.74 74475 S X-ray control, cath insert 0297 5.253 $311.73 $122.13 $62.35 74480 S X-ray control, cath insert 0296 2.2452 $133.24 $53.29 $26.65 74485 S X-ray guide, GU dilation 0296 2.2452 $133.24 $53.29 $26.65 74710 X X-ray measurement of pelvis 0261 1.2901 $76.56 $15.31 74740 X X-ray, female genital tract 0264 3.524 $209.12 $79.41 $41.82 74742 X X-ray, fallopian tube 0264 3.524 $209.12 $79.41 $41.82 74775 S X-ray exam of perineum 0278 2.6434 $156.87 $62.74 $31.37 75552 S Heart mri for morph w/o dye 0336 6.0742 $360.46 $144.18 $72.09 75553 S Heart mri for morph w/dye 0284 6.4201 $380.99 $152.39 $76.20 75554 S Cardiac MRI/function 0336 6.0742 $360.46 $144.18 $72.09 75555 S Cardiac MRI/limited study 0336 6.0742 $360.46 $144.18 $72.09 75556 E Cardiac MRI/flow mapping 75600 S Contrast x-ray exam of aorta 0280 20.7902 $1,233.75 $353.85 $246.75 75605 S Contrast x-ray exam of aorta 0280 20.7902 $1,233.75 $353.85 $246.75 75625 S Contrast x-ray exam of aorta 0280 20.7902 $1,233.75 $353.85 $246.75 75630 S X-ray aorta, leg arteries 0280 20.7902 $1,233.75 $353.85 $246.75 75635* S Ct angio abdominal arteries 0662 5.1621 $306.33 $122.53 $61.27 75650 S Artery x-rays, head & neck 0280 20.7902 $1,233.75 $353.85 $246.75 75658 S Artery x-rays, arm 0279 8.9319 $530.05 $150.03 $106.01 75660 S Artery x-rays, head & neck 0668 6.5024 $385.87 $114.67 $77.17 75662 S Artery x-rays, head & neck 0280 20.7902 $1,233.75 $353.85 $246.75 75665 S Artery x-rays, head & neck 0280 20.7902 $1,233.75 $353.85 $246.75 75671 S Artery x-rays, head & neck 0280 20.7902 $1,233.75 $353.85 $246.75 75676 S Artery x-rays, neck 0280 20.7902 $1,233.75 $353.85 $246.75 75680 S Artery x-rays, neck 0280 20.7902 $1,233.75 $353.85 $246.75 75685 S Artery x-rays, spine 0280 20.7902 $1,233.75 $353.85 $246.75 75705 S Artery x-rays, spine 0668 6.5024 $385.87 $114.67 $77.17 75710 S Artery x-rays, arm/leg 0280 20.7902 $1,233.75 $353.85 $246.75 75716 S Artery x-rays, arms/legs 0280 20.7902 $1,233.75 $353.85 $246.75 75722 S Artery x-rays, kidney 0280 20.7902 $1,233.75 $353.85 $246.75 Start Printed Page 50786 75724 S Artery x-rays, kidneys 0280 20.7902 $1,233.75 $353.85 $246.75 75726 S Artery x-rays, abdomen 0280 20.7902 $1,233.75 $353.85 $246.75 75731 S Artery x-rays, adrenal gland 0280 20.7902 $1,233.75 $353.85 $246.75 75733 S Artery x-rays, adrenals 0668 6.5024 $385.87 $114.67 $77.17 75736 S Artery x-rays, pelvis 0280 20.7902 $1,233.75 $353.85 $246.75 75741 S Artery x-rays, lung 0279 8.9319 $530.05 $150.03 $106.01 75743 S Artery x-rays, lungs 0280 20.7902 $1,233.75 $353.85 $246.75 75746 S Artery x-rays, lung 0279 8.9319 $530.05 $150.03 $106.01 75756 S Artery x-rays, chest 0279 8.9319 $530.05 $150.03 $106.01 75774 S Artery x-ray, each vessel 0279 8.9319 $530.05 $150.03 $106.01 75790 S Visualize A-V shunt 0279 8.9319 $530.05 $150.03 $106.01 75801 X Lymph vessel x-ray, arm/leg 0264 3.524 $209.12 $79.41 $41.82 75803 X Lymph vessel x-ray,arms/legs 0264 3.524 $209.12 $79.41 $41.82 75805 X Lymph vessel x-ray, trunk 0264 3.524 $209.12 $79.41 $41.82 75807 X Lymph vessel x-ray, trunk 0264 3.524 $209.12 $79.41 $41.82 75809 X Nonvascular shunt, x-ray 0263 1.7476 $103.71 $24.40 $20.74 75810 S Vein x-ray, spleen/liver 0279 8.9319 $530.05 $150.03 $106.01 75820 S Vein x-ray, arm/leg 0668 6.5024 $385.87 $114.67 $77.17 75822 S Vein x-ray, arms/legs 0668 6.5024 $385.87 $114.67 $77.17 75825 S Vein x-ray, trunk 0279 8.9319 $530.05 $150.03 $106.01 75827 S Vein x-ray, chest 0279 8.9319 $530.05 $150.03 $106.01 75831 S Vein x-ray, kidney 0279 8.9319 $530.05 $150.03 $106.01 75833 S Vein x-ray, kidneys 0279 8.9319 $530.05 $150.03 $106.01 75840 S Vein x-ray, adrenal gland 0280 20.7902 $1,233.75 $353.85 $246.75 75842 S Vein x-ray, adrenal glands 0280 20.7902 $1,233.75 $353.85 $246.75 75860 S Vein x-ray, neck 0668 6.5024 $385.87 $114.67 $77.17 75870 S Vein x-ray, skull 0668 6.5024 $385.87 $114.67 $77.17 75872 S Vein x-ray, skull 0279 8.9319 $530.05 $150.03 $106.01 75880 S Vein x-ray, eye socket 0668 6.5024 $385.87 $114.67 $77.17 75885 S Vein x-ray, liver 0280 20.7902 $1,233.75 $353.85 $246.75 75887 S Vein x-ray, liver 0279 8.9319 $530.05 $150.03 $106.01 75889 S Vein x-ray, liver 0280 20.7902 $1,233.75 $353.85 $246.75 75891 S Vein x-ray, liver 0279 8.9319 $530.05 $150.03 $106.01 75893 N Venous sampling by catheter 75894 S X-rays, transcath therapy 0297 5.253 $311.73 $122.13 $62.35 75896 S X-rays, transcath therapy 0297 5.253 $311.73 $122.13 $62.35 75898 X Follow-up angiography 0263 1.7476 $103.71 $24.40 $20.74 75900 C Arterial catheter exchange 75901 X Remove cva device obstruct 0263 1.7476 $103.71 $24.40 $20.74 75902 X Remove cva lumen obstruct 0263 1.7476 $103.71 $24.40 $20.74 75940 S X-ray placement, vein filter 0297 5.253 $311.73 $122.13 $62.35 75945 S Intravascular us 0267 2.6327 $156.23 $62.18 $31.25 75946 S Intravascular us add-on 0266 1.6393 $97.28 $38.91 $19.46 75952 C Endovasc repair abdom aorta 75953 C Abdom aneurysm endovas rpr 75954 C Iliac aneurysm endovas rpr 75960 S Transcatheter intro, stent 0668 6.5024 $385.87 $114.67 $77.17 75961 S Retrieval, broken catheter 0668 6.5024 $385.87 $114.67 $77.17 75962 S Repair arterial blockage 0668 6.5024 $385.87 $114.67 $77.17 75964 S Repair artery blockage, each 0668 6.5024 $385.87 $114.67 $77.17 75966 S Repair arterial blockage 0668 6.5024 $385.87 $114.67 $77.17 75968 S Repair artery blockage, each 0668 6.5024 $385.87 $114.67 $77.17 75970 S Vascular biopsy 0668 6.5024 $385.87 $114.67 $77.17 75978 S Repair venous blockage 0668 6.5024 $385.87 $114.67 $77.17 75980 S Contrast xray exam bile duct 0297 5.253 $311.73 $122.13 $62.35 75982 S Contrast xray exam bile duct 0297 5.253 $311.73 $122.13 $62.35 75984 X Xray control catheter change 0263 1.7476 $103.71 $24.40 $20.74 75989 N Abscess drainage under x-ray 75992 S Atherectomy, x-ray exam 0279 8.9319 $530.05 $150.03 $106.01 75993 S Atherectomy, x-ray exam 0279 8.9319 $530.05 $150.03 $106.01 75994 S Atherectomy, x-ray exam 0279 8.9319 $530.05 $150.03 $106.01 75995 S Atherectomy, x-ray exam 0279 8.9319 $530.05 $150.03 $106.01 75996 S Atherectomy, x-ray exam 0279 8.9319 $530.05 $150.03 $106.01 75998 N Fluoroguide for vein device 76000 X Fluoroscope examination 0272 1.3801 $81.90 $32.76 $16.38 76001 N Fluoroscope exam, extensive Start Printed Page 50787 76003 N Needle localization by x-ray 76005 N Fluoroguide for spine inject 76006 X X-ray stress view 0260 0.7555 $44.83 $17.93 $8.97 76010 X X-ray, nose to rectum 0260 0.7555 $44.83 $17.93 $8.97 76012 S Percut vertebroplasty fluor 0274 3.0413 $180.48 $72.19 $36.10 76013 S Percut vertebroplasty, ct 0274 3.0413 $180.48 $72.19 $36.10 76020 X X-rays for bone age 0260 0.7555 $44.83 $17.93 $8.97 76040 X X-rays, bone evaluation 0261 1.2901 $76.56 $15.31 76061 X X-rays, bone survey 0261 1.2901 $76.56 $15.31 76062 X X-rays, bone survey 0261 1.2901 $76.56 $15.31 76065 X X-rays, bone evaluation 0261 1.2901 $76.56 $15.31 76066 X Joint survey, single view 0260 0.7555 $44.83 $17.93 $8.97 76070 S CT scan, bone density study 0288 1.2568 $74.58 $14.92 76071 S Ct bone density, peripheral 0282 1.6542 $98.17 $39.26 $19.63 76075 S Dexa, axial skeleton study 0288 1.2568 $74.58 $14.92 76076 S Dexa, peripheral study 0665 0.6464 $38.36 $7.67 76077 X Dxa bone density/v-fracture 0260 0.7555 $44.83 $17.93 $8.97 76078 X Radiographic absorptiometry 0260 0.7555 $44.83 $17.93 $8.97 76080 X X-ray exam of fistula 0263 1.7476 $103.71 $24.40 $20.74 76082 A Computer mammogram add-on 76083 A Computer mammogram add-on 76086 X X-ray of mammary duct 0263 1.7476 $103.71 $24.40 $20.74 76088 X X-ray of mammary ducts 0263 1.7476 $103.71 $24.40 $20.74 76090 A Mammogram, one breast 76091 A Mammogram, both breasts 76092 A Mammogram, screening 76093 E Magnetic image, breast 76094 E Magnetic image, both breasts 76095 X Stereotactic breast biopsy 0264 3.524 $209.12 $79.41 $41.82 76096 X X-ray of needle wire, breast 0263 1.7476 $103.71 $24.40 $20.74 76098 X X-ray exam, breast specimen 0260 0.7555 $44.83 $17.93 $8.97 76100 X X-ray exam of body section 0261 1.2901 $76.56 $15.31 76101 X Complex body section x-ray 0263 1.7476 $103.71 $24.40 $20.74 76102 X Complex body section x-rays 0264 3.524 $209.12 $79.41 $41.82 76120 X Cine/video x-rays 0272 1.3801 $81.90 $32.76 $16.38 76125 X Cine/video x-rays add-on 0260 0.7555 $44.83 $17.93 $8.97 76140 E X-ray consultation 76150 X X-ray exam, dry process 0260 0.7555 $44.83 $17.93 $8.97 76350 N Special x-ray contrast study 76355 S Ct scan for localization 0283 4.4253 $262.61 $105.04 $52.52 76360 S Ct scan for needle biopsy 0283 4.4253 $262.61 $105.04 $52.52 76362 S Ct guide for tissue ablation 0332 3.2694 $194.02 $77.60 $38.80 76370 S Ct scan for therapy guide 0282 1.6542 $98.17 $39.26 $19.63 76375 S 3d/holograph reconstr add-on 0282 1.6542 $98.17 $39.26 $19.63 76380 S CAT scan follow-up study 0282 1.6542 $98.17 $39.26 $19.63 76390 E Mr spectroscopy 76393 S Mr guidance for needle place 0335 5.1581 $306.10 $122.43 $61.22 76394 S Mri for tissue ablation 0335 5.1581 $306.10 $122.43 $61.22 76400 S Magnetic image, bone marrow 0335 5.1581 $306.10 $122.43 $61.22 76496 X Fluoroscopic procedure 0272 1.3801 $81.90 $32.76 $16.38 76497 S Ct procedure 0282 1.6542 $98.17 $39.26 $19.63 76498 S Mri procedure 0335 5.1581 $306.10 $122.43 $61.22 76499 X Radiographic procedure 0260 0.7555 $44.83 $17.93 $8.97 76506 S Echo exam of head 0265 1.0213 $60.61 $24.24 $12.12 76510 S Ophth us, b & quant a 0266 1.6393 $97.28 $38.91 $19.46 76511 S Echo exam of eye 0266 1.6393 $97.28 $38.91 $19.46 76512 S Echo exam of eye 0266 1.6393 $97.28 $38.91 $19.46 76513 S Echo exam of eye, water bath 0266 1.6393 $97.28 $38.91 $19.46 76514 X Echo exam of eye, thickness 0340 0.6384 $37.88 $7.58 76516 S Echo exam of eye 0265 1.0213 $60.61 $24.24 $12.12 76519 S Echo exam of eye 0266 1.6393 $97.28 $38.91 $19.46 76529 S Echo exam of eye 0265 1.0213 $60.61 $24.24 $12.12 76536 S Us exam of head and neck 0266 1.6393 $97.28 $38.91 $19.46 76604* S Us exam, chest, b-scan 0266 1.6393 $97.28 $38.91 $19.46 76645* S Us exam, breast(s) 0265 1.0213 $60.61 $24.24 $12.12 76700* S Us exam, abdom, complete 0266 1.6393 $97.28 $38.91 $19.46 Start Printed Page 50788 76705* S Echo exam of abdomen 0266 1.6393 $97.28 $38.91 $19.46 76770* S Us exam abdo back wall, comp 0266 1.6393 $97.28 $38.91 $19.46 76775* S Us exam abdo back wall, lim 0266 1.6393 $97.28 $38.91 $19.46 76778* S Us exam kidney transplant 0266 1.6393 $97.28 $38.91 $19.46 76800 S Us exam, spinal canal 0266 1.6393 $97.28 $38.91 $19.46 76801 S Ob us < 14 wks, single fetus 0266 1.6393 $97.28 $38.91 $19.46 76802 S Ob us < 14 wks, add'l fetus 0265 1.0213 $60.61 $24.24 $12.12 76805 S Us exam, pg uterus, compl 0266 1.6393 $97.28 $38.91 $19.46 76810 S Us exam, pg uterus, mult 0266 1.6393 $97.28 $38.91 $19.46 76811 S Ob us, detailed, sngl fetus 0267 2.6327 $156.23 $62.18 $31.25 76812 S Ob us, detailed, addl fetus 0266 1.6393 $97.28 $38.91 $19.46 76815 S Us exam, pg uterus limit 0265 1.0213 $60.61 $24.24 $12.12 76816 S Us exam pg uterus repeat 0265 1.0213 $60.61 $24.24 $12.12 76817 S Transvaginal us, obstetric 0266 1.6393 $97.28 $38.91 $19.46 76818 S Fetal biophys profile w/nst 0266 1.6393 $97.28 $38.91 $19.46 76819 S Fetal biophys profil w/o nst 0266 1.6393 $97.28 $38.91 $19.46 76820 S Umbilical artery echo 0096 1.6307 $96.77 $38.70 $19.35 76821 S Middle cerebral artery echo 0096 1.6307 $96.77 $38.70 $19.35 76825 S Echo exam of fetal heart 0671 1.7028 $101.05 $40.42 $20.21 76826 S Echo exam of fetal heart 0697 1.5357 $91.13 $36.45 $18.23 76827 S Echo exam of fetal heart 0671 1.7028 $101.05 $40.42 $20.21 76828 S Echo exam of fetal heart 0697 1.5357 $91.13 $36.45 $18.23 76830* S Transvaginal us, non-ob 0266 1.6393 $97.28 $38.91 $19.46 76831* S Echo exam, uterus 0267 2.6327 $156.23 $62.18 $31.25 76856* S Us exam, pelvic, complete 0266 1.6393 $97.28 $38.91 $19.46 76857* S Us exam, pelvic, limited 0265 1.0213 $60.61 $24.24 $12.12 76870 S Us exam, scrotum 0266 1.6393 $97.28 $38.91 $19.46 76872 S Us, transrectal 0266 1.6393 $97.28 $38.91 $19.46 76873 S Echograp trans r, pros study 0266 1.6393 $97.28 $38.91 $19.46 76880 S Us exam, extremity 0266 1.6393 $97.28 $38.91 $19.46 76885 S Us exam infant hips, dynamic 0265 1.0213 $60.61 $24.24 $12.12 76886 S Us exam infant hips, static 0266 1.6393 $97.28 $38.91 $19.46 76930 S Echo guide, cardiocentesis 0268 1.061 $62.96 $12.59 76932 S Echo guide for heart biopsy 0268 1.061 $62.96 $12.59 76936 S Echo guide for artery repair 0268 1.061 $62.96 $12.59 76937 N Us guide, vascular access 76940 S Us guide, tissue ablation 0268 1.061 $62.96 $12.59 76941 S Echo guide for transfusion 0268 1.061 $62.96 $12.59 76942 S Echo guide for biopsy 0268 1.061 $62.96 $12.59 76945 S Echo guide, villus sampling 0268 1.061 $62.96 $12.59 76946 S Echo guide for amniocentesis 0268 1.061 $62.96 $12.59 76948 S Echo guide, ova aspiration 0268 1.061 $62.96 $12.59 76950 S Echo guidance radiotherapy 0268 1.061 $62.96 $12.59 76965 S Echo guidance radiotherapy 0268 1.061 $62.96 $12.59 76970 S Ultrasound exam follow-up 0265 1.0213 $60.61 $24.24 $12.12 76975 S GI endoscopic ultrasound 0266 1.6393 $97.28 $38.91 $19.46 76977 X Us bone density measure 0340 0.6384 $37.88 $7.58 76986 S Ultrasound guide intraoper 0266 1.6393 $97.28 $38.91 $19.46 76999 S Echo examination procedure 0265 1.0213 $60.61 $24.24 $12.12 77261 E Radiation therapy planning 77262 E Radiation therapy planning 77263 E Radiation therapy planning 77280 X Set radiation therapy field 0304 1.7738 $105.26 $41.52 $21.05 77285 X Set radiation therapy field 0305 4.0036 $237.59 $91.38 $47.52 77290 X Set radiation therapy field 0305 4.0036 $237.59 $91.38 $47.52 77295 X Set radiation therapy field 0310 13.949 $827.78 $325.27 $165.56 77299 E Radiation therapy planning 77300 X Radiation therapy dose plan 0304 1.7738 $105.26 $41.52 $21.05 77301 X Radiotherapy dose plan, imrt 0310 13.949 $827.78 $325.27 $165.56 77305 X Teletx isodose plan simple 0304 1.7738 $105.26 $41.52 $21.05 77310 X Teletx isodose plan intermed 0305 4.0036 $237.59 $91.38 $47.52 77315 X Teletx isodose plan complex 0305 4.0036 $237.59 $91.38 $47.52 77321 X Special teletx port plan 0305 4.0036 $237.59 $91.38 $47.52 77326 X Radiation therapy dose plan 0304 1.7738 $105.26 $41.52 $21.05 77327 X Brachytx isodose calc interm 0305 4.0036 $237.59 $91.38 $47.52 77328 X Brachytx isodose plan compl 0305 4.0036 $237.59 $91.38 $47.52 Start Printed Page 50789 77331 X Special radiation dosimetry 0304 1.7738 $105.26 $41.52 $21.05 77332 X Radiation treatment aid(s) 0303 2.8356 $168.27 $66.95 $33.65 77333 X Radiation treatment aid(s) 0303 2.8356 $168.27 $66.95 $33.65 77334 X Radiation treatment aid(s) 0303 2.8356 $168.27 $66.95 $33.65 77336 X Radiation physics consult 0304 1.7738 $105.26 $41.52 $21.05 77370 X Radiation physics consult 0304 1.7738 $105.26 $41.52 $21.05 77399 X External radiation dosimetry 0304 1.7738 $105.26 $41.52 $21.05 77401 S Radiation treatment delivery 0300 1.5198 $90.19 $18.04 77402 S Radiation treatment delivery 0300 1.5198 $90.19 $18.04 77403 S Radiation treatment delivery 0300 1.5198 $90.19 $18.04 77404 S Radiation treatment delivery 0300 1.5198 $90.19 $18.04 77406 S Radiation treatment delivery 0300 1.5198 $90.19 $18.04 77407 S Radiation treatment delivery 0300 1.5198 $90.19 $18.04 77408 S Radiation treatment delivery 0300 1.5198 $90.19 $18.04 77409 S Radiation treatment delivery 0300 1.5198 $90.19 $18.04 77411 S Radiation treatment delivery 0301 2.2195 $131.71 $26.34 77412 S Radiation treatment delivery 0301 2.2195 $131.71 $26.34 77413 S Radiation treatment delivery 0301 2.2195 $131.71 $26.34 77414 S Radiation treatment delivery 0301 2.2195 $131.71 $26.34 77416 S Radiation treatment delivery 0301 2.2195 $131.71 $26.34 77417 X Radiology port film(s) 0260 0.7555 $44.83 $17.93 $8.97 77418 S Radiation tx delivery, imrt 0412 5.3643 $318.33 $63.67 77427 E Radiation tx management, x5 77431 E Radiation therapy management 77432 E Stereotactic radiation trmt 77470 S Special radiation treatment 0299 5.8482 $347.05 $69.41 77499 E Radiation therapy management 77520 S Proton trmt, simple w/o comp 0664 12.9439 $768.13 $153.63 77522 S Proton trmt, simple w/comp 0664 12.9439 $768.13 $153.63 77523 S Proton trmt, intermediate 0667 15.4857 $918.97 $183.79 77525 S Proton treatment, complex 0667 15.4857 $918.97 $183.79 77600 S Hyperthermia treatment 0314 5.9945 $355.73 $98.36 $71.15 77605 S Hyperthermia treatment 0314 5.9945 $355.73 $98.36 $71.15 77610 S Hyperthermia treatment 0314 5.9945 $355.73 $98.36 $71.15 77615 S Hyperthermia treatment 0314 5.9945 $355.73 $98.36 $71.15 77620 S Hyperthermia treatment 0314 5.9945 $355.73 $98.36 $71.15 77750 S Infuse radioactive materials 0301 2.2195 $131.71 $26.34 77761 S Apply intrcav radiat simple 0312 5.0032 $296.90 $59.38 77762 S Apply intrcav radiat interm 0312 5.0032 $296.90 $59.38 77763 S Apply intrcav radiat compl 0312 5.0032 $296.90 $59.38 77776 S Apply interstit radiat simpl 0312 5.0032 $296.90 $59.38 77777 S Apply interstit radiat inter 0312 5.0032 $296.90 $59.38 77778 S Apply interstit radiat compl 0651 12.1448 $720.71 $144.14 77781 S High intensity brachytherapy 0313 12.8655 $763.48 $152.70 77782 S High intensity brachytherapy 0313 12.8655 $763.48 $152.70 77783 S High intensity brachytherapy 0313 12.8655 $763.48 $152.70 77784 S High intensity brachytherapy 0313 12.8655 $763.48 $152.70 77789 S Apply surface radiation 0300 1.5198 $90.19 $18.04 77790 N Radiation handling 77799 S Radium/radioisotope therapy 0313 12.8655 $763.48 $152.70 78000 S Thyroid, single uptake 0389 1.4976 $88.87 $35.54 $17.77 78001 S Thyroid, multiple uptakes 0389 1.4976 $88.87 $35.54 $17.77 78003 S Thyroid suppress/stimul 0389 1.4976 $88.87 $35.54 $17.77 78006 S Thyroid imaging with uptake 0390 2.5562 $151.69 $60.67 $30.34 78007 S Thyroid image, mult uptakes 0391 2.8774 $170.75 $68.30 $34.15 78010 S Thyroid imaging 0390 2.5562 $151.69 $60.67 $30.34 78011 S Thyroid imaging with flow 0390 2.5562 $151.69 $60.67 $30.34 78015 S Thyroid met imaging 0406 4.3035 $255.38 $102.15 $51.08 78016 S Thyroid met imaging/studies 0406 4.3035 $255.38 $102.15 $51.08 78018 S Thyroid met imaging, body 0406 4.3035 $255.38 $102.15 $51.08 78020 S Thyroid met uptake 0399 1.5192 $90.15 $36.06 $18.03 78070 S Parathyroid nuclear imaging 0391 2.8774 $170.75 $68.30 $34.15 78075 S Adrenal nuclear imaging 0391 2.8774 $170.75 $68.30 $34.15 78099 S Endocrine nuclear procedure 0390 2.5562 $151.69 $60.67 $30.34 78102 S Bone marrow imaging, ltd 0400 4.1335 $245.29 $98.11 $49.06 78103 S Bone marrow imaging, mult 0400 4.1335 $245.29 $98.11 $49.06 Start Printed Page 50790 78104 S Bone marrow imaging, body 0400 4.1335 $245.29 $98.11 $49.06 78110 S Plasma volume, single 0393 3.4438 $204.37 $81.74 $40.87 78111 S Plasma volume, multiple 0393 3.4438 $204.37 $81.74 $40.87 78120 S Red cell mass, single 0393 3.4438 $204.37 $81.74 $40.87 78121 S Red cell mass, multiple 0393 3.4438 $204.37 $81.74 $40.87 78122 S Blood volume 0393 3.4438 $204.37 $81.74 $40.87 78130 S Red cell survival study 0393 3.4438 $204.37 $81.74 $40.87 78135 S Red cell survival kinetics 0393 3.4438 $204.37 $81.74 $40.87 78140 S Red cell sequestration 0393 3.4438 $204.37 $81.74 $40.87 78160 S Plasma iron turnover 0393 3.4438 $204.37 $81.74 $40.87 78162 S Radioiron absorption exam 0393 3.4438 $204.37 $81.74 $40.87 78170 S Red cell iron utilization 0393 3.4438 $204.37 $81.74 $40.87 78172 S Total body iron estimation 0393 3.4438 $204.37 $81.74 $40.87 78185 S Spleen imaging 0400 4.1335 $245.29 $98.11 $49.06 78190 S Platelet survival, kinetics 0389 1.4976 $88.87 $35.54 $17.77 78191 S Platelet survival 0389 1.4976 $88.87 $35.54 $17.77 78195 S Lymph system imaging 0400 4.1335 $245.29 $98.11 $49.06 78199 S Blood/lymph nuclear exam 0400 4.1335 $245.29 $98.11 $49.06 78201 S Liver imaging 0394 4.463 $264.85 $105.93 $52.97 78202 S Liver imaging with flow 0394 4.463 $264.85 $105.93 $52.97 78205 S Liver imaging (3D) 0394 4.463 $264.85 $105.93 $52.97 78206 S Liver image (3d) with flow 0394 4.463 $264.85 $105.93 $52.97 78215 S Liver and spleen imaging 0394 4.463 $264.85 $105.93 $52.97 78216 S Liver & spleen image/flow 0394 4.463 $264.85 $105.93 $52.97 78220 S Liver function study 0394 4.463 $264.85 $105.93 $52.97 78223 S Hepatobiliary imaging 0394 4.463 $264.85 $105.93 $52.97 78230 S Salivary gland imaging 0395 3.8699 $229.65 $91.86 $45.93 78231 S Serial salivary imaging 0395 3.8699 $229.65 $91.86 $45.93 78232 S Salivary gland function exam 0395 3.8699 $229.65 $91.86 $45.93 78258 S Esophageal motility study 0395 3.8699 $229.65 $91.86 $45.93 78261 S Gastric mucosa imaging 0395 3.8699 $229.65 $91.86 $45.93 78262 S Gastroesophageal reflux exam 0395 3.8699 $229.65 $91.86 $45.93 78264 S Gastric emptying study 0395 3.8699 $229.65 $91.86 $45.93 78267 A Breath tst attain/anal c-14 78268 A Breath test analysis, c-14 78270 S Vit B-12 absorption exam 0389 1.4976 $88.87 $35.54 $17.77 78271 S Vit b-12 absrp exam, int fac 0389 1.4976 $88.87 $35.54 $17.77 78272 S Vit B-12 absorp, combined 0389 1.4976 $88.87 $35.54 $17.77 78278 S Acute GI blood loss imaging 0395 3.8699 $229.65 $91.86 $45.93 78282 S GI protein loss exam 0395 3.8699 $229.65 $91.86 $45.93 78290 S Meckel's divert exam 0395 3.8699 $229.65 $91.86 $45.93 78291 S Leveen/shunt patency exam 0395 3.8699 $229.65 $91.86 $45.93 78299 S GI nuclear procedure 0395 3.8699 $229.65 $91.86 $45.93 78300 S Bone imaging, limited area 0396 4.1426 $245.83 $98.33 $49.17 78305 S Bone imaging, multiple areas 0396 4.1426 $245.83 $98.33 $49.17 78306 S Bone imaging, whole body 0396 4.1426 $245.83 $98.33 $49.17 78315 S Bone imaging, 3 phase 0396 4.1426 $245.83 $98.33 $49.17 78320 S Bone imaging (3D) 0396 4.1426 $245.83 $98.33 $49.17 78350 X Bone mineral, single photon 0260 0.7555 $44.83 $17.93 $8.97 78351 E Bone mineral, dual photon 78399 S Musculoskeletal nuclear exam 0396 4.1426 $245.83 $98.33 $49.17 78414 S Non-imaging heart function 0398 4.3093 $255.73 $102.29 $51.15 78428 S Cardiac shunt imaging 0398 4.3093 $255.73 $102.29 $51.15 78445 S Vascular flow imaging 0397 2.2646 $134.39 $53.75 $26.88 78455 S Venous thrombosis study 0397 2.2646 $134.39 $53.75 $26.88 78456 S Acute venous thrombus image 0397 2.2646 $134.39 $53.75 $26.88 78457 S Venous thrombosis imaging 0397 2.2646 $134.39 $53.75 $26.88 78458 S Ven thrombosis images, bilat 0397 2.2646 $134.39 $53.75 $26.88 78459 S Heart muscle imaging (PET) 0285 17.1798 $1,019.50 $318.72 $203.90 78460 S Heart muscle blood, single 0398 4.3093 $255.73 $102.29 $51.15 78461 S Heart muscle blood, multiple 0377 6.8344 $405.57 $162.22 $81.11 78464 S Heart image (3d), single 0398 4.3093 $255.73 $102.29 $51.15 78465 S Heart image (3d), multiple 0377 6.8344 $405.57 $162.22 $81.11 78466 S Heart infarct image 0398 4.3093 $255.73 $102.29 $51.15 78468 S Heart infarct image (ef) 0398 4.3093 $255.73 $102.29 $51.15 78469 S Heart infarct image (3D) 0398 4.3093 $255.73 $102.29 $51.15 Start Printed Page 50791 78472 S Gated heart, planar, single 0398 4.3093 $255.73 $102.29 $51.15 78473 S Gated heart, multiple 0376 5.1975 $308.44 $121.42 $61.69 78478 S Heart wall motion add-on 0399 1.5192 $90.15 $36.06 $18.03 78480 S Heart function add-on 0399 1.5192 $90.15 $36.06 $18.03 78481 S Heart first pass, single 0398 4.3093 $255.73 $102.29 $51.15 78483 S Heart first pass, multiple 0376 5.1975 $308.44 $121.42 $61.69 78491 S Heart image (pet), single 0285 17.1798 $1,019.50 $318.72 $203.90 78492 S Heart image (pet), multiple 0285 17.1798 $1,019.50 $318.72 $203.90 78494 S Heart image, spect 0398 4.3093 $255.73 $102.29 $51.15 78496 S Heart first pass add-on 0399 1.5192 $90.15 $36.06 $18.03 78499 S Cardiovascular nuclear exam 0398 4.3093 $255.73 $102.29 $51.15 78580 S Lung perfusion imaging 0401 3.415 $202.66 $81.06 $40.53 78584 S Lung V/Q image single breath 0378 5.4997 $326.37 $130.54 $65.27 78585 S Lung V/Q imaging 0378 5.4997 $326.37 $130.54 $65.27 78586 S Aerosol lung image, single 0401 3.415 $202.66 $81.06 $40.53 78587 S Aerosol lung image, multiple 0401 3.415 $202.66 $81.06 $40.53 78588 S Perfusion lung image 0378 5.4997 $326.37 $130.54 $65.27 78591 S Vent image, 1 breath, 1 proj 0401 3.415 $202.66 $81.06 $40.53 78593 S Vent image, 1 proj, gas 0401 3.415 $202.66 $81.06 $40.53 78594 S Vent image, mult proj, gas 0401 3.415 $202.66 $81.06 $40.53 78596 S Lung differential function 0378 5.4997 $326.37 $130.54 $65.27 78599 S Respiratory nuclear exam 0401 3.415 $202.66 $81.06 $40.53 78600 S Brain imaging, ltd static 0402 5.1847 $307.68 $123.07 $61.54 78601 S Brain imaging, ltd w/flow 0402 5.1847 $307.68 $123.07 $61.54 78605 S Brain imaging, complete 0402 5.1847 $307.68 $123.07 $61.54 78606 S Brain imaging, compl w/flow 0402 5.1847 $307.68 $123.07 $61.54 78607 S Brain imaging (3D) 0402 5.1847 $307.68 $123.07 $61.54 78608 S Brain imaging (PET) 1513 $1,150.00 $230.00 78609 S Brain imaging (PET) 1513 $1,150.00 $230.00 78610 S Brain flow imaging only 0402 5.1847 $307.68 $123.07 $61.54 78615 S Cerebral vascular flow image 0402 5.1847 $307.68 $123.07 $61.54 78630 S Cerebrospinal fluid scan 0403 3.6138 $214.45 $85.78 $42.89 78635 S CSF ventriculography 0403 3.6138 $214.45 $85.78 $42.89 78645 S CSF shunt evaluation 0403 3.6138 $214.45 $85.78 $42.89 78647 S Cerebrospinal fluid scan 0403 3.6138 $214.45 $85.78 $42.89 78650 S CSF leakage imaging 0403 3.6138 $214.45 $85.78 $42.89 78660 S Nuclear exam of tear flow 0403 3.6138 $214.45 $85.78 $42.89 78699 S Nervous system nuclear exam 0402 5.1847 $307.68 $123.07 $61.54 78700 S Kidney imaging, static 0267 2.6327 $156.23 $62.18 $31.25 78701 S Kidney imaging with flow 0404 3.8559 $228.82 $91.52 $45.76 78704 S Imaging renogram 0404 3.8559 $228.82 $91.52 $45.76 78707 S Kidney flow/function image 0404 3.8559 $228.82 $91.52 $45.76 78708 S Kidney flow/function image 0405 4.2674 $253.24 $101.29 $50.65 78709 S Kidney flow/function image 0405 4.2674 $253.24 $101.29 $50.65 78710 S Kidney imaging (3D) 0404 3.8559 $228.82 $91.52 $45.76 78715 S Renal vascular flow exam 0404 3.8559 $228.82 $91.52 $45.76 78725 S Kidney function study 0389 1.4976 $88.87 $35.54 $17.77 78730 X Urinary bladder retention 0340 0.6384 $37.88 $7.58 78740 S Ureteral reflux study 0404 3.8559 $228.82 $91.52 $45.76 78760 S Testicular imaging 0404 3.8559 $228.82 $91.52 $45.76 78761 S Testicular imaging/flow 0404 3.8559 $228.82 $91.52 $45.76 78799 S Genitourinary nuclear exam 0404 3.8559 $228.82 $91.52 $45.76 78800 S Tumor imaging, limited area 0406 4.3035 $255.38 $102.15 $51.08 78801 S Tumor imaging, mult areas 0406 4.3035 $255.38 $102.15 $51.08 78802 S Tumor imaging, whole body 0406 4.3035 $255.38 $102.15 $51.08 78803 S Tumor imaging (3D) 0406 4.3035 $255.38 $102.15 $51.08 78804 S Tumor imaging, whole body 1508 $650.00 $130.00 78805 S Abscess imaging, ltd area 0406 4.3035 $255.38 $102.15 $51.08 78806 S Abscess imaging, whole body 0406 4.3035 $255.38 $102.15 $51.08 78807 S Nuclear localization/abscess 0406 4.3035 $255.38 $102.15 $51.08 78811 S Tumor imaging (pet), limited 1513 $1,150.00 $230.00 78812 S Tumor image (pet)/skul-thigh 1513 $1,150.00 $230.00 78813 S Tumor image (pet) full body 1513 $1,150.00 $230.00 78814 S Tumor image pet/ct, limited 1514 $1,250.00 $250.00 78815 S Tumorimage pet/ct skul-thigh 1514 $1,250.00 $250.00 78816 S Tumor image pet/ct full body 1514 $1,250.00 $250.00 Start Printed Page 50792 78890 N Nuclear medicine data proc 78891 N Nuclear med data proc 78999 S Nuclear diagnostic exam 0389 1.4976 $88.87 $35.54 $17.77 79005 S Nuclear rx, oral admin 0407 3.9839 $236.42 $94.56 $47.28 79101 S Nuclear rx, iv admin 0407 3.9839 $236.42 $94.56 $47.28 79200 S Intracavitary nuclear trmt 0407 3.9839 $236.42 $94.56 $47.28 79300 S Interstitial nuclear therapy 0407 3.9839 $236.42 $94.56 $47.28 79403 S Hematopoetic nuclear therapy 1507 $550.00 $110.00 79440 S Nuclear joint therapy 0407 3.9839 $236.42 $94.56 $47.28 79445 S Nuclear rx, intra-arterial 0407 3.9839 $236.42 $94.56 $47.28 79999 S Nuclear medicine therapy 0407 3.9839 $236.42 $94.56 $47.28 80048 A Basic metabolic panel 80050 E General health panel 80051 A Electrolyte panel 80053 A Comprehen metabolic panel 80055 E Obstetric panel 80061 A Lipid panel 80069 A Renal function panel 80074 A Acute hepatitis panel 80076 A Hepatic function panel 80100 A Drug screen, qualitate/multi 80101 A Drug screen, single 80102 A Drug confirmation 80103 N Drug analysis, tissue prep 80150 A Assay of amikacin 80152 A Assay of amitriptyline 80154 A Assay of benzodiazepines 80156 A Assay, carbamazepine, total 80157 A Assay, carbamazepine, free 80158 A Assay of cyclosporine 80160 A Assay of desipramine 80162 A Assay of digoxin 80164 A Assay, dipropylacetic acid 80166 A Assay of doxepin 80168 A Assay of ethosuximide 80170 A Assay of gentamicin 80172 A Assay of gold 80173 A Assay of haloperidol 80174 A Assay of imipramine 80176 A Assay of lidocaine 80178 A Assay of lithium 80182 A Assay of nortriptyline 80184 A Assay of phenobarbital 80185 A Assay of phenytoin, total 80186 A Assay of phenytoin, free 80188 A Assay of primidone 80190 A Assay of procainamide 80192 A Assay of procainamide 80194 A Assay of quinidine 80196 A Assay of salicylate 80197 A Assay of tacrolimus 80198 A Assay of theophylline 80200 A Assay of tobramycin 80201 A Assay of topiramate 80202 A Assay of vancomycin 80299 A Quantitative assay, drug 80400 A Acth stimulation panel 80402 A Acth stimulation panel 80406 A Acth stimulation panel 80408 A Aldosterone suppression eval 80410 A Calcitonin stimul panel 80412 A CRH stimulation panel 80414 A Testosterone response 80415 A Estradiol response panel 80416 A Renin stimulation panel 80417 A Renin stimulation panel Start Printed Page 50793 80418 A Pituitary evaluation panel 80420 A Dexamethasone panel 80422 A Glucagon tolerance panel 80424 A Glucagon tolerance panel 80426 A Gonadotropin hormone panel 80428 A Growth hormone panel 80430 A Growth hormone panel 80432 A Insulin suppression panel 80434 A Insulin tolerance panel 80435 A Insulin tolerance panel 80436 A Metyrapone panel 80438 A TRH stimulation panel 80439 A TRH stimulation panel 80440 A TRH stimulation panel 80500 X Lab pathology consultation 0433 0.2581 $15.32 $6.12 $3.06 80502 X Lab pathology consultation 0342 0.156 $9.26 $3.70 $1.85 81000 A Urinalysis, nonauto w/scope 81001 A Urinalysis, auto w/scope 81002 A Urinalysis nonauto w/o scope 81003 A Urinalysis, auto, w/o scope 81005 A Urinalysis 81007 A Urine screen for bacteria 81015 A Microscopic exam of urine 81020 A Urinalysis, glass test 81025 A Urine pregnancy test 81050 A Urinalysis, volume measure 81099 A Urinalysis test procedure 82000 A Assay of blood acetaldehyde 82003 A Assay of acetaminophen 82009 A Test for acetone/ketones 82010 A Acetone assay 82013 A Acetylcholinesterase assay 82016 A Acylcarnitines, qual 82017 A Acylcarnitines, quant 82024 A Assay of acth 82030 A Assay of adp & amp 82040 A Assay of serum albumin 82042 A Assay of urine albumin 82043 A Microalbumin, quantitative 82044 A Microalbumin, semiquant 82045 A Albumin, ischemia modified 82055 A Assay of ethanol 82075 A Assay of breath ethanol 82085 A Assay of aldolase 82088 A Assay of aldosterone 82101 A Assay of urine alkaloids 82103 A Alpha-1-antitrypsin, total 82104 A Alpha-1-antitrypsin, pheno 82105 A Alpha-fetoprotein, serum 82106 A Alpha-fetoprotein, amniotic 82108 A Assay of aluminum 82120 A Amines, vaginal fluid qual 82127 A Amino acid, single qual 82128 A Amino acids, mult qual 82131 A Amino acids, single quant 82135 A Assay, aminolevulinic acid 82136 A Amino acids, quant, 2-5 82139 A Amino acids, quan, 6 or more 82140 A Assay of ammonia 82143 A Amniotic fluid scan 82145 A Assay of amphetamines 82150 A Assay of amylase 82154 A Androstanediol glucuronide 82157 A Assay of androstenedione 82160 A Assay of androsterone 82163 A Assay of angiotensin II Start Printed Page 50794 82164 A Angiotensin I enzyme test 82172 A Assay of apolipoprotein 82175 A Assay of arsenic 82180 A Assay of ascorbic acid 82190 A Atomic absorption 82205 A Assay of barbiturates 82232 A Assay of beta-2 protein 82239 A Bile acids, total 82240 A Bile acids, cholylglycine 82247 A Bilirubin, total 82248 A Bilirubin, direct 82252 A Fecal bilirubin test 82261 A Assay of biotinidase 82270 A Test for blood, feces 82273 A Test for blood, other source 82274 A Assay test for blood, fecal 82286 A Assay of bradykinin 82300 A Assay of cadmium 82306 A Assay of vitamin D 82307 A Assay of vitamin D 82308 A Assay of calcitonin 82310 A Assay of calcium 82330 A Assay of calcium 82331 A Calcium infusion test 82340 A Assay of calcium in urine 82355 A Calculus analysis, qual 82360 A Calculus assay, quant 82365 A Calculus spectroscopy 82370 A X-ray assay, calculus 82373 A Assay, c-d transfer measure 82374 A Assay, blood carbon dioxide 82375 A Assay, blood carbon monoxide 82376 A Test for carbon monoxide 82378 A Carcinoembryonic antigen 82379 A Assay of carnitine 82380 A Assay of carotene 82382 A Assay, urine catecholamines 82383 A Assay, blood catecholamines 82384 A Assay, three catecholamines 82387 A Assay of cathepsin-d 82390 A Assay of ceruloplasmin 82397 A Chemiluminescent assay 82415 A Assay of chloramphenicol 82435 A Assay of blood chloride 82436 A Assay of urine chloride 82438 A Assay, other fluid chlorides 82441 A Test for chlorohydrocarbons 82465 A Assay, bld/serum cholesterol 82480 A Assay, serum cholinesterase 82482 A Assay, rbc cholinesterase 82485 A Assay, chondroitin sulfate 82486 A Gas/liquid chromatography 82487 A Paper chromatography 82488 A Paper chromatography 82489 A Thin layer chromatography 82491 A Chromotography, quant, sing 82492 A Chromotography, quant, mult 82495 A Assay of chromium 82507 A Assay of citrate 82520 A Assay of cocaine 82523 A Collagen crosslinks 82525 A Assay of copper 82528 A Assay of corticosterone 82530 A Cortisol, free 82533 A Total cortisol 82540 A Assay of creatine Start Printed Page 50795 82541 A Column chromotography, qual 82542 A Column chromotography, quant 82543 A Column chromotograph/isotope 82544 A Column chromotograph/isotope 82550 A Assay of ck (cpk) 82552 A Assay of cpk in blood 82553 A Creatine, MB fraction 82554 A Creatine, isoforms 82565 A Assay of creatinine 82570 A Assay of urine creatinine 82575 A Creatinine clearance test 82585 A Assay of cryofibrinogen 82595 A Assay of cryoglobulin 82600 A Assay of cyanide 82607 A Vitamin B-12 82608 A B-12 binding capacity 82615 A Test for urine cystines 82626 A Dehydroepiandrosterone 82627 A Dehydroepiandrosterone 82633 A Desoxycorticosterone 82634 A Deoxycortisol 82638 A Assay of dibucaine number 82646 A Assay of dihydrocodeinone 82649 A Assay of dihydromorphinone 82651 A Assay of dihydrotestosterone 82652 A Assay of dihydroxyvitamin d 82654 A Assay of dimethadione 82656 A Pancreatic elastase, fecal 82657 A Enzyme cell activity 82658 A Enzyme cell activity, ra 82664 A Electrophoretic test 82666 A Assay of epiandrosterone 82668 A Assay of erythropoietin 82670 A Assay of estradiol 82671 A Assay of estrogens 82672 A Assay of estrogen 82677 A Assay of estriol 82679 A Assay of estrone 82690 A Assay of ethchlorvynol 82693 A Assay of ethylene glycol 82696 A Assay of etiocholanolone 82705 A Fats/lipids, feces, qual 82710 A Fats/lipids, feces, quant 82715 A Assay of fecal fat 82725 A Assay of blood fatty acids 82726 A Long chain fatty acids 82728 A Assay of ferritin 82731 A Assay of fetal fibronectin 82735 A Assay of fluoride 82742 A Assay of flurazepam 82746 A Blood folic acid serum 82747 A Assay of folic acid, rbc 82757 A Assay of semen fructose 82759 A Assay of rbc galactokinase 82760 A Assay of galactose 82775 A Assay galactose transferase 82776 A Galactose transferase test 82784 A Assay of gammaglobulin igm 82785 A Assay of gammaglobulin ige 82787 A Igg 1, 2, 3 or 4, each 82800 A Blood pH 82803 A Blood gases pH, pO2 & pCO2 82805 A Blood gases W/02 saturation 82810 A Blood gases, O2 sat only 82820 A Hemoglobin-oxygen affinity 82926 A Assay of gastric acid Start Printed Page 50796 82928 A Assay of gastric acid 82938 A Gastrin test 82941 A Assay of gastrin 82943 A Assay of glucagon 82945 A Glucose other fluid 82946 A Glucagon tolerance test 82947 A Assay, glucose, blood quant 82948 A Reagent strip/blood glucose 82950 A Glucose test 82951 A Glucose tolerance test (GTT) 82952 A GTT-added samples 82953 A Glucose-tolbutamide test 82955 A Assay of g6pd enzyme 82960 A Test for G6PD enzyme 82962 A Glucose blood test 82963 A Assay of glucosidase 82965 A Assay of gdh enzyme 82975 A Assay of glutamine 82977 A Assay of GGT 82978 A Assay of glutathione 82979 A Assay, rbc glutathione 82980 A Assay of glutethimide 82985 A Glycated protein 83001 A Gonadotropin (FSH) 83002 A Gonadotropin (LH) 83003 A Assay, growth hormone (hgh) 83008 A Assay of guanosine 83009 A H pylori (c-13), blood 83010 A Assay of haptoglobin, quant 83012 A Assay of haptoglobins 83013 A H pylori analysis 83014 A H pylori drug admin/collect 83015 A Heavy metal screen 83018 A Quantitative screen, metals 83020 A Hemoglobin electrophoresis 83021 A Hemoglobin chromotography 83026 A Hemoglobin, copper sulfate 83030 A Fetal hemoglobin, chemical 83033 A Fetal hemoglobin assay, qual 83036 A Glycated hemoglobin test 83045 A Blood methemoglobin test 83050 A Blood methemoglobin assay 83051 A Assay of plasma hemoglobin 83055 A Blood sulfhemoglobin test 83060 A Blood sulfhemoglobin assay 83065 A Assay of hemoglobin heat 83068 A Hemoglobin stability screen 83069 A Assay of urine hemoglobin 83070 A Assay of hemosiderin, qual 83071 A Assay of hemosiderin, quant 83080 A Assay of b hexosaminidase 83088 A Assay of histamine 83090 A Assay of homocystine 83150 A Assay of for hva 83491 A Assay of corticosteroids 83497 A Assay of 5-hiaa 83498 A Assay of progesterone 83499 A Assay of progesterone 83500 A Assay, free hydroxyproline 83505 A Assay, total hydroxyproline 83516 A Immunoassay, nonantibody 83518 A Immunoassay, dipstick 83519 A Immunoassay, nonantibody 83520 A Immunoassay, RIA 83525 A Assay of insulin 83527 A Assay of insulin Start Printed Page 50797 83528 A Assay of intrinsic factor 83540 A Assay of iron 83550 A Iron binding test 83570 A Assay of idh enzyme 83582 A Assay of ketogenic steroids 83586 A Assay 17- ketosteroids 83593 A Fractionation, ketosteroids 83605 A Assay of lactic acid 83615 A Lactate (LD) (LDH) enzyme 83625 A Assay of ldh enzymes 83630 A Lactoferrin, fecal (qual) 83632 A Placental lactogen 83633 A Test urine for lactose 83634 A Assay of urine for lactose 83655 A Assay of lead 83661 A L/s ratio, fetal lung 83662 A Foam stability, fetal lung 83663 A Fluoro polarize, fetal lung 83664 A Lamellar bdy, fetal lung 83670 A Assay of lap enzyme 83690 A Assay of lipase 83715 A Assay of blood lipoproteins 83716 A Assay of blood lipoproteins 83718 A Assay of lipoprotein 83719 A Assay of blood lipoprotein 83721 A Assay of blood lipoprotein 83727 A Assay of lrh hormone 83735 A Assay of magnesium 83775 A Assay of md enzyme 83785 A Assay of manganese 83788 A Mass spectrometry qual 83789 A Mass spectrometry quant 83805 A Assay of meprobamate 83825 A Assay of mercury 83835 A Assay of metanephrines 83840 A Assay of methadone 83857 A Assay of methemalbumin 83858 A Assay of methsuximide 83864 A Mucopolysaccharides 83866 A Mucopolysaccharides screen 83872 A Assay synovial fluid mucin 83873 A Assay of csf protein 83874 A Assay of myoglobin 83880 A Natriuretic peptide 83883 A Assay, nephelometry not spec 83885 A Assay of nickel 83887 A Assay of nicotine 83890 A Molecule isolate 83891 A Molecule isolate nucleic 83892 A Molecular diagnostics 83893 A Molecule dot/slot/blot 83894 A Molecule gel electrophor 83896 A Molecular diagnostics 83897 A Molecule nucleic transfer 83898 A Molecule nucleic ampli 83901 A Molecule nucleic ampli 83902 A Molecular diagnostics 83903 A Molecule mutation scan 83904 A Molecule mutation identify 83905 A Molecule mutation identify 83906 A Molecule mutation identify 83912 A Genetic examination 83915 A Assay of nucleotidase 83916 A Oligoclonal bands 83918 A Organic acids, total, quant 83919 A Organic acids, qual, each Start Printed Page 50798 83921 A Organic acid, single, quant 83925 A Assay of opiates 83930 A Assay of blood osmolality 83935 A Assay of urine osmolality 83937 A Assay of osteocalcin 83945 A Assay of oxalate 83950 A Oncoprotein, her-2/neu 83970 A Assay of parathormone 83986 A Assay of body fluid acidity 83992 A Assay for phencyclidine 84022 A Assay of phenothiazine 84030 A Assay of blood pku 84035 A Assay of phenylketones 84060 A Assay acid phosphatase 84061 A Phosphatase, forensic exam 84066 A Assay prostate phosphatase 84075 A Assay alkaline phosphatase 84078 A Assay alkaline phosphatase 84080 A Assay alkaline phosphatases 84081 A Amniotic fluid enzyme test 84085 A Assay of rbc pg6d enzyme 84087 A Assay phosphohexose enzymes 84100 A Assay of phosphorus 84105 A Assay of urine phosphorus 84106 A Test for porphobilinogen 84110 A Assay of porphobilinogen 84119 A Test urine for porphyrins 84120 A Assay of urine porphyrins 84126 A Assay of feces porphyrins 84127 A Assay of feces porphyrins 84132 A Assay of serum potassium 84133 A Assay of urine potassium 84134 A Assay of prealbumin 84135 A Assay of pregnanediol 84138 A Assay of pregnanetriol 84140 A Assay of pregnenolone 84143 A Assay of 17-hydroxypregneno 84144 A Assay of progesterone 84146 A Assay of prolactin 84150 A Assay of prostaglandin 84152 A Assay of psa, complexed 84153 A Assay of psa, total 84154 A Assay of psa, free 84155 A Assay of protein, serum 84156 A Assay of protein, urine 84157 A Assay of protein, other 84160 A Assay of protein, any source 84163 A Pappa, serum 84165 A Electrophoreisis of proteins 84166 A Protein e-phoresis/urine/csf 84181 A Western blot test 84182 A Protein, western blot test 84202 A Assay RBC protoporphyrin 84203 A Test RBC protoporphyrin 84206 A Assay of proinsulin 84207 A Assay of vitamin b-6 84210 A Assay of pyruvate 84220 A Assay of pyruvate kinase 84228 A Assay of quinine 84233 A Assay of estrogen 84234 A Assay of progesterone 84235 A Assay of endocrine hormone 84238 A Assay, nonendocrine receptor 84244 A Assay of renin 84252 A Assay of vitamin b-2 84255 A Assay of selenium Start Printed Page 50799 84260 A Assay of serotonin 84270 A Assay of sex hormone globul 84275 A Assay of sialic acid 84285 A Assay of silica 84295 A Assay of serum sodium 84300 A Assay of urine sodium 84302 A Assay of sweat sodium 84305 A Assay of somatomedin 84307 A Assay of somatostatin 84311 A Spectrophotometry 84315 A Body fluid specific gravity 84375 A Chromatogram assay, sugars 84376 A Sugars, single, qual 84377 A Sugars, multiple, qual 84378 A Sugars, single, quant 84379 A Sugars multiple quant 84392 A Assay of urine sulfate 84402 A Assay of testosterone 84403 A Assay of total testosterone 84425 A Assay of vitamin b-1 84430 A Assay of thiocyanate 84432 A Assay of thyroglobulin 84436 A Assay of total thyroxine 84437 A Assay of neonatal thyroxine 84439 A Assay of free thyroxine 84442 A Assay of thyroid activity 84443 A Assay thyroid stim hormone 84445 A Assay of tsi 84446 A Assay of vitamin e 84449 A Assay of transcortin 84450 A Transferase (AST) (SGOT) 84460 A Alanine amino (ALT) (SGPT) 84466 A Assay of transferrin 84478 A Assay of triglycerides 84479 A Assay of thyroid (t3 or t4) 84480 A Assay, triiodothyronine (t3) 84481 A Free assay (FT-3) 84482 A T3 reverse 84484 A Assay of troponin, quant 84485 A Assay duodenal fluid trypsin 84488 A Test feces for trypsin 84490 A Assay of feces for trypsin 84510 A Assay of tyrosine 84512 A Assay of troponin, qual 84520 A Assay of urea nitrogen 84525 A Urea nitrogen semi-quant 84540 A Assay of urine/urea-n 84545 A Urea-N clearance test 84550 A Assay of blood/uric acid 84560 A Assay of urine/uric acid 84577 A Assay of feces/urobilinogen 84578 A Test urine urobilinogen 84580 A Assay of urine urobilinogen 84583 A Assay of urine urobilinogen 84585 A Assay of urine vma 84586 A Assay of vip 84588 A Assay of vasopressin 84590 A Assay of vitamin a 84591 A Assay of nos vitamin 84597 A Assay of vitamin k 84600 A Assay of volatiles 84620 A Xylose tolerance test 84630 A Assay of zinc 84681 A Assay of c-peptide 84702 A Chorionic gonadotropin test 84703 A Chorionic gonadotropin assay Start Printed Page 50800 84830 A Ovulation tests 84999 A Clinical chemistry test 85002 A Bleeding time test 85004 A Automated diff wbc count 85007 A Differential WBC count 85008 A Nondifferential WBC count 85009 A Differential WBC count 85013 A Spun microhematocrit 85014 A Hematocrit 85018 A Hemoglobin 85025 A Automated hemogram 85027 A Automated hemogram 85032 A Manual cell count, each 85041 A Red blood cell (RBC) count 85044 A Reticulocyte count 85045 A Reticulocyte count 85046 A Reticyte/hgb concentrate 85048 A White blood cell (WBC) count 85049 A Automated platelet count 85055 A Reticulated platelet assay 85060 B Blood smear interpretation 85097 X Bone marrow interpretation 0343 0.4786 $28.40 $11.10 $5.68 85130 A Chromogenic substrate assay 85170 A Blood clot retraction 85175 A Blood clot lysis time 85210 A Blood clot factor II test 85220 A Blood clot factor V test 85230 A Blood clot factor VII test 85240 A Blood clot factor VIII test 85244 A Blood clot factor VIII test 85245 A Blood clot factor VIII test 85246 A Blood clot factor VIII test 85247 A Blood clot factor VIII test 85250 A Blood clot factor IX test 85260 A Blood clot factor X test 85270 A Blood clot factor XI test 85280 A Blood clot factor XII test 85290 A Blood clot factor XIII test 85291 A Blood clot factor XIII test 85292 A Blood clot factor assay 85293 A Blood clot factor assay 85300 A Antithrombin III test 85301 A Antithrombin III test 85302 A Blood clot inhibitor antigen 85303 A Blood clot inhibitor test 85305 A Blood clot inhibitor assay 85306 A Blood clot inhibitor test 85307 A Assay activated protein c 85335 A Factor inhibitor test 85337 A Thrombomodulin 85345 A Coagulation time 85347 A Coagulation time 85348 A Coagulation time 85360 A Euglobulin lysis 85362 A Fibrin degradation products 85366 A Fibrinogen test 85370 A Fibrinogen test 85378 A Fibrin degradation 85379 A Fibrin degradation, quant 85380 A Fibrin degradation, vte 85384 A Fibrinogen 85385 A Fibrinogen 85390 A Fibrinolysins screen 85396 N Clotting assay, whole blood 85400 A Fibrinolytic plasmin 85410 A Fibrinolytic antiplasmin Start Printed Page 50801 85415 A Fibrinolytic plasminogen 85420 A Fibrinolytic plasminogen 85421 A Fibrinolytic plasminogen 85441 A Heinz bodies, direct 85445 A Heinz bodies, induced 85460 A Hemoglobin, fetal 85461 A Hemoglobin, fetal 85475 A Hemolysin 85520 A Heparin assay 85525 A Heparin neutralization 85530 A Heparin-protamine tolerance 85536 A Iron stain peripheral blood 85540 A Wbc alkaline phosphatase 85547 A RBC mechanical fragility 85549 A Muramidase 85555 A RBC osmotic fragility 85557 A RBC osmotic fragility 85576 A Blood platelet aggregation 85597 A Platelet neutralization 85610 A Prothrombin time 85611 A Prothrombin test 85612 A Viper venom prothrombin time 85613 A Russell viper venom, diluted 85635 A Reptilase test 85651 A Rbc sed rate, nonautomated 85652 A Rbc sed rate, automated 85660 A RBC sickle cell test 85670 A Thrombin time, plasma 85675 A Thrombin time, titer 85705 A Thromboplastin inhibition 85730 A Thromboplastin time, partial 85732 A Thromboplastin time, partial 85810 A Blood viscosity examination 85999 A Hematology procedure 86000 A Agglutinins, febrile 86001 A Allergen specific igg 86003 A Allergen specific IgE 86005 A Allergen specific IgE 86021 A WBC antibody identification 86022 A Platelet antibodies 86023 A Immunoglobulin assay 86038 A Antinuclear antibodies 86039 A Antinuclear antibodies (ANA) 86060 A Antistreptolysin o, titer 86063 A Antistreptolysin o, screen 86064 A B cells, total count 86077 X Physician blood bank service 0433 0.2581 $15.32 $6.12 $3.06 86078 X Physician blood bank service 0343 0.4786 $28.40 $11.10 $5.68 86079 X Physician blood bank service 0433 0.2581 $15.32 $6.12 $3.06 86140 A C-reactive protein 86141 A C-reactive protein, hs 86146 A Glycoprotein antibody 86147 A Cardiolipin antibody 86148 A Phospholipid antibody 86155 A Chemotaxis assay 86156 A Cold agglutinin, screen 86157 A Cold agglutinin, titer 86160 A Complement, antigen 86161 A Complement/function activity 86162 A Complement, total (CH50) 86171 A Complement fixation, each 86185 A Counterimmunoelectrophoresis 86215 A Deoxyribonuclease, antibody 86225 A DNA antibody 86226 A DNA antibody, single strand 86235 A Nuclear antigen antibody Start Printed Page 50802 86243 A Fc receptor 86255 A Fluorescent antibody, screen 86256 A Fluorescent antibody, titer 86277 A Growth hormone antibody 86280 A Hemagglutination inhibition 86294 A Immunoassay, tumor, qual 86300 A Immunoassay, tumor, ca 15-3 86301 A Immunoassay, tumor, ca 19-9 86304 A Immunoassay, tumor, ca 125 86308 A Heterophile antibodies 86309 A Heterophile antibodies 86310 A Heterophile antibodies 86316 A Immunoassay, tumor other 86317 A Immunoassay,infectious agent 86318 A Immunoassay,infectious agent 86320 A Serum immunoelectrophoresis 86325 A Other immunoelectrophoresis 86327 A Immunoelectrophoresis assay 86329 A Immunodiffusion 86331 A Immunodiffusion ouchterlony 86332 A Immune complex assay 86334 A Immunofixation procedure 86335 A Immunfix e-phorsis/urine/csf 86336 A Inhibin A 86337 A Insulin antibodies 86340 A Intrinsic factor antibody 86341 A Islet cell antibody 86343 A Leukocyte histamine release 86344 A Leukocyte phagocytosis 86353 A Lymphocyte transformation 86359 A T cells, total count 86360 A T cell, absolute count/ratio 86361 A T cell, absolute count 86376 A Microsomal antibody 86378 A Migration inhibitory factor 86379 A Nk cells, total count 86382 A Neutralization test, viral 86384 A nitroblue tetrazolium dye 86403 A Particle agglutination test 86406 A Particle agglutination test 86430 A Rheumatoid factor test 86431 A Rheumatoid factor, quant 86485 X Skin test, candida 0341 0.1112 $6.60 $2.62 $1.32 86490 X Coccidioidomycosis skin test 0341 0.1112 $6.60 $2.62 $1.32 86510 X Histoplasmosis skin test 0341 0.1112 $6.60 $2.62 $1.32 86580 X TB intradermal test 0341 0.1112 $6.60 $2.62 $1.32 86585 X TB tine test 0341 0.1112 $6.60 $2.62 $1.32 86586 X Skin test, unlisted 0341 0.1112 $6.60 $2.62 $1.32 86587 A Stem cells, total count 86590 A Streptokinase, antibody 86592 A Blood serology, qualitative 86593 A Blood serology, quantitative 86602 A Antinomyces antibody 86603 A Adenovirus antibody 86606 A Aspergillus antibody 86609 A Bacterium antibody 86611 A Bartonella antibody 86612 A Blastomyces antibody 86615 A Bordetella antibody 86617 A Lyme disease antibody 86618 A Lyme disease antibody 86619 A Borrelia antibody 86622 A Brucella antibody 86625 A Campylobacter antibody 86628 A Candida antibody 86631 A Chlamydia antibody Start Printed Page 50803 86632 A Chlamydia igm antibody 86635 A Coccidioides antibody 86638 A Q fever antibody 86641 A Cryptococcus antibody 86644 A CMV antibody 86645 A CMV antibody, IgM 86648 A Diphtheria antibody 86651 A Encephalitis antibody 86652 A Encephalitis antibody 86653 A Encephalitis antibody 86654 A Encephalitis antibody 86658 A Enterovirus antibody 86663 A Epstein-barr antibody 86664 A Epstein-barr antibody 86665 A Epstein-barr antibody 86666 A Ehrlichia antibody 86668 A Francisella tularensis 86671 A Fungus antibody 86674 A Giardia lamblia antibody 86677 A Helicobacter pylori 86682 A Helminth antibody 86684 A Hemophilus influenza 86687 A Htlv-i antibody 86688 A Htlv-ii antibody 86689 A HTLV/HIV confirmatory test 86692 A Hepatitis, delta agent 86694 A Herpes simplex test 86695 A Herpes simplex test 86696 A Herpes simplex type 2 86698 A Histoplasma 86701 A HIV-1 86702 A HIV-2 86703 A HIV-1/HIV-2, single assay 86704 A Hep b core antibody, total 86705 A Hep b core antibody, igm 86706 A Hep b surface antibody 86707 A Hep be antibody 86708 A Hep a antibody, total 86709 A Hep a antibody, igm 86710 A Influenza virus antibody 86713 A Legionella antibody 86717 A Leishmania antibody 86720 A Leptospira antibody 86723 A Listeria monocytogenes ab 86727 A Lymph choriomeningitis ab 86729 A Lympho venereum antibody 86732 A Mucormycosis antibody 86735 A Mumps antibody 86738 A Mycoplasma antibody 86741 A Neisseria meningitidis 86744 A Nocardia antibody 86747 A Parvovirus antibody 86750 A Malaria antibody 86753 A Protozoa antibody nos 86756 A Respiratory virus antibody 86757 A Rickettsia antibody 86759 A Rotavirus antibody 86762 A Rubella antibody 86765 A Rubeola antibody 86768 A Salmonella antibody 86771 A Shigella antibody 86774 A Tetanus antibody 86777 A Toxoplasma antibody 86778 A Toxoplasma antibody, igm 86781 A Treponema pallidum, confirm 86784 A Trichinella antibody Start Printed Page 50804 86787 A Varicella-zoster antibody 86790 A Virus antibody nos 86793 A Yersinia antibody 86800 A Thyroglobulin antibody 86803 A Hepatitis c ab test 86804 A Hep c ab test, confirm 86805 A Lymphocytotoxicity assay 86806 A Lymphocytotoxicity assay 86807 A Cytotoxic antibody screening 86808 A Cytotoxic antibody screening 86812 A HLA typing, A, B, or C 86813 A HLA typing, A, B, or C 86816 A HLA typing, DR/DQ 86817 A HLA typing, DR/DQ 86821 A Lymphocyte culture, mixed 86822 A Lymphocyte culture, primed 86849 A Immunology procedure 86850 X RBC antibody screen 0345 0.2277 $13.51 $3.01 $2.70 86860 X RBC antibody elution 0346 0.3434 $20.38 $4.54 $4.08 86870 X RBC antibody identification 0346 0.3434 $20.38 $4.54 $4.08 86880 X Coombs test, direct 0409 0.1258 $7.47 $2.22 $1.49 86885 X Coombs test, indirect, qual 0409 0.1258 $7.47 $2.22 $1.49 86886 X Coombs test, indirect, titer 0409 0.1258 $7.47 $2.22 $1.49 86890 X Autologous blood process 0347 0.8434 $50.05 $12.35 $10.01 86891 X Autologous blood, op salvage 0346 0.3434 $20.38 $4.54 $4.08 86900 X Blood typing, ABO 0409 0.1258 $7.47 $2.22 $1.49 86901 X Blood typing, Rh (D) 0409 0.1258 $7.47 $2.22 $1.49 86903 X Blood typing, antigen screen 0345 0.2277 $13.51 $3.01 $2.70 86904 X Blood typing, patient serum 0346 0.3434 $20.38 $4.54 $4.08 86905 X Blood typing, RBC antigens 0345 0.2277 $13.51 $3.01 $2.70 86906 X Blood typing, Rh phenotype 0345 0.2277 $13.51 $3.01 $2.70 86910 E Blood typing, paternity test 86911 E Blood typing, antigen system 86920 X Compatibility test 0346 0.3434 $20.38 $4.54 $4.08 86921 X Compatibility test 0345 0.2277 $13.51 $3.01 $2.70 86922 X Compatibility test 0346 0.3434 $20.38 $4.54 $4.08 86927 X Plasma, fresh frozen 0345 0.2277 $13.51 $3.01 $2.70 86930 X Frozen blood prep 0347 0.8434 $50.05 $12.35 $10.01 86931 X Frozen blood thaw 0347 0.8434 $50.05 $12.35 $10.01 86932 X Frozen blood freeze/thaw 0347 0.8434 $50.05 $12.35 $10.01 86940 A Hemolysins/agglutinins, auto 86941 A Hemolysins/agglutinins 86945 X Blood product/irradiation 0345 0.2277 $13.51 $3.01 $2.70 86950 X Leukacyte transfusion 0345 0.2277 $13.51 $3.01 $2.70 86965 X Pooling blood platelets 0345 0.2277 $13.51 $3.01 $2.70 86970 X RBC pretreatment 0345 0.2277 $13.51 $3.01 $2.70 86971 X RBC pretreatment 0345 0.2277 $13.51 $3.01 $2.70 86972 X RBC pretreatment 0346 0.3434 $20.38 $4.54 $4.08 86975 X RBC pretreatment, serum 0345 0.2277 $13.51 $3.01 $2.70 86976 X RBC pretreatment, serum 0345 0.2277 $13.51 $3.01 $2.70 86977 X RBC pretreatment, serum 0345 0.2277 $13.51 $3.01 $2.70 86978 X RBC pretreatment, serum 0345 0.2277 $13.51 $3.01 $2.70 86985 X Split blood or products 0345 0.2277 $13.51 $3.01 $2.70 86999 X Transfusion procedure 0345 0.2277 $13.51 $3.01 $2.70 87001 A Small animal inoculation 87003 A Small animal inoculation 87015 A Specimen concentration 87040 A Blood culture for bacteria 87045 A Feces culture, bacteria 87046 A Stool cultr, bacteria, each 87070 A Culture, bacteria, other 87071 A Culture bacteri aerobic othr 87073 A Culture bacteria anaerobic 87075 A Cultr bacteria, except blood 87076 A Culture anaerobe ident, each 87077 A Culture aerobic identify Start Printed Page 50805 87081 A Culture screen only 87084 A Culture of specimen by kit 87086 A Urine culture/colony count 87088 A Urine bacteria culture 87101 A Skin fungi culture 87102 A Fungus isolation culture 87103 A Blood fungus culture 87106 A Fungi identification, yeast 87107 A Fungi identification, mold 87109 A Mycoplasma 87110 A Chlamydia culture 87116 A Mycobacteria culture 87118 A Mycobacteric identification 87140 A Culture type immunofluoresc 87143 A Culture typing, glc/hplc 87147 A Culture type, immunologic 87149 A Culture type, nucleic acid 87152 A Culture type pulse field gel 87158 A Culture typing, added method 87164 A Dark field examination 87166 A Dark field examination 87168 A Macroscopic exam arthropod 87169 A Macroscopic exam parasite 87172 A Pinworm exam 87176 A Tissue homogenization, cultr 87177 A Ova and parasites smears 87181 A Microbe susceptible, diffuse 87184 A Microbe susceptible, disk 87185 A Microbe susceptible, enzyme 87186 A Microbe susceptible, mic 87187 A Microbe susceptible, mlc 87188 A Microbe suscept, macrobroth 87190 A Microbe suscept, mycobacteri 87197 A Bactericidal level, serum 87205 A Smear, gram stain 87206 A Smear, fluorescent/acid stai 87207 A Smear, special stain 87210 A Smear, wet mount, saline/ink 87220 A Tissue exam for fungi 87230 A Assay, toxin or antitoxin 87250 A Virus inoculate, eggs/animal 87252 A Virus inoculation, tissue 87253 A Virus inoculate tissue, addl 87254 A Virus inoculation, shell via 87255 A Genet virus isolate, hsv 87260 A Adenovirus ag, if 87265 A Pertussis ag, if 87267 A Enterovirus antibody, dfa 87269 A Giardia ag, if 87270 A Chlamydia trachomatis ag, if 87271 A Cryptosporidum/gardia ag, if 87272 A Cryptosporidium ag, if 87273 A Herpes simplex 2, ag, if 87274 A Herpes simplex 1, ag, if 87275 A Influenza b, ag, if 87276 A Influenza a, ag, if 87277 A Legionella micdadei, ag, if 87278 A Legion pneumophilia ag, if 87279 A Parainfluenza, ag, if 87280 A Respiratory syncytial ag, if 87281 A Pneumocystis carinii, ag, if 87283 A Rubeola, ag, if 87285 A Treponema pallidum, ag, if 87290 A Varicella zoster, ag, if 87299 A Antibody detection, nos, if 87300 A Ag detection, polyval, if Start Printed Page 50806 87301 A Adenovirus ag, eia 87320 A Chylmd trach ag, eia 87324 A Clostridium ag, eia 87327 A Cryptococcus neoform ag, eia 87328 A Cryptosporidium ag, eia 87329 A Giardia ag, eia 87332 A Cytomegalovirus ag, eia 87335 A E coli 0157 ag, eia 87336 A Entamoeb hist dispr, ag, eia 87337 A Entamoeb hist group, ag, eia 87338 A Hpylori, stool, eia 87339 A H pylori ag, eia 87340 A Hepatitis b surface ag, eia 87341 A Hepatitis b surface, ag, eia 87350 A Hepatitis be ag, eia 87380 A Hepatitis delta ag, eia 87385 A Histoplasma capsul ag, eia 87390 A Hiv-1 ag, eia 87391 A Hiv-2 ag, eia 87400 A Influenza a/b, ag, eia 87420 A Resp syncytial ag, eia 87425 A Rotavirus ag, eia 87427 A Shiga-like toxin ag, eia 87430 A Strep a ag, eia 87449 A Ag detect nos, eia, mult 87450 A Ag detect nos, eia, single 87451 A Ag detect polyval, eia, mult 87470 A Bartonella, dna, dir probe 87471 A Bartonella, dna, amp probe 87472 A Bartonella, dna, quant 87475 A Lyme dis, dna, dir probe 87476 A Lyme dis, dna, amp probe 87477 A Lyme dis, dna, quant 87480 A Candida, dna, dir probe 87481 A Candida, dna, amp probe 87482 A Candida, dna, quant 87485 A Chylmd pneum, dna, dir probe 87486 A Chylmd pneum, dna, amp probe 87487 A Chylmd pneum, dna, quant 87490 A Chylmd trach, dna, dir probe 87491 A Chylmd trach, dna, amp probe 87492 A Chylmd trach, dna, quant 87495 A Cytomeg, dna, dir probe 87496 A Cytomeg, dna, amp probe 87497 A Cytomeg, dna, quant 87510 A Gardner vag, dna, dir probe 87511 A Gardner vag, dna, amp probe 87512 A Gardner vag, dna, quant 87515 A Hepatitis b, dna, dir probe 87516 A Hepatitis b, dna, amp probe 87517 A Hepatitis b, dna, quant 87520 A Hepatitis c, rna, dir probe 87521 A Hepatitis c, rna, amp probe 87522 A Hepatitis c, rna, quant 87525 A Hepatitis g, dna, dir probe 87526 A Hepatitis g, dna, amp probe 87527 A Hepatitis g, dna, quant 87528 A Hsv, dna, dir probe 87529 A Hsv, dna, amp probe 87530 A Hsv, dna, quant 87531 A Hhv-6, dna, dir probe 87532 A Hhv-6, dna, amp probe 87533 A Hhv-6, dna, quant 87534 A Hiv-1, dna, dir probe 87535 A Hiv-1, dna, amp probe 87536 A Hiv-1, dna, quant Start Printed Page 50807 87537 A Hiv-2, dna, dir probe 87538 A Hiv-2, dna, amp probe 87539 A Hiv-2, dna, quant 87540 A Legion pneumo, dna, dir prob 87541 A Legion pneumo, dna, amp prob 87542 A Legion pneumo, dna, quant 87550 A Mycobacteria, dna, dir probe 87551 A Mycobacteria, dna, amp probe 87552 A Mycobacteria, dna, quant 87555 A M.tuberculo, dna, dir probe 87556 A M.tuberculo, dna, amp probe 87557 A M.tuberculo, dna, quant 87560 A M.avium-intra, dna, dir prob 87561 A M.avium-intra, dna, amp prob 87562 A M.avium-intra, dna, quant 87580 A M.pneumon, dna, dir probe 87581 A M.pneumon, dna, amp probe 87582 A M.pneumon, dna, quant 87590 A N.gonorrhoeae, dna, dir prob 87591 A N.gonorrhoeae, dna, amp prob 87592 A N.gonorrhoeae, dna, quant 87620 A Hpv, dna, dir probe 87621 A Hpv, dna, amp probe 87622 A Hpv, dna, quant 87650 A Strep a, dna, dir probe 87651 A Strep a, dna, amp probe 87652 A Strep a, dna, quant 87660 A Trichomonas vagin, dir probe 87797 A Detect agent nos, dna, dir 87798 A Detect agent nos, dna, amp 87799 A Detect agent nos, dna, quant 87800 A Detect agnt mult, dna, direc 87801 A Detect agnt mult, dna, ampli 87802 A Strep b assay w/optic 87803 A Clostridium toxin a w/optic 87804 A Influenza assay w/optic 87807 A Rsv assay w/optic 87810 A Chylmd trach assay w/optic 87850 A N. gonorrhoeae assay w/optic 87880 A Strep a assay w/optic 87899 A Agent nos assay w/optic 87901 A Genotype, dna, hiv reverse t 87902 A Genotype, dna, hepatitis C 87903 A Phenotype, dna hiv w/culture 87904 A Phenotype, dna hiv w/clt add 87999 A Microbiology procedure 88000 E Autopsy (necropsy), gross 88005 E Autopsy (necropsy), gross 88007 E Autopsy (necropsy), gross 88012 E Autopsy (necropsy), gross 88014 E Autopsy (necropsy), gross 88016 E Autopsy (necropsy), gross 88020 E Autopsy (necropsy), complete 88025 E Autopsy (necropsy), complete 88027 E Autopsy (necropsy), complete 88028 E Autopsy (necropsy), complete 88029 E Autopsy (necropsy), complete 88036 E Limited autopsy 88037 E Limited autopsy 88040 E Forensic autopsy (necropsy) 88045 E Coroner's autopsy (necropsy) 88099 E Necropsy (autopsy) procedure 88104 X Cytopathology, fluids 0433 0.2581 $15.32 $6.12 $3.06 88106 X Cytopathology, fluids 0433 0.2581 $15.32 $6.12 $3.06 88107 X Cytopathology, fluids 0433 0.2581 $15.32 $6.12 $3.06 88108 X Cytopath, concentrate tech 0433 0.2581 $15.32 $6.12 $3.06 Start Printed Page 50808 88112 X Cytopath, cell enhance tech 0343 0.4786 $28.40 $11.10 $5.68 88125 X Forensic cytopathology 0342 0.156 $9.26 $3.70 $1.85 88130 A Sex chromatin identification 88140 A Sex chromatin identification 88141 N Cytopath, c/v, interpret 88142 A Cytopath, c/v, thin layer 88143 A Cytopath c/v thin layer redo 88147 A Cytopath, c/v, automated 88148 A Cytopath, c/v, auto rescreen 88150 A Cytopath, c/v, manual 88152 A Cytopath, c/v, auto redo 88153 A Cytopath, c/v, redo 88154 A Cytopath, c/v, select 88155 A Cytopath, c/v, index add-on 88160 X Cytopath smear, other source 0433 0.2581 $15.32 $6.12 $3.06 88161 X Cytopath smear, other source 0433 0.2581 $15.32 $6.12 $3.06 88162 X Cytopath smear, other source 0433 0.2581 $15.32 $6.12 $3.06 88164 A Cytopath tbs, c/v, manual 88165 A Cytopath tbs, c/v, redo 88166 A Cytopath tbs, c/v, auto redo 88167 A Cytopath tbs, c/v, select 88172 X Cytopathology eval of fna 0343 0.4786 $28.40 $11.10 $5.68 88173 X Cytopath eval, fna, report 0343 0.4786 $28.40 $11.10 $5.68 88174 A Cytopath, c/v auto, in fluid 88175 A Cytopath c/v auto fluid redo 88182 X Cell marker study 0344 0.7996 $47.45 $15.66 $9.49 88184 X Flowcytometry/ tc, 1 marker 0344 0.7996 $47.45 $15.66 $9.49 88185 X Flowcytometry/tc, add-on 0343 0.4786 $28.40 $11.10 $5.68 88187 X Flowcytometry/read, 2-8 0433 0.2581 $15.32 $6.12 $3.06 88188 X Flowcytometry/read, 9-15 0433 0.2581 $15.32 $6.12 $3.06 88189 X Flowcytometry/read, 16 & > 0343 0.4786 $28.40 $11.10 $5.68 88199 A Cytopathology procedure 88230 A Tissue culture, lymphocyte 88233 A Tissue culture, skin/biopsy 88235 A Tissue culture, placenta 88237 A Tissue culture, bone marrow 88239 A Tissue culture, tumor 88240 A Cell cryopreserve/storage 88241 A Frozen cell preparation 88245 A Chromosome analysis, 20-25 88248 A Chromosome analysis, 50-100 88249 A Chromosome analysis, 100 88261 A Chromosome analysis, 5 88262 A Chromosome analysis, 15-20 88263 A Chromosome analysis, 45 88264 A Chromosome analysis, 20-25 88267 A Chromosome analys, placenta 88269 A Chromosome analys, amniotic 88271 A Cytogenetics, dna probe 88272 A Cytogenetics, 3-5 88273 A Cytogenetics, 10-30 88274 A Cytogenetics, 25-99 88275 A Cytogenetics, 100-300 88280 A Chromosome karyotype study 88283 A Chromosome banding study 88285 A Chromosome count, additional 88289 A Chromosome study, additional 88291 A Cyto/molecular report 88299 X Cytogenetic study 0342 0.156 $9.26 $3.70 $1.85 88300 X Surgical path, gross 0433 0.2581 $15.32 $6.12 $3.06 88302 X Tissue exam by pathologist 0433 0.2581 $15.32 $6.12 $3.06 88304 X Tissue exam by pathologist 0343 0.4786 $28.40 $11.10 $5.68 88305 X Tissue exam by pathologist 0343 0.4786 $28.40 $11.10 $5.68 88307 X Tissue exam by pathologist 0344 0.7996 $47.45 $15.66 $9.49 88309 X Tissue exam by pathologist 0344 0.7996 $47.45 $15.66 $9.49 88311 X Decalcify tissue 0342 0.156 $9.26 $3.70 $1.85 Start Printed Page 50809 88312 X Special stains 0433 0.2581 $15.32 $6.12 $3.06 88313 X Special stains 0433 0.2581 $15.32 $6.12 $3.06 88314 X Histochemical stain 0342 0.156 $9.26 $3.70 $1.85 88318 X Chemical histochemistry 0433 0.2581 $15.32 $6.12 $3.06 88319 X Enzyme histochemistry 0343 0.4786 $28.40 $11.10 $5.68 88321 X Microslide consultation 0433 0.2581 $15.32 $6.12 $3.06 88323 X Microslide consultation 0343 0.4786 $28.40 $11.10 $5.68 88325 X Comprehensive review of data 0344 0.7996 $47.45 $15.66 $9.49 88329 X Path consult introp 0433 0.2581 $15.32 $6.12 $3.06 88331 X Path consult intraop, 1 bloc 0343 0.4786 $28.40 $11.10 $5.68 88332 X Path consult intraop, add'l 0433 0.2581 $15.32 $6.12 $3.06 88342 X Immunohistochemistry 0343 0.4786 $28.40 $11.10 $5.68 88346 X Immunofluorescent study 0343 0.4786 $28.40 $11.10 $5.68 88347 X Immunofluorescent study 0343 0.4786 $28.40 $11.10 $5.68 88348 X Electron microscopy 0661 3.3775 $200.43 $80.17 $40.09 88349 X Scanning electron microscopy 0661 3.3775 $200.43 $80.17 $40.09 88355 X Analysis, skeletal muscle 0343 0.4786 $28.40 $11.10 $5.68 88356 X Analysis, nerve 0344 0.7996 $47.45 $15.66 $9.49 88358 X Analysis, tumor 0344 0.7996 $47.45 $15.66 $9.49 88360 X Tumor immunohistochem/manual 0344 0.7996 $47.45 $15.66 $9.49 88361 X Immunohistochemistry, tumor 0344 0.7996 $47.45 $15.66 $9.49 88362 X Nerve teasing preparations 0344 0.7996 $47.45 $15.66 $9.49 88365 X Tissue hybridization 0344 0.7996 $47.45 $15.66 $9.49 88367 X Insitu hybridization, auto 0344 0.7996 $47.45 $15.66 $9.49 88368 X Insitu hybridization, manual 0344 0.7996 $47.45 $15.66 $9.49 88371 A Protein, western blot tissue 88372 A Protein analysis w/probe 88380 A Microdissection 88399 A Surgical pathology procedure 88400 A Bilirubin total transcut 89050 A Body fluid cell count 89051 A Body fluid cell count 89055 A Leukocyte assessment, fecal 89060 A Exam,synovial fluid crystals 89100 X Sample intestinal contents 0360 1.4739 $87.47 $34.98 $17.49 89105 X Sample intestinal contents 0360 1.4739 $87.47 $34.98 $17.49 89125 A Specimen fat stain 89130 X Sample stomach contents 0360 1.4739 $87.47 $34.98 $17.49 89132 X Sample stomach contents 0360 1.4739 $87.47 $34.98 $17.49 89135 X Sample stomach contents 0360 1.4739 $87.47 $34.98 $17.49 89136 X Sample stomach contents 0360 1.4739 $87.47 $34.98 $17.49 89140 X Sample stomach contents 0360 1.4739 $87.47 $34.98 $17.49 89141 X Sample stomach contents 0360 1.4739 $87.47 $34.98 $17.49 89160 A Exam feces for meat fibers 89190 A Nasal smear for eosinophils 89220 X Sputum specimen collection 0343 0.4786 $28.40 $11.10 $5.68 89225 A Starch granules, feces 89230 X Collect sweat for test 0433 0.2581 $15.32 $6.12 $3.06 89235 A Water load test 89240 A Pathology lab procedure 89250 X Cultr oocyte/embryo <4 days 0348 0.7927 $47.04 $9.41 89251 X Cultr oocyte/embryo <4 days 0348 0.7927 $47.04 $9.41 89253 X Embryo hatching 0348 0.7927 $47.04 $9.41 89254 X Oocyte identification 0348 0.7927 $47.04 $9.41 89255 X Prepare embryo for transfer 0348 0.7927 $47.04 $9.41 89257 X Sperm identification 0348 0.7927 $47.04 $9.41 89258 X Cryopreservation embryo(s) 0348 0.7927 $47.04 $9.41 89259 X Cryopreservation, sperm 0348 0.7927 $47.04 $9.41 89260 X Sperm isolation, simple 0348 0.7927 $47.04 $9.41 89261 X Sperm isolation, complex 0348 0.7927 $47.04 $9.41 89264 X Identify sperm tissue 0348 0.7927 $47.04 $9.41 89268 X Insemination of oocytes 0348 0.7927 $47.04 $9.41 89272 X Extended culture of oocytes 0348 0.7927 $47.04 $9.41 89280 X Assist oocyte fertilization 0348 0.7927 $47.04 $9.41 89281 X Assist oocyte fertilization 0348 0.7927 $47.04 $9.41 89290 X Biopsy, oocyte polar body 0348 0.7927 $47.04 $9.41 Start Printed Page 50810 89291 X Biopsy, oocyte polar body 0348 0.7927 $47.04 $9.41 89300 A Semen analysis w/huhner 89310 A Semen analysis 89320 A Semen analysis, complete 89321 A Semen analysis & motility 89325 A Sperm antibody test 89329 A Sperm evaluation test 89330 A Evaluation, cervical mucus 89335 X Cryopreserve testicular tiss 0348 0.7927 $47.04 $9.41 89342 X Storage/year embryo(s) 0348 0.7927 $47.04 $9.41 89343 X Storage/year sperm/semen 0348 0.7927 $47.04 $9.41 89344 X Storage/year reprod tissue 0348 0.7927 $47.04 $9.41 89346 X Storage/year oocyte 0348 0.7927 $47.04 $9.41 89352 X Thawing cryopresrved embryo 0348 0.7927 $47.04 $9.41 89353 X Thawing cryopresrved sperm 0348 0.7927 $47.04 $9.41 89354 X Thaw cryoprsvrd reprod tiss 0348 0.7927 $47.04 $9.41 89356 X Thawing cryopresrved oocyte 0348 0.7927 $47.04 $9.41 90281 E Human ig, im 90283 E Human ig, iv 90287 E Botulinum antitoxin 90288 E Botulism ig, iv 90291 E Cmv ig, iv 90296 N Diphtheria antitoxin 90371 E Hep b ig, im 90375 K Rabies ig, im/sc 9133 $64.56 $12.91 90376 K Rabies ig, heat treated 9134 $69.79 $13.96 90378 E Rsv ig, im, 50mg 90379 E Rsv ig, iv 90384 E Rh ig, full-dose, im 90385 N Rh ig, minidose, im 90386 E Rh ig, iv 90389 E Tetanus ig, im 90393 N Vaccina ig, im 90396 K Varicella-zoster ig, im 9135 $96.58 $19.32 90399 E Immune globulin 90465 B Immune admin 1 inj, < 8 yrs 90466 B Immune admin addl inj, < 8 y 90467 B Immune admin o or n, < 8 yrs 90468 B Immune admin o/n, addl < 8 y 90471 X Immunization admin 0353 0.3954 $23.46 $4.69 90472 X Immunization admin, each add 0353 0.3954 $23.46 $4.69 90473 S Immune admin oral/nasal 1491 $5.00 $1.00 90474 S Immune admin oral/nasal addl 1491 $5.00 $1.00 90476 K Adenovirus vaccine, type 4 9136 0.9499 $56.37 $11.27 90477 N Adenovirus vaccine, type 7 90581 K Anthrax vaccine, sc 9169 $128.95 $25.79 90585 K Bcg vaccine, percut 9137 $124.54 $24.91 90586 B Bcg vaccine, intravesical 90632 N Hep a vaccine, adult im 90633 N Hep a vacc, ped/adol, 2 dose 90634 N Hep a vacc, ped/adol, 3 dose 90636 K Hep a/hep b vacc, adult im 9138 0.9674 $57.41 $11.48 90645 N Hib vaccine, hboc, im 90646 N Hib vaccine, prp-d, im 90647 N Hib vaccine, prp-omp, im 90648 N Hib vaccine, prp-t, im 90655 L Flu vaccine, 6-35 mo, im 90656 L Flu vaccine no preserv 3 & > 90657 L Flu vaccine, 6-35 mo, im 90658 L Flu vaccine, 3 yrs, im 90660 E Flu vaccine, nasal 90665 N Lyme disease vaccine, im 90669 E Pneumococcal vacc, ped <5 90675 K Rabies vaccine, im 9139 $128.04 $25.61 90676 K Rabies vaccine, id 9140 1.4959 $88.77 $17.75 90680 N Rotovirus vaccine, oral Start Printed Page 50811 90690 N Typhoid vaccine, oral 90691 N Typhoid vaccine, im 90692 N Typhoid vaccine, h-p, sc/id 90693 N Typhoid vaccine, akd, sc 90698 N Dtap-hib-ip vaccine, im 90700 N Dtap vaccine, im 90701 N Dtp vaccine, im 90702 N Dt vaccine < 7, im 90703 N Tetanus vaccine, im 90704 N Mumps vaccine, sc 90705 N Measles vaccine, sc 90706 N Rubella vaccine, sc 90707 N Mmr vaccine, sc 90708 K Measles-rubella vaccine, sc 9141 0.9467 $56.18 $11.24 90710 N Mmrv vaccine, sc 90712 N Oral poliovirus vaccine 90713 N Poliovirus, ipv, sc 90715 N Tdap vaccine >7 im 90716 K Chicken pox vaccine, sc 9142 $64.29 $12.86 90717 N Yellow fever vaccine, sc 90718 N Td vaccine > 7, im 90719 N Diphtheria vaccine, im 90720 N Dtp/hib vaccine, im 90721 N Dtap/hib vaccine, im 90723 E Dtap-hep b-ipv vaccine, im 90725 N Cholera vaccine, injectable 90727 N Plague vaccine, im 90732 L Pneumococcal vaccine 90733 K Meningococcal vaccine, sc 9143 $56.75 $11.35 90734 K Meningococcal vaccine, im 9145 0.8948 $53.10 $10.62 90735 K Encephalitis vaccine, sc 9144 $67.73 $13.55 90740 F Hepb vacc, ill pat 3 dose im 90743 F Hep b vacc, adol, 2 dose, im 90744 F Hepb vacc ped/adol 3 dose im 90746 F Hep b vaccine, adult, im 90747 F Hepb vacc, ill pat 4 dose im 90748 E Hep b/hib vaccine, im 90749 N Vaccine toxoid 90780 S IV infusion therapy, 1 hour 0120 2.0193 $119.83 $28.21 $23.97 90781 N IV infusion, additional hour 90782 X Injection, sc/im 0353 0.3954 $23.46 $4.69 90783 X Injection, ia 0359 0.8312 $49.33 $9.87 90784 X Injection, iv 0359 0.8312 $49.33 $9.87 90788 X Injection of antibiotic 0359 0.8312 $49.33 $9.87 90799 X Ther/prophylactic/dx inject 0352 0.1413 $8.39 $1.68 90801 S Psy dx interview 0323 1.6227 $96.30 $20.08 $19.26 90802 S Intac psy dx interview 0323 1.6227 $96.30 $20.08 $19.26 90804 S Psytx, office, 20-30 min 0322 1.2319 $73.10 $14.62 90805 S Psytx, off, 20-30 min w/e&m 0322 1.2319 $73.10 $14.62 90806 S Psytx, off, 45-50 min 0323 1.6227 $96.30 $20.08 $19.26 90807 S Psytx, off, 45-50 min w/e&m 0323 1.6227 $96.30 $20.08 $19.26 90808 S Psytx, office, 75-80 min 0323 1.6227 $96.30 $20.08 $19.26 90809 S Psytx, off, 75-80, w/e&m 0323 1.6227 $96.30 $20.08 $19.26 90810 S Intac psytx, off, 20-30 min 0322 1.2319 $73.10 $14.62 90811 S Intac psytx, 20-30, w/e&m 0322 1.2319 $73.10 $14.62 90812 S Intac psytx, off, 45-50 min 0323 1.6227 $96.30 $20.08 $19.26 90813 S Intac psytx, 45-50 min w/e&m 0323 1.6227 $96.30 $20.08 $19.26 90814 S Intac psytx, off, 75-80 min 0323 1.6227 $96.30 $20.08 $19.26 90815 S Intac psytx, 75-80 w/e&m 0323 1.6227 $96.30 $20.08 $19.26 90816 S Psytx, hosp, 20-30 min 0322 1.2319 $73.10 $14.62 90817 S Psytx, hosp, 20-30 min w/e&m 0322 1.2319 $73.10 $14.62 90818 S Psytx, hosp, 45-50 min 0323 1.6227 $96.30 $20.08 $19.26 90819 S Psytx, hosp, 45-50 min w/e&m 0323 1.6227 $96.30 $20.08 $19.26 90821 S Psytx, hosp, 75-80 min 0323 1.6227 $96.30 $20.08 $19.26 90822 S Psytx, hosp, 75-80 min w/e&m 0323 1.6227 $96.30 $20.08 $19.26 90823 S Intac psytx, hosp, 20-30 min 0322 1.2319 $73.10 $14.62 Start Printed Page 50812 90824 S Intac psytx, hsp 20-30 w/e&m 0322 1.2319 $73.10 $14.62 90826 S Intac psytx, hosp, 45-50 min 0323 1.6227 $96.30 $20.08 $19.26 90827 S Intac psytx, hsp 45-50 w/e&m 0323 1.6227 $96.30 $20.08 $19.26 90828 S Intac psytx, hosp, 75-80 min 0323 1.6227 $96.30 $20.08 $19.26 90829 S Intac psytx, hsp 75-80 w/e&m 0323 1.6227 $96.30 $20.08 $19.26 90845 S Psychoanalysis 0323 1.6227 $96.30 $20.08 $19.26 90846 S Family psytx w/o patient 0324 2.0997 $124.60 $24.92 90847 S Family psytx w/patient 0324 2.0997 $124.60 $24.92 90849 S Multiple family group psytx 0325 1.3189 $78.27 $17.10 $15.65 90853 S Group psychotherapy 0325 1.3189 $78.27 $17.10 $15.65 90857 S Intac group psytx 0325 1.3189 $78.27 $17.10 $15.65 90862 X Medication management 0374 1.0414 $61.80 $12.36 90865 S Narcosynthesis 0323 1.6227 $96.30 $20.08 $19.26 90870 S Electroconvulsive therapy 0320 5.3765 $319.06 $80.06 $63.81 90871 E Electroconvulsive therapy 90875 E Psychophysiological therapy 90876 E Psychophysiological therapy 90880 S Hypnotherapy 0323 1.6227 $96.30 $20.08 $19.26 90882 E Environmental manipulation 90885 N Psy evaluation of records 90887 N Consultation with family 90889 N Preparation of report 90899 S Psychiatric service/therapy 0322 1.2319 $73.10 $14.62 90901 A Biofeedback train, any meth 90911 S Biofeedback peri/uro/rectal 0321 1.3579 $80.58 $21.71 $16.12 90918 E ESRD related services, month 90919 E ESRD related services, month 90920 E ESRD related services, month 90921 E ESRD related services, month 90922 E ESRD related services, day 90923 E Esrd related services, day 90924 E Esrd related services, day 90925 E Esrd related services, day 90935 S Hemodialysis, one evaluation 0170 5.8994 $350.09 $70.02 90937 E Hemodialysis, repeated eval 90939 N Hemodialysis study, transcut 90940 N Hemodialysis access study 90945 S Dialysis, one evaluation 0170 5.8994 $350.09 $70.02 90947 E Dialysis, repeated eval 90989 B Dialysis training, complete 90993 B Dialysis training, incompl 90997 E Hemoperfusion 90999 B Dialysis procedure 91000 X Esophageal intubation 0361 3.6216 $214.92 $83.23 $42.98 91010 X Esophagus motility study 0361 3.6216 $214.92 $83.23 $42.98 91011 X Esophagus motility study 0361 3.6216 $214.92 $83.23 $42.98 91012 X Esophagus motility study 0361 3.6216 $214.92 $83.23 $42.98 91020 X Gastric motility 0361 3.6216 $214.92 $83.23 $42.98 91030 X Acid perfusion of esophagus 0361 3.6216 $214.92 $83.23 $42.98 91034 X Gastroesophageal reflux test 0361 3.6216 $214.92 $83.23 $42.98 91035 S G-esoph reflx tst w/electrod 1506 $450.00 $90.00 91037 X Esoph imped function test 0361 3.6216 $214.92 $83.23 $42.98 91038 X Esoph imped funct test > 1h 0361 3.6216 $214.92 $83.23 $42.98 91040 X Esoph balloon distension tst 0360 1.4739 $87.47 $34.98 $17.49 91052 X Gastric analysis test 0361 3.6216 $214.92 $83.23 $42.98 91055 X Gastric intubation for smear 0360 1.4739 $87.47 $34.98 $17.49 91060 X Gastric saline load test 0360 1.4739 $87.47 $34.98 $17.49 91065 X Breath hydrogen test 0360 1.4739 $87.47 $34.98 $17.49 91100 X Pass intestine bleeding tube 0360 1.4739 $87.47 $34.98 $17.49 91105 X Gastric intubation treatment 0360 1.4739 $87.47 $34.98 $17.49 91110 T Gi tract capsule endoscopy 0142 9.3487 $554.78 $152.78 $110.96 91120 T Rectal sensation test 0156 2.5751 $152.81 $40.52 $30.56 91122 T Anal pressure record 0156 2.5751 $152.81 $40.52 $30.56 91123 N Irrigate fecal impaction 91132 X Electrogastrography 0360 1.4739 $87.47 $34.98 $17.49 91133 X Electrogastrography w/test 0360 1.4739 $87.47 $34.98 $17.49 Start Printed Page 50813 91299 X Gastroenterology procedure 0360 1.4739 $87.47 $34.98 $17.49 92002 V Eye exam, new patient 0601 1.0038 $59.57 $11.91 92004 V Eye exam, new patient 0601 1.0038 $59.57 $11.91 92012 V Eye exam established pat 0600 0.8688 $51.56 $10.31 92014 V Eye exam & treatment 0601 1.0038 $59.57 $11.91 92015 E Refraction 92018 T New eye exam & treatment 0699 10.0177 $594.48 $118.90 92019 T Eye exam & treatment 0699 10.0177 $594.48 $118.90 92020 S Special eye evaluation 0230 0.7858 $46.63 $14.97 $9.33 92060 S Special eye evaluation 0230 0.7858 $46.63 $14.97 $9.33 92065 S Orthoptic/pleoptic training 0698 1.2438 $73.81 $16.55 $14.76 92070 N Fitting of contact lens 92081 S Visual field examination(s) 0230 0.7858 $46.63 $14.97 $9.33 92082 S Visual field examination(s) 0230 0.7858 $46.63 $14.97 $9.33 92083 S Visual field examination(s) 0230 0.7858 $46.63 $14.97 $9.33 92100 N Serial tonometry exam(s) 92120 S Tonography & eye evaluation 0230 0.7858 $46.63 $14.97 $9.33 92130 S Water provocation tonography 0230 0.7858 $46.63 $14.97 $9.33 92135 S Opthalmic dx imaging 0230 0.7858 $46.63 $14.97 $9.33 92136 S Ophthalmic biometry 0698 1.2438 $73.81 $16.55 $14.76 92140 S Glaucoma provocative tests 0698 1.2438 $73.81 $16.55 $14.76 92225 S Special eye exam, initial 0230 0.7858 $46.63 $14.97 $9.33 92226 S Special eye exam, subsequent 0230 0.7858 $46.63 $14.97 $9.33 92230 T Eye exam with photos 0699 10.0177 $594.48 $118.90 92235 S Eye exam with photos 0231 1.9278 $114.40 $44.61 $22.88 92240 S Icg angiography 0231 1.9278 $114.40 $44.61 $22.88 92250 S Eye exam with photos 0230 0.7858 $46.63 $14.97 $9.33 92260 S Ophthalmoscopy/dynamometry 0698 1.2438 $73.81 $16.55 $14.76 92265 S Eye muscle evaluation 0230 0.7858 $46.63 $14.97 $9.33 92270 S Electro-oculography 0230 0.7858 $46.63 $14.97 $9.33 92275 S Electroretinography 0231 1.9278 $114.40 $44.61 $22.88 92283 S Color vision examination 0230 0.7858 $46.63 $14.97 $9.33 92284 S Dark adaptation eye exam 0698 1.2438 $73.81 $16.55 $14.76 92285 S Eye photography 0230 0.7858 $46.63 $14.97 $9.33 92286 S Internal eye photography 0698 1.2438 $73.81 $16.55 $14.76 92287 S Internal eye photography 0698 1.2438 $73.81 $16.55 $14.76 92310 E Contact lens fitting 92311 X Contact lens fitting 0362 2.6607 $157.89 $31.58 92312 X Contact lens fitting 0362 2.6607 $157.89 $31.58 92313 X Contact lens fitting 0362 2.6607 $157.89 $31.58 92314 E Prescription of contact lens 92315 X Prescription of contact lens 0362 2.6607 $157.89 $31.58 92316 X Prescription of contact lens 0362 2.6607 $157.89 $31.58 92317 X Prescription of contact lens 0362 2.6607 $157.89 $31.58 92325 X Modification of contact lens 0362 2.6607 $157.89 $31.58 92326 X Replacement of contact lens 0362 2.6607 $157.89 $31.58 92330 S Fitting of artificial eye 0230 0.7858 $46.63 $14.97 $9.33 92335 N Fitting of artificial eye 92340 E Fitting of spectacles 92341 E Fitting of spectacles 92342 E Fitting of spectacles 92352 X Special spectacles fitting 0362 2.6607 $157.89 $31.58 92353 X Special spectacles fitting 0362 2.6607 $157.89 $31.58 92354 X Special spectacles fitting 0362 2.6607 $157.89 $31.58 92355 X Special spectacles fitting 0362 2.6607 $157.89 $31.58 92358 X Eye prosthesis service 0362 2.6607 $157.89 $31.58 92370 E Repair & adjust spectacles 92371 X Repair & adjust spectacles 0362 2.6607 $157.89 $31.58 92390 E Supply of spectacles 92391 E Supply of contact lenses 92392 E Supply of low vision aids 92393 E Supply of artificial eye 92395 E Supply of spectacles 92396 E Supply of contact lenses 92499 S Eye service or procedure 0230 0.7858 $46.63 $14.97 $9.33 92502 T Ear and throat examination 0251 2.0101 $119.29 $23.86 Start Printed Page 50814 92504 N Ear microscopy examination 92506 A Speech/hearing evaluation 92507 A Speech/hearing therapy 92508 A Speech/hearing therapy 92510 E Rehab for ear implant 92511 T Nasopharyngoscopy 0071 0.7915 $46.97 $11.31 $9.39 92512 X Nasal function studies 0363 0.9128 $54.17 $17.44 $10.83 92516 X Facial nerve function test 0660 1.6419 $97.44 $30.66 $19.49 92520 X Laryngeal function studies 0660 1.6419 $97.44 $30.66 $19.49 92526 A Oral function therapy 92531 N Spontaneous nystagmus study 92532 N Positional nystagmus test 92533 N Caloric vestibular test 92534 N Optokinetic nystagmus test 92541 X Spontaneous nystagmus test 0363 0.9128 $54.17 $17.44 $10.83 92542 X Positional nystagmus test 0363 0.9128 $54.17 $17.44 $10.83 92543 X Caloric vestibular test 0660 1.6419 $97.44 $30.66 $19.49 92544 X Optokinetic nystagmus test 0363 0.9128 $54.17 $17.44 $10.83 92545 X Oscillating tracking test 0363 0.9128 $54.17 $17.44 $10.83 92546 X Sinusoidal rotational test 0660 1.6419 $97.44 $30.66 $19.49 92547 X Supplemental electrical test 0363 0.9128 $54.17 $17.44 $10.83 92548 X Posturography 0660 1.6419 $97.44 $30.66 $19.49 92551 E Pure tone hearing test, air 92552 X Pure tone audiometry, air 0364 0.4708 $27.94 $9.06 $5.59 92553 X Audiometry, air & bone 0365 1.2356 $73.32 $18.95 $14.66 92555 X Speech threshold audiometry 0364 0.4708 $27.94 $9.06 $5.59 92556 X Speech audiometry, complete 0364 0.4708 $27.94 $9.06 $5.59 92557 X Comprehensive hearing test 0365 1.2356 $73.32 $18.95 $14.66 92559 E Group audiometric testing 92560 E Bekesy audiometry, screen 92561 X Bekesy audiometry, diagnosis 0364 0.4708 $27.94 $9.06 $5.59 92562 X Loudness balance test 0364 0.4708 $27.94 $9.06 $5.59 92563 X Tone decay hearing test 0364 0.4708 $27.94 $9.06 $5.59 92564 X Sisi hearing test 0364 0.4708 $27.94 $9.06 $5.59 92565 X Stenger test, pure tone 0364 0.4708 $27.94 $9.06 $5.59 92567 X Tympanometry 0364 0.4708 $27.94 $9.06 $5.59 92568 X Acoustic reflex testing 0364 0.4708 $27.94 $9.06 $5.59 92569 X Acoustic reflex decay test 0364 0.4708 $27.94 $9.06 $5.59 92571 X Filtered speech hearing test 0364 0.4708 $27.94 $9.06 $5.59 92572 X Staggered spondaic word test 0365 1.2356 $73.32 $18.95 $14.66 92573 X Lombard test 0364 0.4708 $27.94 $9.06 $5.59 92575 X Sensorineural acuity test 0364 0.4708 $27.94 $9.06 $5.59 92576 X Synthetic sentence test 0364 0.4708 $27.94 $9.06 $5.59 92577 X Stenger test, speech 0366 1.7743 $105.29 $30.04 $21.06 92579 X Visual audiometry (vra) 0365 1.2356 $73.32 $18.95 $14.66 92582 X Conditioning play audiometry 0365 1.2356 $73.32 $18.95 $14.66 92583 X Select picture audiometry 0364 0.4708 $27.94 $9.06 $5.59 92584 X Electrocochleography 0660 1.6419 $97.44 $30.66 $19.49 92585 S Auditor evoke potent, compre 0216 2.672 $158.56 $31.71 92586 S Auditor evoke potent, limit 0218 1.1408 $67.70 $13.54 92587 X Evoked auditory test 0363 0.9128 $54.17 $17.44 $10.83 92588 X Evoked auditory test 0363 0.9128 $54.17 $17.44 $10.83 92590 E Hearing aid exam, one ear 92591 E Hearing aid exam, both ears 92592 E Hearing aid check, one ear 92593 E Hearing aid check, both ears 92594 E Electro hearng aid test, one 92595 E Electro hearng aid tst, both 92596 X Ear protector evaluation 0364 0.4708 $27.94 $9.06 $5.59 92597 A Voice Prosthetic Evaluation 92601 X Cochlear implt f/up exam < 7 0366 1.7743 $105.29 $30.04 $21.06 92602 X Reprogram cochlear implt < 7 0366 1.7743 $105.29 $30.04 $21.06 92603 X Cochlear implt f/up exam 7 > 0366 1.7743 $105.29 $30.04 $21.06 92604 X Reprogram cochlear implt 7 > 0366 1.7743 $105.29 $30.04 $21.06 92605 A Eval for nonspeech device rx 92606 A Non-speech device service Start Printed Page 50815 92607 A Ex for speech device rx, 1hr 92608 A Ex for speech device rx addl 92609 A Use of speech device service 92610 A Evaluate swallowing function 92611 A Motion fluoroscopy/swallow 92612 A Endoscopy swallow tst (fees) 92613 E Endoscopy swallow tst (fees) 92614 A Laryngoscopic sensory test 92615 E Eval laryngoscopy sense tst 92616 A Fees w/laryngeal sense test 92617 E Interprt fees/laryngeal test 92620 X Auditory function, 60 min 0364 0.4708 $27.94 $9.06 $5.59 92621 N Auditory function, + 15 min 92625 X Tinnitus assessment 0364 0.4708 $27.94 $9.06 $5.59 92700 X Ent procedure/service 0364 0.4708 $27.94 $9.06 $5.59 92950 S Heart/lung resuscitation cpr 0094 2.5363 $150.51 $47.62 $30.10 92953 S Temporary external pacing 0094 2.5363 $150.51 $47.62 $30.10 92960 S Cardioversion electric, ext 0679 5.5774 $330.98 $95.30 $66.20 92961 S Cardioversion, electric, int 0679 5.5774 $330.98 $95.30 $66.20 92970 C Cardioassist, internal 92971 C Cardioassist, external 92973 T Percut coronary thrombectomy 0676 2.4105 $143.05 $28.61 92974 T Cath place, cardio brachytx 0103 14.7142 $873.18 $223.63 $174.64 92975 C Dissolve clot, heart vessel 92977 T Dissolve clot, heart vessel 0676 2.4105 $143.05 $28.61 92978 S Intravasc us, heart add-on 0670 25.4131 $1,508.09 $472.46 $301.62 92979 S Intravasc us, heart add-on 0416 19.5542 $1,160.40 $232.08 92980 T Insert intracoronary stent 0104 79.0094 $4,688.65 $937.73 92981 T Insert intracoronary stent 0104 79.0094 $4,688.65 $937.73 92982 T Coronary artery dilation 0083 50.8925 $3,020.11 $604.02 92984 T Coronary artery dilation 0083 50.8925 $3,020.11 $604.02 92986 T Revision of aortic valve 0083 50.8925 $3,020.11 $604.02 92987 T Revision of mitral valve 0083 50.8925 $3,020.11 $604.02 92990 T Revision of pulmonary valve 0083 50.8925 $3,020.11 $604.02 92992 C Revision of heart chamber 92993 C Revision of heart chamber 92995 T Coronary atherectomy 0082 85.0126 $5,044.90 $1,085.20 $1,008.98 92996 T Coronary atherectomy add-on 0082 85.0126 $5,044.90 $1,085.20 $1,008.98 92997 T Pul art balloon repr, percut 0081 34.4473 $2,044.21 $408.84 92998 T Pul art balloon repr, percut 0081 34.4473 $2,044.21 $408.84 93000 B Electrocardiogram, complete 93005 S Electrocardiogram, tracing 0099 0.3821 $22.67 $4.53 93010 A Electrocardiogram report 93012 N Transmission of ecg 93014 B Report on transmitted ecg 93015 B Cardiovascular stress test 93016 B Cardiovascular stress test 93017 X Cardiovascular stress test 0100 2.4968 $148.17 $41.44 $29.63 93018 B Cardiovascular stress test 93024 X Cardiac drug stress test 0100 2.4968 $148.17 $41.44 $29.63 93025 X Microvolt t-wave assess 0100 2.4968 $148.17 $41.44 $29.63 93040 B Rhythm ECG with report 93041 S Rhythm ECG, tracing 0099 0.3821 $22.67 $4.53 93042 B Rhythm ECG, report 93224 B ECG monitor/report, 24 hrs 93225 X ECG monitor/record, 24 hrs 0097 1.0223 $60.67 $23.79 $12.13 93226 X ECG monitor/report, 24 hrs 0097 1.0223 $60.67 $23.79 $12.13 93227 B ECG monitor/review, 24 hrs 93230 B ECG monitor/report, 24 hrs 93231 X Ecg monitor/record, 24 hrs 0097 1.0223 $60.67 $23.79 $12.13 93232 X ECG monitor/report, 24 hrs 0097 1.0223 $60.67 $23.79 $12.13 93233 B ECG monitor/review, 24 hrs 93235 B ECG monitor/report, 24 hrs 93236 X ECG monitor/report, 24 hrs 0097 1.0223 $60.67 $23.79 $12.13 93237 B ECG monitor/review, 24 hrs 93268 B ECG record/review Start Printed Page 50816 93270 X ECG recording 0097 1.0223 $60.67 $23.79 $12.13 93271 X Ecg/monitoring and analysis 0097 1.0223 $60.67 $23.79 $12.13 93272 B Ecg/review, interpret only 93278 S ECG/signal-averaged 0099 0.3821 $22.67 $4.53 93303 S Echo transthoracic 0269 3.2437 $192.49 $76.99 $38.50 93304 S Echo transthoracic 0697 1.5357 $91.13 $36.45 $18.23 93307 S Echo exam of heart 0269 3.2437 $192.49 $76.99 $38.50 93308 S Echo exam of heart 0697 1.5357 $91.13 $36.45 $18.23 93312 S Echo transesophageal 0270 6.0192 $357.20 $142.88 $71.44 93313 S Echo transesophageal 0270 6.0192 $357.20 $142.88 $71.44 93314 N Echo transesophageal 93315 S Echo transesophageal 0270 6.0192 $357.20 $142.88 $71.44 93316 S Echo transesophageal 0270 6.0192 $357.20 $142.88 $71.44 93317 N Echo transesophageal 93318 S Echo transesophageal intraop 0270 6.0192 $357.20 $142.88 $71.44 93320 S Doppler echo exam, heart 0671 1.7028 $101.05 $40.42 $20.21 93321 S Doppler echo exam, heart 0697 1.5357 $91.13 $36.45 $18.23 93325 S Doppler color flow add-on 0697 1.5357 $91.13 $36.45 $18.23 93350 S Echo transthoracic 0269 3.2437 $192.49 $76.99 $38.50 93501 T Right heart catheterization 0080 37.1361 $2,203.77 $838.92 $440.75 93503 T Insert/place heart catheter 0103 14.7142 $873.18 $223.63 $174.64 93505 T Biopsy of heart lining 0103 14.7142 $873.18 $223.63 $174.64 93508 T Cath placement, angiography 0080 37.1361 $2,203.77 $838.92 $440.75 93510 T Left heart catheterization 000 37.1361 $2,203.77 $838.92 $440.75 93511 T Left heart catheterization 0080 37.1361 $2,203.77 $838.92 $440.75 93514 T Left heart catheterization 0080 37.1361 $2,203.77 $838.92 $440.75 93524 T Left heart catheterization 0080 37.1361 $2,203.77 $838.92 $440.75 93526 T Rt & Lt heart catheters 0080 37.1361 $2,203.77 $838.92 $440.75 93527 T Rt & Lt heart catheters 0080 37.1361 $2,203.77 $838.92 $440.75 93528 T Rt & Lt heart catheters 0080 37.1361 $2,203.77 $838.92 $440.75 93529 T Rt, lt heart catheterization 0080 37.1361 $2,203.77 $838.92 $440.75 93530 T Rt heart cath, congenital 0080 37.1361 $2,203.77 $838.92 $440.75 93531 T R & l heart cath, congenital 0080 37.1361 $2,203.77 $838.92 $440.75 93532 T R & l heart cath, congenital 0080 37.1361 $2,203.77 $838.92 $440.75 93533 T R & l heart cath, congenital 0080 37.1361 $2,203.77 $838.92 $440.75 93539 N Injection, cardiac cath 93540 N Injection, cardiac cath 93541 N Injection for lung angiogram 93542 N Injection for heart x-rays 93543 N Injection for heart x-rays 93544 N Injection for aortography 93545 N Inject for coronary x-rays 93555 N Imaging, cardiac cath 93556 N Imaging, cardiac cath 93561 N Cardiac output measurement 93562 N Cardiac output measurement 93571 S Heart flow reserve measure 0670 25.4131 $1,508.09 $472.46 $301.62 93572 S Heart flow reserve measure 0416 19.5542 $1,160.40 $232.08 93580 T Transcath closure of asd 0434 90.7877 $5,387.61 $1,077.52 93581 T Transcath closure of vsd 0434 90.7877 $5,387.61 $1,077.52 93600 T Bundle of His recording 0087 30.7101 $1,822.43 $364.49 93602 T Intra-atrial recording 0087 30.7101 $1,822.43 $364.49 93603 T Right ventricular recording 0087 30.7101 $1,822.43 $364.49 93609 T Map tachycardia, add-on 0087 30.7101 $1,822.43 $364.49 93610 T Intra-atrial pacing 0087 30.7101 $1,822.43 $364.49 93612 T Intraventricular pacing 0087 30.7101 $1,822.43 $364.49 93613 T Electrophys map 3d, add-on 0087 30.7101 $1,822.43 $364.49 93615 T Esophageal recording 0087 30.7101 $1,822.43 $364.49 93616 T Esophageal recording 0087 30.7101 $1,822.43 $364.49 93618 T Heart rhythm pacing 0087 30.7101 $1,822.43 $364.49 93619 T Electrophysiology evaluation 0085 35.1882 $2,088.17 $426.25 $417.63 93620 T Electrophysiology evaluation 0085 35.1882 $2,088.17 $426.25 $417.63 93621 T Electrophysiology evaluation 0085 35.1882 $2,088.17 $426.25 $417.63 93622 T Electrophysiology evaluation 0085 35.1882 $2,088.17 $426.25 $417.63 93623 T Stimulation, pacing heart 0087 30.7101 $1,822.43 $364.49 93624 T Electrophysiologic study 0085 35.1882 $2,088.17 $426.25 $417.63 Start Printed Page 50817 93631 T Heart pacing, mapping 0087 30.7101 $1,822.43 $364.49 93640 S Evaluation heart device 0084 10.0205 $594.65 $118.93 93641 S Electrophysiology evaluation 0084 10.0205 $594.65 $118.93 93642 S Electrophysiology evaluation 0084 10.0205 $594.65 $118.93 93650 T Ablate heart dysrhythm focus 0086 44.2596 $2,626.50 $833.33 $525.30 93651 T Ablate heart dysrhythm focus 0086 44.2596 $2,626.50 $833.33 $525.30 93652 T Ablate heart dysrhythm focus 0086 44.2596 $2,626.50 $833.33 $525.30 93660 S Tilt table evaluation 0101 4.2787 $253.91 $101.56 $50.78 93662 S Intracardiac ecg (ice) 0670 25.4131 $1,508.09 $472.46 $301.62 93668 E Peripheral vascular rehab 93701 S Bioimpedance, thoracic 0099 0.3821 $22.67 $4.53 93720 B Total body plethysmography 93721 X Plethysmography tracing 0368 0.9761 $57.92 $23.16 $11.58 93722 B Plethysmography report 93724 S Analyze pacemaker system 0690 0.3755 $22.28 $8.91 $4.46 93727 S Analyze ilr system 0690 0.3755 $22.28 $8.91 $4.46 93731 S Analyze pacemaker system 0690 0.3755 $22.28 $8.91 $4.46 93732 S Analyze pacemaker system 0690 0.3755 $22.28 $8.91 $4.46 93733 S Telephone analy, pacemaker 0690 0.3755 $22.28 $8.91 $4.46 93734 S Analyze pacemaker system 0690 0.3755 $22.28 $8.91 $4.46 93735 S Analyze pacemaker system 0690 0.3755 $22.28 $8.91 $4.46 93736 S Telephonic analy, pacemaker 0690 0.3755 $22.28 $8.91 $4.46 93740 X Temperature gradient studies 0368 0.9761 $57.92 $23.16 $11.58 93741 S Analyze ht pace device sngl 0689 0.5735 $34.03 $6.81 93742 S Analyze ht pace device sngl 0689 0.5735 $34.03 $6.81 93743 S Analyze ht pace device dual 0689 0.5735 $34.03 $6.81 93744 S Analyze ht pace device dual 0689 0.5735 $34.03 $6.81 93745 S Set-up cardiovert-defibrill 0689 0.5735 $34.03 $6.81 93760 E Cephalic thermogram 93762 E Peripheral thermogram 93770 N Measure venous pressure 93784 E Ambulatory BP monitoring 93786 X Ambulatory BP recording 0097 1.0223 $60.67 $23.79 $12.13 93788 X Ambulatory BP analysis 0097 1.0223 $60.67 $23.79 $12.13 93790 B Review/report BP recording 93797 S Cardiac rehab 0095 0.5885 $34.92 $13.96 $6.98 93798 S Cardiac rehab/monitor 0095 0.5885 $34.92 $13.96 $6.98 93799 S Cardiovascular procedure 0096 1.6307 $96.77 $38.70 $19.35 93875 S Extracranial study 0096 1.6307 $96.77 $38.70 $19.35 93880 S Extracranial study 0267 2.6327 $156.23 $62.18 $31.25 93882 S Extracranial study 0267 2.6327 $156.23 $62.18 $31.25 93886 S Intracranial study 0267 2.6327 $156.23 $62.18 $31.25 93888 S Intracranial study 0266 1.6393 $97.28 $38.91 $19.46 93890 S Tcd, vasoreactivity study 0266 1.6393 $97.28 $38.91 $19.46 93892 S Tcd, emboli detect w/o inj 0266 1.6393 $97.28 $38.91 $19.46 93893 S Tcd, emboli detect w/inj 0266 1.6393 $97.28 $38.91 $19.46 93922 S Extremity study 0096 1.6307 $96.77 $38.70 $19.35 93923 S Extremity study 0096 1.6307 $96.77 $38.70 $19.35 93924 S Extremity study 0096 1.6307 $96.77 $38.70 $19.35 93925 S Lower extremity study 0267 2.6327 $156.23 $62.18 $31.25 93926 S Lower extremity study 0266 1.6393 $97.28 $38.91 $19.46 93930 S Upper extremity study 0267 2.6327 $156.23 $62.18 $31.25 93931 S Upper extremity study 0266 1.6393 $97.28 $38.91 $19.46 93965 S Extremity study 0096 1.6307 $96.77 $38.70 $19.35 93970 S Extremity study 0267 2.6327 $156.23 $62.18 $31.25 93971 S Extremity study 0266 1.6393 $97.28 $38.91 $19.46 93975 S Vascular study 0267 2.6327 $156.23 $62.18 $31.25 93976 S Vascular study 0267 2.6327 $156.23 $62.18 $31.25 93978 S Vascular study 0266 1.6393 $97.28 $38.91 $19.46 93979 S Vascular study 0266 1.6393 $97.28 $38.91 $19.46 93980 S Penile vascular study 0267 2.6327 $156.23 $62.18 $31.25 93981 S Penile vascular study 0266 1.6393 $97.28 $38.91 $19.46 93990 S Doppler flow testing 0266 1.6393 $97.28 $38.91 $19.46 94010 X Breathing capacity test 0368 0.9761 $57.92 $23.16 $11.58 94014 X Patient recorded spirometry 0367 0.6659 $39.52 $14.80 $7.90 94015 X Patient recorded spirometry 0367 0.6659 $39.52 $14.80 $7.90 Start Printed Page 50818 94016 A Review patient spirometry 94060 X Evaluation of wheezing 0368 0.9761 $57.92 $23.16 $11.58 94070 X Evaluation of wheezing 0369 2.7519 $163.31 $44.18 $32.66 94150 X Vital capacity test 0367 0.6659 $39.52 $14.80 $7.90 94200 X Lung function test (MBC/MVV) 0367 0.6659 $39.52 $14.80 $7.90 94240 X Residual lung capacity 0368 0.9761 $57.92 $23.16 $11.58 94250 X Expired gas collection 0367 0.6659 $39.52 $14.80 $7.90 94260 X Thoracic gas volume 0367 0.6659 $39.52 $14.80 $7.90 94350 X Lung nitrogen washout curve 0367 0.6659 $39.52 $14.80 $7.90 94360 X Measure airflow resistance 0367 0.6659 $39.52 $14.80 $7.90 94370 X Breath airway closing volume 0367 0.6659 $39.52 $14.80 $7.90 94375 X Respiratory flow volume loop 0367 0.6659 $39.52 $14.80 $7.90 94400 X CO2 breathing response curve 0367 0.6659 $39.52 $14.80 $7.90 94450 X Hypoxia response curve 0368 0.9761 $57.92 $23.16 $11.58 94452 X Hast w/report 0368 0.9761 $57.92 $23.16 $11.58 94453 X Hast w/oxygen titrate 0368 0.9761 $57.92 $23.16 $11.58 94620 X Pulmonary stress test/simple 0368 0.9761 $57.92 $23.16 $11.58 94621 X Pulm stress test/complex 0369 2.7519 $163.31 $44.18 $32.66 94640 S Airway inhalation treatment 0077 0.3444 $20.44 $7.74 $4.09 94642 S Aerosol inhalation treatment 0078 1.0236 $60.74 $14.55 $12.15 94656 S Initial ventilator mgmt 0079 2.3482 $139.35 $27.87 94657 S Continued ventilator mgmt 0079 2.3482 $139.35 $27.87 94660 S Pos airway pressure, CPAP 0068 1.2293 $72.95 $29.18 $14.59 94662 S Neg press ventilation, cnp 0079 2.3482 $139.35 $27.87 94664 S Aerosol or vapor inhalations 0077 0.3444 $20.44 $7.74 $4.09 94667 S Chest wall manipulation 0077 0.3444 $20.44 $7.74 $4.09 94668 S Chest wall manipulation 0077 0.3444 $20.44 $7.74 $4.09 94680 X Exhaled air analysis, o2 0367 0.6659 $39.52 $14.80 $7.90 94681 X Exhaled air analysis, o2/co2 0368 0.9761 $57.92 $23.16 $11.58 94690 X Exhaled air analysis 0368 0.9761 $57.92 $23.16 $11.58 94720 X Monoxide diffusing capacity 0368 0.9761 $57.92 $23.16 $11.58 94725 X Membrane diffusion capacity 0368 0.9761 $57.92 $23.16 $11.58 94750 X Pulmonary compliance study 0368 0.9761 $57.92 $23.16 $11.58 94760 N Measure blood oxygen level 94761 N Measure blood oxygen level 94762 N Measure blood oxygen level 94770 X Exhaled carbon dioxide test 0367 0.6659 $39.52 $14.80 $7.90 94772 X Breath recording, infant 0369 2.7519 $163.31 $44.18 $32.66 94799 X Pulmonary service/procedure 0367 0.6659 $39.52 $14.80 $7.90 95004 X Percut allergy skin tests 0381 0.1884 $11.18 $2.35 $2.24 95010 X Percut allergy titrate test 0381 0.1884 $11.18 $2.35 $2.24 95015 X Id allergy titrate-drug/bug 0381 0.1884 $11.18 $2.35 $2.24 95024 X Id allergy test, drug/bug 0381 0.1884 $11.18 $2.35 $2.24 95027 X Skin end point titration 0381 0.1884 $11.18 $2.35 $2.24 95028 X Id allergy test-delayed type 0381 0.1884 $11.18 $2.35 $2.24 95044 X Allergy patch tests 0381 0.1884 $11.18 $2.35 $2.24 95052 X Photo patch test 0381 0.1884 $11.18 $2.35 $2.24 95056 X Photosensitivity tests 0370 1.1232 $66.65 $13.33 95060 X Eye allergy tests 0370 1.1232 $66.65 $13.33 95065 X Nose allergy test 0381 0.1884 $11.18 $2.35 $2.24 95070 X Bronchial allergy tests 0369 2.7519 $163.31 $44.18 $32.66 95071 X Bronchial allergy tests 0369 2.7519 $163.31 $44.18 $32.66 95075 X Ingestion challenge test 0361 3.6216 $214.92 $83.23 $42.98 95078 X Provocative testing 0370 1.1232 $66.65 $13.33 95115 X Immunotherapy, one injection 0352 0.1413 $8.39 $1.68 95117 X Immunotherapy injections 0353 0.3954 $23.46 $4.69 95120 B Immunotherapy, one injection 95125 B Immunotherapy, many antigens 95130 B Immunotherapy, insect venom 95131 B Immunotherapy, insect venoms 95132 B Immunotherapy, insect venoms 95133 B Immunotherapy, insect venoms 95134 B Immunotherapy, insect venoms 95144 X Antigen therapy services 0353 0.3954 $23.46 $4.69 95145 X Antigen therapy services 0353 0.3954 $23.46 $4.69 95146 X Antigen therapy services 0359 0.8312 $49.33 $9.87 Start Printed Page 50819 95147 X Antigen therapy services 0359 0.8312 $49.33 $9.87 95148 X Antigen therapy services 0353 0.3954 $23.46 $4.69 95149 X Antigen therapy services 0352 0.1413 $8.39 $1.68 95165 X Antigen therapy services 0353 0.3954 $23.46 $4.69 95170 X Antigen therapy services 0352 0.1413 $8.39 $1.68 95180 X Rapid desensitization 0370 1.1232 $66.65 $13.33 95199 X Allergy immunology services 0370 1.1232 $66.65 $13.33 95250 X Glucose monitoring, cont 0421 1.66 $98.51 $19.70 95805 S Multiple sleep latency test 0209 11.5713 $686.68 $274.67 $137.34 95806 S Sleep study, unattended 0213 2.2932 $136.09 $54.43 $27.22 95807 S Sleep study, attended 0209 11.5713 $686.68 $274.67 $137.34 95808 S Polysomnography, 1-3 0209 11.5713 $686.68 $274.67 $137.34 95810 S Polysomnography, 4 or more 0209 11.5713 $686.68 $274.67 $137.34 95811 S Polysomnography w/cpap 0209 11.5713 $686.68 $274.67 $137.34 95812 S Electroencephalogram (EEG) 0213 2.2932 $136.09 $54.43 $27.22 95813 S Eeg, over 1 hour 0213 2.2932 $136.09 $54.43 $27.22 95816 S Electroencephalogram (EEG) 0213 2.2932 $136.09 $54.43 $27.22 95819 S Electroencephalogram (EEG) 0213 2.2932 $136.09 $54.43 $27.22 95822 S Sleep electroencephalogram 0213 2.2932 $136.09 $54.43 $27.22 95824 S Eeg, cerebral death only 0214 1.1353 $67.37 $26.94 $13.47 95827 S night electroencephalogram 0213 2.2932 $136.09 $54.43 $27.22 95829 S Surgery electrocorticogram 0214 1.1353 $67.37 $26.94 $13.47 95830 B Insert electrodes for EEG 95831 A Limb muscle testing, manual 95832 A Hand muscle testing, manual 95833 A Body muscle testing, manual 95834 A Body muscle testing, manual 95851 A Range of motion measurements 95852 A Range of motion measurements 95857 S Tensilon test 0218 1.1408 $67.70 $13.54 95858 S Tensilon test & myogram 0215 0.6115 $36.29 $14.51 $7.26 95860 S Muscle test, one limb 0218 1.1408 $67.70 $13.54 95861 S Muscle test, 2 limbs 0218 1.1408 $67.70 $13.54 95863 S Muscle test, 3 limbs 0218 1.1408 $67.70 $13.54 95864 S Muscle test, 4 limbs 0218 1.1408 $67.70 $13.54 95867 S Muscle test, head or neck 0218 1.1408 $67.70 $13.54 95868 S Muscle test cran nerve bilat 0218 1.1408 $67.70 $13.54 95869 S Muscle test, thor paraspinal 0215 0.6115 $36.29 $14.51 $7.26 95870 S Muscle test, nonparaspinal 0215 0.6115 $36.29 $14.51 $7.26 95872 S Muscle test, one fiber 0218 1.1408 $67.70 $13.54 95875 S Limb exercise test 0215 0.6115 $36.29 $14.51 $7.26 95900 S Motor nerve conduction test 0215 0.6115 $36.29 $14.51 $7.26 95903 S Motor nerve conduction test 0215 0.6115 $36.29 $14.51 $7.26 95904 S Sense nerve conduction test 0215 0.6115 $36.29 $14.51 $7.26 95920 S Intraop nerve test add-on 0216 2.672 $158.56 $31.71 95921 S Autonomic nerv function test 0218 1.1408 $67.70 $13.54 95922 S Autonomic nerv function test 0218 1.1408 $67.70 $13.54 95923 S Autonomic nerv function test 0218 1.1408 $67.70 $13.54 95925 S Somatosensory testing 0216 2.672 $158.56 $31.71 95926 S Somatosensory testing 0216 2.672 $158.56 $31.71 95927 S Somatosensory testing 0216 2.672 $158.56 $31.71 95928 S C motor evoked, uppr limbs 0218 1.1408 $67.70 $13.54 95929 S C motor evoked, lwr limbs 0218 1.1408 $67.70 $13.54 95930 S Visual evoked potential test 0216 2.672 $158.56 $31.71 95933 S Blink reflex test 0215 0.6115 $36.29 $14.51 $7.26 95934 S H-reflex test 0215 0.6115 $36.29 $14.51 $7.26 95936 S H-reflex test 0215 0.6115 $36.29 $14.51 $7.26 95937 S Neuromuscular junction test 0218 1.1408 $67.70 $13.54 95950 S Ambulatory eeg monitoring 0209 11.5713 $686.68 $274.67 $137.34 95951 S EEG monitoring/videorecord 0209 11.5713 $686.68 $274.67 $137.34 95953 S EEG monitoring/computer 0209 11.5713 $686.68 $274.67 $137.34 95954 S EEG monitoring/giving drugs 0214 1.1353 $67.37 $26.94 $13.47 95955 S EEG during surgery 0213 2.2932 $136.09 $54.43 $27.22 95956 S Eeg monitoring, cable/radio 0209 11.5713 $686.68 $274.67 $137.34 95957 S EEG digital analysis 0214 1.1353 $67.37 $26.94 $13.47 95958 S EEG monitoring/function test 0213 2.2932 $136.09 $54.43 $27.22 Start Printed Page 50820 95961 S Electrode stimulation, brain 0216 2.672 $158.56 $31.71 95962 S Electrode stim, brain add-on 0216 2.672 $158.56 $31.71 95965 T Meg, spontaneous 0430 11.404 $676.75 $135.35 95966 T Meg, evoked, single 0430 11.404 $676.75 $135.35 95967 T Meg, evoked, each add'l 0430 11.404 $676.75 $135.35 95970 S Analyze neurostim, no prog 0218 1.1408 $67.70 $13.54 95971 S Analyze neurostim, simple 0692 2.0111 $119.34 $30.16 $23.87 95972 S Analyze neurostim, complex 0692 2.0111 $119.34 $30.16 $23.87 95973 S Analyze neurostim, complex 0692 2.0111 $119.34 $30.16 $23.87 95974 S Cranial neurostim, complex 0692 2.0111 $119.34 $30.16 $23.87 95975 S Cranial neurostim, complex 0692 2.0111 $119.34 $30.16 $23.87 95978 S Analyze neurostim brain/1h 0692 2.0111 $119.34 $30.16 $23.87 95979 S Analyz neurostim brain addon 0692 2.0111 $119.34 $30.16 $23.87 95990 T Spin/brain pump refil & main 0125 1.9331 $114.72 $22.94 95991 T Spin/brain pump refil & main 0125 1.9331 $114.72 $22.94 95999 S Neurological procedure 0215 0.6115 $36.29 $14.51 $7.26 96000 S Motion analysis, video/3d 0216 2.672 $158.56 $31.71 96001 S Motion test w/ft press meas 0216 2.672 $158.56 $31.71 96002 S Dynamic surface emg 0218 1.1408 $67.70 $13.54 96003 S Dynamic fine wire emg 0215 0.6115 $36.29 $14.51 $7.26 96004 E Phys review of motion tests 96100 X Psychological testing 0373 2.1926 $130.12 $26.02 96105 A Assessment of aphasia 96110 X Developmental test, lim 0373 2.1926 $130.12 $26.02 96111 X Developmental test, extend 0373 2.1926 $130.12 $26.02 96115 X Neurobehavior status exam 0373 2.1926 $130.12 $26.02 96117 X Neuropsych test battery 0373 2.1926 $130.12 $26.02 96150 S Assess lth/behave, init 0432 0.6949 $41.24 $8.25 96151 S Assess hlth/behave, subseq 0432 0.6949 $41.24 $8.25 96152 S Intervene hlth/behave, indiv 0432 0.6949 $41.24 $8.25 96153 S Intervene hlth/behave, group 0432 0.6949 $41.24 $8.25 96154 S Interv hlth/behav, fam w/pt 0432 0.6949 $41.24 $8.25 96155 E Interv hlth/behav fam no pt 96400 S Chemotherapy, sc/im 0116 1.1453 $67.97 $13.59 96405 S Intralesional chemo admin 0116 1.1453 $67.97 $13.59 96406 S Intralesional chemo admin 0116 1.1453 $67.97 $13.59 96408 S Chemotherapy, push technique 0116 1.1453 $67.97 $13.59 96410 S Chemotherapy,infusion method 0117 3.2378 $192.14 $42.54 $38.43 96412 N Chemo, infuse method add-on 96414 S Chemo, infuse method add-on 0117 3.2378 $192.14 $42.54 $38.43 96420 S Chemotherapy, push technique 0116 1.1453 $67.97 $13.59 96422 S Chemotherapy,infusion method 0117 3.2378 $192.14 $42.54 $38.43 96423 N Chemo, infuse method add-on 96425 S Chemotherapy,infusion method 0117 3.2378 $192.14 $42.54 $38.43 96440 S Chemotherapy, intracavitary 0116 1.1453 $67.97 $13.59 96445 S Chemotherapy, intracavitary 0116 1.1453 $67.97 $13.59 96450 S Chemotherapy, into CNS 0116 1.1453 $67.97 $13.59 96520 T Port pump refill & main 0125 1.9331 $114.72 $22.94 96530 T Pump refilling, maintenance 0125 1.9331 $114.72 $22.94 96542 S Chemotherapy injection 0116 1.1453 $67.97 $13.59 96545 N Provide chemotherapy agent 96549 S Chemotherapy, unspecified 0116 1.1453 $67.97 $13.59 96567 T Photodynamic tx, skin 0016 2.5834 $153.31 $33.57 $30.66 96570 T Photodynamic tx, 30 min 0015 1.6514 $98.00 $20.29 $19.60 96571 T Photodynamic tx, addl 15 min 0015 1.6514 $98.00 $20.29 $19.60 96900 S Ultraviolet light therapy 0001 0.4213 $25.00 $7.00 $5.00 96902 N Trichogram 96910 S Photochemotherapy with UV-B 0001 0.4213 $25.00 $7.00 $5.00 96912 S Photochemotherapy with UV-A 0001 0.4213 $25.00 $7.00 $5.00 96913 S Photochemotherapy, UV-A or B 0683 1.9006 $112.79 $25.34 $22.56 96920 T Laser tx, skin < 250 sq cm 0013 1.1078 $65.74 $14.20 $13.15 96921 T Laser tx, skin 250-500 sq cm 0013 1.1078 $65.74 $14.20 $13.15 96922 T Laser tx, skin > 500 sq cm 0013 1.1078 $65.74 $14.20 $13.15 96999 T Dermatological procedure 0010 0.5719 $33.94 $9.65 $6.79 97001 A Pt evaluation 97002 A Pt re-evaluation Start Printed Page 50821 97003 A Ot evaluation 97004 A Ot re-evaluation 97005 E Athletic train eval 97006 E Athletic train reeval 97010 A Hot or cold packs therapy 97012 A Mechanical traction therapy 97014 E Electric stimulation therapy 97016 A Vasopneumatic device therapy 97018 A Paraffin bath therapy 97020 A Microwave therapy 97022 A Whirlpool therapy 97024 A Diathermy treatment 97026 A Infrared therapy 97028 A Ultraviolet therapy 97032 A Electrical stimulation 97033 A Electric current therapy 97034 A Contrast bath therapy 97035 A Ultrasound therapy 97036 A Hydrotherapy 97039 A Physical therapy treatment 97110 A Therapeutic exercises 97112 A Neuromuscular reeducation 97113 A Aquatic therapy/exercises 97116 A Gait training therapy 97124 A Massage therapy 97139 A Physical medicine procedure 97140 A Manual therapy 97150 A Group therapeutic procedures 97504 A Orthotic training 97520 A Prosthetic training 97530 A Therapeutic activities 97532 A Cognitive skills development 97533 A Sensory integration 97535 A Self care mngment training 97537 A Community/work reintegration 97542 A Wheelchair mngment training 97545 A Work hardening 97546 A Work hardening add-on 97597 A Active wound care/20 cm or < 97598 A Active wound care > 20 cm 97602 A Wound(s) care non-selective 97605 A Neg press wound tx, < 50 cm 97606 A Neg press wound tx, > 50 cm 97703 A Prosthetic checkout 97750 A Physical performance test 97755 A Assistive technology assess 97799 A Physical medicine procedure 97802 A Medical nutrition, indiv, in 97803 A Med nutrition, indiv, subseq 97804 A Medical nutrition, group 97810 E Acupunct w/o stimul 15 min 97811 E Acupunct w/o stimul addl 15m 97813 E Acupunct w/stimul 15 min 97814 E Acupunct w/stimul addl 15m 98925 S Osteopathic manipulation 0060 0.4935 $29.29 $5.86 98926 S Osteopathic manipulation 0060 0.4935 $29.29 $5.86 98927 S Osteopathic manipulation 0060 0.4935 $29.29 $5.86 98928 S Osteopathic manipulation 0060 0.4935 $29.29 $5.86 98929 S Osteopathic manipulation 0060 0.4935 $29.29 $5.86 98940 S Chiropractic manipulation 0060 0.4935 $29.29 $5.86 98941 S Chiropractic manipulation 0060 0.4935 $29.29 $5.86 98942 S Chiropractic manipulation 0060 0.4935 $29.29 $5.86 98943 E Chiropractic manipulation 99000 B Specimen handling 99001 B Specimen handling 99002 B Device handling Start Printed Page 50822 99024 B Postop follow-up visit 99026 E In-hospital on call service 99027 E Out-of-hosp on call service 99050 B Medical services after hrs 99052 B Medical services at night 99054 B Medical servcs, unusual hrs 99056 B Non-office medical services 99058 B Office emergency care 99070 B Special supplies 99071 B Patient education materials 99075 E Medical testimony 99078 N Group health education 99080 B Special reports or forms 99082 B Unusual physician travel 99090 B Computer data analysis 99091 E Collect/review data from pt 99100 B Special anesthesia service 99116 B Anesthesia with hypothermia 99135 B Special anesthesia procedure 99140 B Emergency anesthesia 99141 N Sedation, iv/im or inhalant 99142 N Sedation, oral/rectal/nasal 99170 T Anogenital exam, child 0191 0.167 $9.91 $2.78 $1.98 99172 E Ocular function screen 99173 E Visual acuity screen 99175 N Induction of vomiting 99183 B Hyperbaric oxygen therapy 99185 N Regional hypothermia 99186 N Total body hypothermia 99190 C Special pump services 99191 C Special pump services 99192 C Special pump services 99195 X Phlebotomy 0372 0.57 $33.83 $10.09 $6.77 99199 B Special service/proc/report 99201 V Office/outpatient visit, new 0600 0.8688 $51.56 $10.31 99202 V Office/outpatient visit, new 0600 0.8688 $51.56 $10.31 99203 V Office/outpatient visit, new 0601 1.0038 $59.57 $11.91 99204 V Office/outpatient visit, new 0602 1.4284 $84.77 $16.95 99205 V Office/outpatient visit, new 0602 1.4284 $84.77 $16.95 99211 V Office/outpatient visit, est 0600 0.8688 $51.56 $10.31 99212 V Office/outpatient visit, est 0600 0.8688 $51.56 $10.31 99213 V Office/outpatient visit, est 0601 1.0038 $59.57 $11.91 99214 V Office/outpatient visit, est 0602 1.4284 $84.77 $16.95 99215 V Office/outpatient visit, est 0602 1.4284 $84.77 $16.95 99217 B Observation care discharge 99218 B Observation care 99219 B Observation care 99220 B Observation care 99221 E Initial hospital care 99222 E Initial hospital care 99223 E Initial hospital care 99231 E Subsequent hospital care 99232 E Subsequent hospital care 99233 E Subsequent hospital care 99234 B Observ/hosp same date 99235 B Observ/hosp same date 99236 B Observ/hosp same date 99238 E Hospital discharge day 99239 E Hospital discharge day 99241 V Office consultation 0600 0.8688 $51.56 $10.31 99242 V Office consultation 0600 0.8688 $51.56 $10.31 99243 V Office consultation 0601 1.0038 $59.57 $11.91 99244 V Office consultation 0602 1.4284 $84.77 $16.95 99245 V Office consultation 0602 1.4284 $84.77 $16.95 99251 C Initial inpatient consult 99252 C Initial inpatient consult Start Printed Page 50823 99253 C Initial inpatient consult 99254 C Initial inpatient consult 99255 C Initial inpatient consult 99261 C Follow-up inpatient consult 99262 C Follow-up inpatient consult 99263 C Follow-up inpatient consult 99271 V Confirmatory consultation 0600 0.8688 $51.56 $10.31 99272 V Confirmatory consultation 0600 0.8688 $51.56 $10.31 99273 V Confirmatory consultation 0601 1.0038 $59.57 $11.91 99274 V Confirmatory consultation 0602 1.4284 $84.77 $16.95 99275 V Confirmatory consultation 0602 1.4284 $84.77 $16.95 99281 V Emergency dept visit 0610 1.2947 $76.83 $19.48 $15.37 99282 V Emergency dept visit 0610 1.2947 $76.83 $19.48 $15.37 99283 V Emergency dept visit 0611 2.2718 $134.82 $35.76 $26.96 99284 V Emergency dept visit 0612 3.9853 $236.50 $54.12 $47.30 99285 V Emergency dept visit 0612 3.9853 $236.50 $54.12 $47.30 99288 B Direct advanced life support 99289 N Pt transport, 30-74 min 99290 N Pt transport, addl 30 min 99291 S Critical care, first hour 0620 8.2996 $492.52 $135.68 $98.50 99292 N Critical care, add=l 30 min 99293 C Ped critical care, initial 99294 C Ped critical care, subseq 99295 C Neonatal critical care 99296 C Neonatal critical care 99298 C Neonatal critical care 99299 C Ic, lbw infant 1500-2500 gm 99301 B Nursing facility care 99302 B Nursing facility care 99303 B Nursing facility care 99311 B Nursing fac care, subseq 99312 B Nursing fac care, subseq 99313 B Nursing fac care, subseq 99315 B Nursing fac discharge day 99316 B Nursing fac discharge day 99321 B Rest home visit, new patient 99322 B Rest home visit, new patient 99323 B Rest home visit, new patient 99331 B Rest home visit, est pat 99332 B Rest home visit, est pat 99333 B Rest home visit, est pat 99341 B Home visit, new patient 99342 B Home visit, new patient 99343 B Home visit, new patient 99344 B Home visit, new patient 99345 B Home visit, new patient 99347 B Home visit, est patient 99348 B Home visit, est patient 99349 B Home visit, est patient 99350 B Home visit, est patient 99354 N Prolonged service, office 99355 N Prolonged service, office 99356 C Prolonged service, inpatient 99357 C Prolonged service, inpatient 99358 N Prolonged serv, w/o contact 99359 N Prolonged serv, w/o contact 99360 B Physician standby services 99361 E Physician/team conference 99362 E Physician/team conference 99371 B Physician phone consultation 99372 B Physician phone consultation 99373 B Physician phone consultation 99374 B Home health care supervision 99375 E Home health care supervision 99377 B Hospice care supervision 99378 E Hospice care supervision Start Printed Page 50824 99379 B Nursing fac care supervision 99380 B Nursing fac care supervision 99381 E Prev visit, new, infant 99382 E Prev visit, new, age 1-4 99383 E Prev visit, new, age 5-11 99384 E Prev visit, new, age 12-17 99385 E Prev visit, new, age 18-39 99386 E Prev visit, new, age 40-64 99387 E Prev visit, new, 65 & over 99391 E Prev visit, est, infant 99392 E Prev visit, est, age 1-4 99393 E Prev visit, est, age 5-11 99394 E Prev visit, est, age 12-17 99395 E Prev visit, est, age 18-39 99396 E Prev visit, est, age 40-64 99397 E Prev visit, est, 65 & over 99401 E Preventive counseling, indiv 99402 E Preventive counseling, indiv 99403 E Preventive counseling, indiv 99404 E Preventive counseling, indiv 99411 E Preventive counseling, group 99412 E Preventive counseling, group 99420 E Health risk assessment test 99429 E Unlisted preventive service 99431 V Initial care, normal newborn 0600 0.8688 $51.56 $10.31 99432 N Newborn care, not in hosp 99433 C Normal newborn care/hospital 99435 E Newborn discharge day hosp 99436 N Attendance, birth 99440 S Newborn resuscitation 0094 2.5363 $150.51 $47.62 $30.10 99450 E Life/disability evaluation 99455 B Disability examination 99456 B Disability examination 99499 B Unlisted e&m service 99500 E Home visit, prenatal 99501 E Home visit, postnatal 99502 E Home visit, nb care 99503 E Home visit, resp therapy 99504 E Home visit mech ventilator 99505 E Home visit, stoma care 99506 E Home visit, im injection 99507 E Home visit, cath maintain 99509 E Home visit day life activity 99510 E Home visit, sing/m/fam couns 99511 E Home visit, fecal/enema mgmt 99512 E Home visit for hemodialysis 99600 E Home visit nos 99601 E Home infusion/visit, 2 hrs 99602 E Home infusion, each addtl hr A0021 E Outside state ambulance serv A0080 E Noninterest escort in non er A0090 E Interest escort in non er A0100 E Nonemergency transport taxi A0110 E Nonemergency transport bus A0120 E Noner transport mini-bus A0130 E Noner transport wheelch van A0140 E Nonemergency transport air A0160 E Noner transport case worker A0170 E Noner transport parking fees A0180 E Noner transport lodgng recip A0190 E Noner transport meals recip A0200 E Noner transport lodgng escrt A0210 E Noner transport meals escort A0225 A Neonatal emergency transport A0380 A Basic life support mileage A0382 A Basic support routine suppls Start Printed Page 50825 A0384 A Bls defibrillation supplies A0390 A Advanced life support mileag A0392 A Als defibrillation supplies A0394 A Als IV drug therapy supplies A0396 A Als esophageal intub suppls A0398 A Als routine disposble suppls A0420 A Ambulance waiting 1/2 hr A0422 A Ambulance 02 life sustaining A0424 A Extra ambulance attendant A0425 A Ground mileage A0426 A Als 1 A0427 A ALS1-emergency A0428 A bls A0429 A BLS-emergency A0430 A Fixed wing air transport A0431 A Rotary wing air transport A0432 A PI volunteer ambulance co A0433 A als 2 A0434 A Specialty care transport A0435 A Fixed wing air mileage A0436 A Rotary wing air mileage A0800 B Amb trans 7pm-7am A0888 E Noncovered ambulance mileage A0999 A Unlisted ambulance service A4206 E 1 CC sterile syringe&needle A4207 E 2 CC sterile syringe&needle A4208 E 3 CC sterile syringe&needle A4209 E 5+ CC sterile syringe&needle A4210 E Nonneedle injection device A4211 B Supp for self-adm injections A4212 B Non coring needle or stylet A4213 E 20+ CC syringe only A4215 E Sterile needle A4216 A Sterile water/saline, 10 ml A4217 A Sterile water/saline, 500 ml A4220 N Infusion pump refill kit A4221 Y Maint drug infus cath per wk A4222 Y Drug infusion pump supplies A4223 E Infusion supplies w/o pump A4230 Y Infus insulin pump non needl A4231 Y Infusion insulin pump needle A4232 Y Syringe w/needle insulin 3cc A4244 E Alcohol or peroxide per pint A4245 E Alcohol wipes per box A4246 E Betadine/phisohex solution A4247 E Betadine/iodine swabs/wipes A4248 N Chlorhexidine antisept A4250 E Urine reagent strips/tablets A4253 Y Blood glucose/reagent strips A4254 Y Battery for glucose monitor A4255 Y Glucose monitor platforms A4256 Y Calibrator solution/chips A4257 Y Replace Lensshield Cartridge A4258 Y Lancet device each A4259 Y Lancets per box A4260 E Levonorgestrel implant A4261 E Cervical cap contraceptive A4262 N Temporary tear duct plug A4263 N Permanent tear duct plug A4265 Y Paraffin A4266 E Diaphragm A4267 E Male condom A4268 E Female condom A4269 E Spermicide A4270 A Disposable endoscope sheath A4280 A Brst prsths adhsv attchmnt Start Printed Page 50826 A4281 E Replacement breastpump tube A4282 E Replacement breastpump adpt A4283 E Replacement breastpump cap A4284 E Replcmnt breast pump shield A4285 E Replcmnt breast pump bottle A4286 E Replcmnt breastpump lok ring A4290 B Sacral nerve stim test lead A4300 N Cath impl vasc access portal A4301 N Implantable access syst perc A4305 A Drug delivery system >=50 ML A4306 A Drug delivery system <=5 ML A4310 A Insert tray w/o bag/cath A4311 A Catheter w/o bag 2-way latex A4312 A Cath w/o bag 2-way silicone A4313 A Catheter w/bag 3-way A4314 A Cath w/drainage 2-way latex A4315 A Cath w/drainage 2-way silcne A4316 A Cath w/drainage 3-way A4320 A Irrigation tray A4321 A Cath therapeutic irrig agent A4322 A Irrigation syringe A4326 A Male external catheter A4327 A Fem urinary collect dev cup A4328 A Fem urinary collect pouch A4330 A Stool collection pouch A4331 A Extension drainage tubing A4332 A Lubricant for cath insertion A4333 A Urinary cath anchor device A4334 A Urinary cath leg strap A4335 A Incontinence supply A4338 A Indwelling catheter latex A4340 A Indwelling catheter special A4344 A Cath indw foley 2 way silicn A4346 A Cath indw foley 3 way A4348 A Male ext cath extended wear A4349 A Disposable male external cat A4351 A Straight tip urine catheter A4352 A Coude tip urinary catheter A4353 A Intermittent urinary cath A4354 A Cath insertion tray w/bag A4355 A Bladder irrigation tubing A4356 A Ext ureth clmp or compr dvc A4357 A Bedside drainage bag A4358 A Urinary leg or abdomen bag A4359 A Urinary suspensory w/o leg b A4361 A Ostomy face plate A4362 A Solid skin barrier A4364 A Adhesive, liquid or equal A4365 A Adhesive remover wipes A4366 A Ostomy vent A4367 A Ostomy belt A4368 A Ostomy filter A4369 A Skin barrier liquid per oz A4371 A Skin barrier powder per oz A4372 A Skin barrier solid 4x4 equiv A4373 A Skin barrier with flange A4375 A Drainable plastic pch w fcpl A4376 A Drainable rubber pch w fcplt A4377 A Drainable plstic pch w/o fp A4378 A Drainable rubber pch w/o fp A4379 A Urinary plastic pouch w fcpl A4380 A Urinary rubber pouch w fcplt A4381 A Urinary plastic pouch w/o fp A4382 A Urinary hvy plstc pch w/o fp A4383 A Urinary rubber pouch w/o fp A4384 A Ostomy faceplt/silicone ring Start Printed Page 50827 A4385 A Ost skn barrier sld ext wear A4387 A Ost clsd pouch w att st barr A4388 A Drainable pch w ex wear barr A4389 A Drainable pch w st wear barr A4390 A Drainable pch ex wear convex A4391 A Urinary pouch w ex wear barr A4392 A Urinary pouch w st wear barr A4393 A Urine pch w ex wear bar conv A4394 A Ostomy pouch liq deodorant A4395 A Ostomy pouch solid deodorant A4396 A Peristomal hernia supprt blt A4397 A Irrigation supply sleeve A4398 A Ostomy irrigation bag A4399 A Ostomy irrig cone/cath w brs A4400 A Ostomy irrigation set A4402 A Lubricant per ounce A4404 A Ostomy ring each A4405 A Nonpectin based ostomy paste A4406 A Pectin based ostomy paste A4407 A Ext wear ost skn barr <=4sq÷ A4408 A Ext wear ost skn barr >4sq÷ A4409 A Ost skn barr w flng <=4 sq÷ A4410 A Ost skn barr w flng >4sq÷ A4413 A 2 pc drainable ost pouch A4414 A Ostomy sknbarr w flng <=4sq÷ A4415 A Ostomy skn barr w flng >4sq÷ A4416 A Ost pch clsd w barrier/filtr A4417 A Ost pch w bar/bltinconv/fltr A4418 A Ost pch clsd w/o bar w filtr A4419 A Ost pch for bar w flange/flt A4420 A Ost pch clsd for bar w lk fl A4421 E Ostomy supply misc A4422 A Ost pouch absorbent material A4423 A Ost pch for bar w lk fl/fltr A4424 A Ost pch drain w bar & filter A4425 A Ost pch drain for barrier fl A4426 A Ost pch drain 2 piece system A4427 A Ost pch drain/barr lk flng/f A4428 A Urine ost pouch w faucet/tap A4429 A Urine ost pch bar w lock fln A4430 A Ost pch urine w lock flng/ft A4431 A Urine ost pch bar w lock fln A4432 A Ost pch urine w lock flng/ft A4433 A Urine ost pch bar w lock fln A4434 A Ost pch urine w lock flng/ft A4450 A Non-waterproof tape A4452 A Waterproof tape A4455 A Adhesive remover per ounce A4458 E Reusable enema bag A4462 A Abdmnl drssng holder/binder A4465 A Non-elastic extremity binder A4470 A Gravlee jet washer A4480 A Vabra aspirator A4481 A Tracheostoma filter A4483 A Moisture exchanger A4490 E Above knee surgical stocking A4495 E Thigh length surg stocking A4500 E Below knee surgical stocking A4510 E Full length surg stocking A4520 E Incontinence garment anytype A4550 B Surgical trays A4554 E Disposable underpads A4555 E Disposable underpad small A4556 Y Electrodes, pair A4557 Y Lead wires, pair A4558 Y Conductive paste or gel Start Printed Page 50828 A4561 N Pessary rubber, any type A4562 N Pessary, non rubber,any type A4565 A Slings A4570 E Splint A4575 E Hyperbaric o2 chamber disps A4580 E Cast supplies (plaster) A4590 E Special casting material A4595 Y TENS suppl 2 lead per month A4605 Y Trach suction cath close sys A4606 A Oxygen probe used w oximeter A4608 Y Transtracheal oxygen cath A4611 Y Heavy duty battery A4612 Y Battery cables A4613 Y Battery charger A4614 A Hand-held PEFR meter A4615 Y Cannula nasal A4616 Y Tubing (oxygen) per foot A4617 Y Mouth piece A4618 Y Breathing circuits A4619 Y Face tent A4620 Y Variable concentration mask A4623 A Tracheostomy inner cannula A4624 Y Tracheal suction tube A4625 A Trach care kit for new trach A4626 A Tracheostomy cleaning brush A4627 E Spacer bag/reservoir A4628 Y Oropharyngeal suction cath A4629 A Tracheostomy care kit A4630 Y Repl bat t.e.n.s. own by pt A4632 Y Infus pump rplcemnt battery A4633 Y Uvl replacement bulb A4634 A Replacement bulb th lightbox A4635 Y Underarm crutch pad A4636 Y Handgrip for cane etc A4637 Y Repl tip cane/crutch/walker A4638 Y Repl batt pulse gen sys A4639 Y Infrared ht sys replcmnt pad A4640 Y Alternating pressure pad A4641 N Diagnostic imaging agent A4642 H Satumomab pendetide per dose 0704 A4643 B High dose contrast MRI A4644 B Contrast 100-199 MGs iodine A4645 B Contrast 200-299 MGs iodine A4646 B Contrast 300-399 MGs iodine A4647 B Supp- paramagnetic contr mat A4649 A Surgical supplies A4651 A Calibrated microcap tube A4652 A Microcapillary tube sealant A4653 A PD catheter anchor belt A4656 A Dialysis needle A4657 A Dialysis syringe w/wo needle A4660 A Sphyg/bp app w cuff and stet A4663 A Dialysis blood pressure cuff A4670 E Automatic bp monitor, dial A4671 B Disposable cycler set A4672 B Drainage ext line, dialysis A4673 B Ext line w easy lock connect A4674 B Chem/antisept solution, 8oz A4680 A Activated carbon filter, ea A4690 A Dialyzer, each A4706 A Bicarbonate conc sol per gal A4707 A Bicarbonate conc pow per pac A4708 A Acetate conc sol per gallon A4709 A Acid conc sol per gallon A4714 A Treated water per gallon A4719 A ÷Y set÷ tubing Start Printed Page 50829 A4720 A Dialysat sol fld vol > 249cc A4721 A Dialysat sol fld vol > 999cc A4722 A Dialys sol fld vol > 1999cc A4723 A Dialys sol fld vol > 2999cc A4724 A Dialys sol fld vol > 3999cc A4725 A Dialys sol fld vol > 4999cc A4726 A Dialys sol fld vol > 5999cc A4728 B Dialysate solution, non-dex A4730 A Fistula cannulation set, ea A4736 A Topical anesthetic, per gram A4737 A Inj anesthetic per 10 ml A4740 A Shunt accessory A4750 A Art or venous blood tubing A4755 A Comb art/venous blood tubing A4760 A Dialysate sol test kit, each A4765 A Dialysate conc pow per pack A4766 A Dialysate conc sol add 10 ml A4770 A Blood collection tube/vacuum A4771 A Serum clotting time tube A4772 A Blood glucose test strips A4773 A Occult blood test strips A4774 A Ammonia test strips A4802 A Protamine sulfate per 50 mg A4860 A Disposable catheter tips A4870 A Plumb/elec wk hm hemo equip A4890 A Repair/maint cont hemo equip A4911 A Drain bag/bottle A4913 A Misc dialysis supplies noc A4918 A Venous pressure clamp A4927 A Non-sterile gloves A4928 A Surgical mask A4929 A Tourniquet for dialysis, ea A4930 A Sterile, gloves per pair A4931 A Reusable oral thermometer A4932 E Reusable rectal thermometer A5051 A Pouch clsd w barr attached A5052 A Clsd ostomy pouch w/o barr A5053 A Clsd ostomy pouch faceplate A5054 A Clsd ostomy pouch w/flange A5055 A Stoma cap A5061 A Pouch drainable w barrier at A5062 A Drnble ostomy pouch w/o barr A5063 A Drain ostomy pouch w/flange A5071 A Urinary pouch w/barrier A5072 A Urinary pouch w/o barrier A5073 A Urinary pouch on barr w/flng A5081 A Continent stoma plug A5082 A Continent stoma catheter A5093 A Ostomy accessory convex inse A5102 A Bedside drain btl w/wo tube A5105 A Urinary suspensory A5112 A Urinary leg bag A5113 A Latex leg strap A5114 A Foam/fabric leg strap A5119 A Skin barrier wipes box pr 50 A5121 A Solid skin barrier 6x6 A5122 A Solid skin barrier 8x8 A5126 A Disk/foam pad +or- adhesive A5131 A Appliance cleaner A5200 A Percutaneous catheter anchor A5500 Y Diab shoe for density insert A5501 Y Diabetic custom molded shoe A5503 Y Diabetic shoe w/roller/rockr A5504 Y Diabetic shoe with wedge A5505 Y Diab shoe w/metatarsal bar A5506 Y Diabetic shoe w/off set heel Start Printed Page 50830 A5507 Y Modification diabetic shoe A5508 Y Diabetic deluxe shoe A5509 E Direct heat form shoe insert A5510 E Compression form shoe insert A5511 E Custom fab molded shoe inser A6000 E Wound warming wound cover A6010 A Collagen based wound filler A6011 A Collagen gel/paste wound fil A6021 A Collagen dressing <=16 sq in A6022 A Collagen drsg>6<=48 sq in A6023 A Collagen dressing >48 sq in A6024 A Collagen dsg wound filler A6025 E Silicone gel sheet, each A6154 A Wound pouch each A6196 A Alginate dressing <=16 sq in A6197 A Alginate drsg >16 <=48 sq in A6198 A alginate dressing > 48 sq in A6199 A Alginate drsg wound filler A6200 A Compos drsg <=16 no border A6201 A Compos drsg >16<=48 no bdr A6202 A Compos drsg >48 no border A6203 A Composite drsg <= 16 sq in A6204 A Composite drsg >16<=48 sq in A6205 A Composite drsg > 48 sq in A6206 A Contact layer <= 16 sq in A6207 A Contact layer >16<= 48 sq in A6208 A Contact layer > 48 sq in A6209 A Foam drsg <=16 sq in w/o bdr A6210 A Foam drg >16<=48 sq in w/o b A6211 A Foam drg > 48 sq in w/o brdr A6212 A Foam drg <=16 sq in w/border A6213 A Foam drg >16<=48 sq in w/bdr A6214 A Foam drg > 48 sq in w/border A6215 A Foam dressing wound filler A6216 A Non-sterile gauze<=16 sq in A6217 A Non-sterile gauze>16<=48 sq A6218 A Non-sterile gauze > 48 sq in A6219 A Gauze <= 16 sq in w/border A6220 A Gauze >16 <=48 sq in w/bordr A6221 A Gauze > 48 sq in w/border A6222 A Gauze <=16 in no w/sal w/o b A6223 A Gauze >16<=48 no w/sal w/o b A6224 A Gauze > 48 in no w/sal w/o b A6228 A Gauze <= 16 sq in water/sal A6229 A Gauze >16<=48 sq in watr/sal A6230 A Gauze > 48 sq in water/salne A6231 A Hydrogel dsg<=16 sq in A6232 A Hydrogel dsg>16<=48 sq in A6233 A Hydrogel dressing >48 sq in A6234 A Hydrocolld drg <=16 w/o bdr A6235 A Hydrocolld drg >16<=48 w/o b A6236 A Hydrocolld drg > 48 in w/o b A6237 A Hydrocolld drg <=16 in w/bdr A6238 A Hydrocolld drg >16<=48 w/bdr A6239 A Hydrocolld drg > 48 in w/bdr A6240 A Hydrocolld drg filler paste A6241 A Hydrocolloid drg filler dry A6242 A Hydrogel drg <=16 in w/o bdr A6243 A Hydrogel drg >16<=48 w/o bdr A6244 A Hydrogel drg >48 in w/o bdr A6245 A Hydrogel drg <= 16 in w/bdr A6246 A Hydrogel drg >16<=48 in w/b A6247 A Hydrogel drg > 48 sq in w/b A6248 A Hydrogel drsg gel filler A6250 A Skin seal protect moisturizr A6251 A Absorpt drg <=16 sq in w/o b Start Printed Page 50831 A6252 A Absorpt drg >16 <=48 w/o bdr A6253 A Absorpt drg > 48 sq in w/o b A6254 A Absorpt drg <=16 sq in w/bdr A6255 A Absorpt drg >16<=48 in w/bdr A6256 A Absorpt drg > 48 sq in w/bdr A6257 A Transparent film <= 16 sq in A6258 A Transparent film >16<=48 in A6259 A Transparent film > 48 sq in A6260 A Wound cleanser any type/size A6261 A Wound filler gel/paste /oz A6262 A Wound filler dry form / gram A6266 A Impreg gauze no h20/sal/yard A6402 A Sterile gauze <= 16 sq in A6403 A Sterile gauze>16 <= 48 sq in A6404 A Sterile gauze > 48 sq in A6407 A Packing strips, non-impreg A6410 A Sterile eye pad A6411 A Non-sterile eye pad A6412 E Occlusive eye patch A6441 A Pad band w>=3÷ <5÷/yd A6442 A Conform band n/s w<3÷/yd A6443 A Conform band n/s w>=3÷<5÷/yd A6444 A Conform band n/s w>=5÷/yd A6445 A Conform band s w <3÷/yd A6446 A Conform band s w>=3÷ <5÷/yd A6447 A Conform band s w >=5÷/yd A6448 A Lt compres band <3÷/yd A6449 A Lt compres band >=3÷ <5÷/yd A6450 A Lt compres band >=5÷/yd A6451 A Mod compres band w>=3÷<5÷/yd A6452 A High compres band w>=3÷<5÷yd A6453 A Self-adher band w <3÷/yd A6454 A Self-adher band w>=3÷ <5÷/yd A6455 A Self-adher band >=5÷/yd A6456 A Zinc paste band w >=3÷<5÷/yd A6501 A Compres burngarment bodysuit A6502 A Compres burngarment chinstrp A6503 A Compres burngarment facehood A6504 A Cmprsburngarment glove-wrist A6505 A Cmprsburngarment glove-elbow A6506 A Cmprsburngrmnt glove-axilla A6507 A Cmprs burngarment foot-knee A6508 A Cmprs burngarment foot-thigh A6509 A Compres burn garment jacket A6510 A Compres burn garment leotard A6511 A Compres burn garment panty A6512 A Compres burn garment, noc A6550 Y Neg pres wound ther drsg set A6551 Y Neg press wound ther canistr A7000 Y Disposable canister for pump A7001 Y Nondisposable pump canister A7002 Y Tubing used w suction pump A7003 Y Nebulizer administration set A7004 Y Disposable nebulizer sml vol A7005 Y Nondisposable nebulizer set A7006 Y Filtered nebulizer admin set A7007 Y Lg vol nebulizer disposable A7008 Y Disposable nebulizer prefill A7009 Y Nebulizer reservoir bottle A7010 Y Disposable corrugated tubing A7011 Y Nondispos corrugated tubing A7012 Y Nebulizer water collec devic A7013 Y Disposable compressor filter A7014 Y Compressor nondispos filter A7015 Y Aerosol mask used w nebulize A7016 Y Nebulizer dome & mouthpiece Start Printed Page 50832 A7017 Y Nebulizer not used w oxygen A7018 Y Water distilled w/nebulizer A7025 Y Replace chest compress vest A7026 Y Replace chst cmprss sys hose A7030 Y CPAP full face mask A7031 Y Replacement facemask interfa A7032 Y Replacement nasal cushion A7033 Y Replacement nasal pillows A7034 Y Nasal application device A7035 Y Pos airway press headgear A7036 Y Pos airway press chinstrap A7037 Y Pos airway pressure tubing A7038 Y Pos airway pressure filter A7039 Y Filter, non disposable w pap A7040 A One way chest drain valve A7041 A Water seal drain container A7042 A Implanted pleural catheter A7043 A Vacuum drainagebottle/tubing A7044 Y PAP oral interface A7045 Y Repl exhalation port for PAP A7046 Y Repl water chamber, PAP dev A7501 A Tracheostoma valve w diaphra A7502 A Replacement diaphragm/fplate A7503 A HMES filter holder or cap A7504 A Tracheostoma HMES filter A7505 A HMES or trach valve housing A7506 A HMES/trachvalve adhesivedisk A7507 A Integrated filter & holder A7508 A Housing & Integrated Adhesiv A7509 A Heat & moisture exchange sys A7520 A Trach/laryn tube non-cuffed A7521 A Trach/laryn tube cuffed A7522 A Trach/laryn tube stainless A7523 A Tracheostomy shower protect A7524 A Tracheostoma stent/stud/bttn A7525 A Tracheostomy mask A7526 A Tracheostomy tube collar A7527 A Trach/laryn tube plug/stop A9150 B Misc/exper non-prescript dru A9152 E Single vitamin nos A9153 E Multi-vitamin nos A9180 E Lice treatment, topical A9270 E Non-covered item or service A9280 E Alert device, noc A9300 E Exercise equipment A9500 H Technetium TC 99m sestamibi 1600 A9502 H Technetium TC99M tetrofosmin 0705 A9503 N Technetium TC 99m medronate A9504 N Technetium tc 99m apcitide A9505 H Thallous chloride TL 201/mci 1603 A9507 H Indium/111 capromab pendetid 1604 A9508 H Iobenguane sulfate I-131, pe 1045 A9510 H Technetium TC99m Disofenin 9146 A9511 H Technetium TC 99m depreotide 9147 A9512 N Technetium tc99m pertechnetate A9513 N Technetium tc-99m mebrofenin A9514 N Technetium tc99m pyrophosphate A9515 N Technetium tc-99m pentetate A9516 H I-123 sodium iodide capsule 9148 A9517 H Th I131 so iodide cap millic 1064 A9519 N Technetium tc-99m macroag albu A9520 N Technetium tc-99m sulfur clld A9521 H Technetium tc-99m exametazine 1096 A9522 B Indium 111i britumomabtiuxetan A9523 B Yttrium 90i britumomabtiuxetan A9524 H Iodinated I-131 serumalbumin 9100 Start Printed Page 50833 A9525 E Low/iso-osmolar contrast mat A9526 H Ammonia N-13, per dose 0737 A9528 H Dx I131 so iodide cap millic 1088 A9529 H Dx I131 so iodide sol millic 1065 A9530 H Th I131 so iodide sol millic 1150 A9531 H Dx I131 so iodide microcurie 9149 A9532 H I-125 serum albumin micro 9150 A9533 B I-131 tositumomab diagnostic A9534 B I-131 tositumomab therapeut A9600 H Strontium-89 chloride 0701 A9605 H Samarium sm153 lexidronamm 0702 A9699 N Noc therapeutic radiopharm A9700 B Echocardiography Contrast A9900 A Supply/accessory/service A9901 A Delivery/set up/dispensing A9999 Y DME supply or accessory, nos B4034 A Enter feed supkit syr by day B4035 A Enteral feed supp pump per d B4036 A Enteral feed sup kit grav by B4081 A Enteral ng tubing w/ stylet B4082 A Enteral ng tubing w/o stylet B4083 A Enteral stomach tube levine B4086 A Gastrostomy/jejunostomy tube B4100 E Food thickener oral B4102 Y EF adult fluids and electro B4103 Y EF ped fluid and electrolyte B4104 E Additive for enteral formula B4149 Y EF blenderized foods B4150 A Enteral formulae category i B4152 A Enteral formulae category ii B4153 A Enteral formulae category III B4154 A Enteral formulae category IV B4155 A Enteral formulae category v B4157 Y EF special metabolic inherit B4158 Y EF ped complete intact nut B4159 Y EF ped complete soy based B4160 Y EF ped calorie dense > / =0.7kc B4161 Y EF ped hydrolyzed/amino acid B4162 Y EF ped specmetabolic inherit B4164 A Parenteral 50% dextrose solu B4168 A Parenteral sol amino acid 3 B4172 A Parenteral sol amino acid 5 B4176 A Parenteral sol amino acid 7- B4178 A Parenteral sol amino acid > B4180 A Parenteral sol carb > 50% B4184 A Parenteral sol lipids 10% B4186 A Parenteral sol lipids 20% B4189 A Parenteral sol amino acid & B4193 A Parenteral sol 52-73 gm prot B4197 A Parenteral sol 74-100 gm pro B4199 A Parenteral sol > 100gm prote B4216 A Parenteral nutrition additiv B4220 A Parenteral supply kit premix B4222 A Parenteral supply kit homemi B4224 A Parenteral administration ki B5000 A Parenteral sol renal-amirosy B5100 A Parenteral sol hepatic-fream B5200 A Parenteral sol stres-brnch c B9000 A Enter infusion pump w/o alrm B9002 A Enteral infusion pump w/ ala B9004 A Parenteral infus pump portab B9006 A Parenteral infus pump statio B9998 A Enteral supp not otherwise c B9999 A Parenteral supp not othrws c C1079 N CO 57/58 per 0.5 uCi C1080 H I-131 tositumomab, dx 1080 Start Printed Page 50834 C1081 H I-131 tositumomab, tx 1081 C1082 H In-111 ibritumomab tiuxetan 9118 C1083 H Yttrium 90 ibritumomab tiuxe 9117 C1091 H IN111 oxyquinoline,per 0.5 mCi 1091 C1092 H IN 111 pentetate per 0.5 mCi 1092 C1093 H TC99M fanolesomab 1093 C1122 H Tc 99M ARCITUMOMAB PER VIAL 9151 C1178 K BUSULFAN IV, 6 Mg 1178 0.2851 $16.92 $3.38 C1200 N TC 99M Sodium Glucoheptonat C1201 H TC 99M SUCCIMER, PER Vial 1201 C1300 S HYPERBARIC Oxygen 0659 1.5473 $91.82 $18.36 C1305 K Apligraf, 44cm2 1305 12.9222 $766.84 $153.37 C1713 N Anchor/screw bn/bn,tis/bn C1714 N Cath, trans atherectomy, dir C1715 N Brachytherapy needle C1716 H Brachytx source, Gold 198 1716 C1717 H Brachytx source, HDR Ir-192 1717 C1718 H Brachytx source, Iodine 125 1718 C1719 H Brachytx sour,Non-HDR Ir-192 1719 C1720 H Brachytx sour, Palladium 103 1720 C1721 N AICD, dual chamber C1722 N AICD, single chamber C1724 N Cath, trans atherec,rotation C1725 N Cath, translumin non-laser C1726 N Cath, bal dil, non-vascular C1727 N Cath, bal tis dis, non-vas C1728 N Cath, brachytx seed adm C1729 N Cath, drainage C1730 N Cath, EP, 19 or few elect C1731 N Cath, EP, 20 or more elec C1732 N Cath, EP, diag/abl, 3D/vect C1733 N Cath, EP, othr than cool-tip C1750 N Cath, hemodialysis,long-term C1751 N Cath, inf, per/cent/midline C1752 N Cath,hemodialysis,short-term C1753 N Cath, intravas ultrasound C1754 N Catheter, intradiscal C1755 N Catheter, intraspinal C1756 N Cath, pacing, transesoph C1757 N Cath, thrombectomy/embolect C1758 N Catheter, ureteral C1759 N Cath, intra echocardiography C1760 N Closure dev, vasc C1762 N Conn tiss, human(inc fascia) C1763 N Conn tiss, non-human C1764 N Event recorder, cardiac C1765 N Adhesion barrier C1766 N Intro/sheath,strble,non-peel C1767 N Generator, neurostim, imp C1768 N Graft, vascular C1769 N Guide wire C1770 N Imaging coil, MR, insertable C1771 N Rep dev, urinary, w/sling C1772 N Infusion pump, programmable C1773 N Ret dev, insertable C1775 H FDG, per dose (4-40 mCi/ml) 1775 C1776 N Joint device (implantable) C1777 N Lead, AICD, endo single coil C1778 N Lead, neurostimulator C1779 N Lead, pmkr, transvenous VDD C1780 N Lens, intraocular (new tech) C1781 N Mesh (implantable) C1782 N Morcellator C1783 N Ocular imp, aqueous drain de C1784 N Ocular dev, intraop, det ret C1785 N Pmkr, dual, rate-resp Start Printed Page 50835 C1786 N Pmkr, single, rate-resp C1787 N Patient progr, neurostim C1788 N Port, indwelling, imp C1789 N Prosthesis, breast, imp C1813 N Prosthesis, penile, inflatab C1814 N Retinal tamp, silicone oil C1815 N Pros, urinary sph, imp C1816 N Receiver/transmitter, neuro C1817 N Septal defect imp sys C1818 N Integrated keratoprosthesis C1819 N Tissue local excision C1874 N Stent, coated/cov w/del sys C1875 N Stent, coated/cov w/o del sy C1876 N Stent, non-coa/non-cov w/del C1877 N Stent, non-coat/cov w/o del C1878 N Matrl for vocal cord C1879 N Tissue marker, implantable C1880 N Vena cava filter C1881 N Dialysis access system C1882 N AICD, other than sing/dual C1883 N Adapt/ext, pacing/neuro lead C1884 N Embolization Protect syst C1885 N Cath, translumin angio laser C1887 N Catheter, guiding C1888 N Endovas non-cardiac abl cath C1891 N Infusion pump,non-prog, perm C1892 N Intro/sheath,fixed,peel-away C1893 N Intro/sheath, fixed,non-peel C1894 N Intro/sheath, non-laser C1895 N Lead, AICD, endo dual coil C1896 N Lead, AICD, non sing/dual C1897 N Lead, neurostim test kit C1898 N Lead, pmkr, other than trans C1899 N Lead, pmkr/AICD combination C1900 N Lead coronary venous C2614 N Probe, perc lumb disc C2615 N Sealant, pulmonary, liquid C2616 H Brachytx source, Yttrium-90 2616 C2617 N Stent, non-cor, tem w/o del C2618 N Probe, cryoablation C2619 N Pmkr, dual, non rate-resp C2620 N Pmkr, single, non rate-resp C2621 N Pmkr, other than sing/dual C2622 N Prosthesis, penile, non-inf C2625 N Stent, non-cor, tem w/del sy C2626 N Infusion pump, non-prog,temp C2627 N Cath, suprapubic/cystoscopic C2628 N Catheter, occlusion C2629 N Intro/sheath, laser C2630 N Cath, EP, cool-tip C2631 N Rep dev, urinary, w/o sling C2632 H Brachytx sol, I-125, per mCi 2632 C2633 H Brachytx source, Cesium-131 2633 C2634 H Brachytx source, HA, I-125 2634 C2635 H Brachytx source, HA, P-103 2635 C2636 H Brachytx linear source, P-10 2636 C8900* S MRA w/cont, abd 0284 6.4201 $380.99 $152.39 $76.20 C8901* S MRA w/o cont, abd 0336 6.0742 $360.46 $144.18 $72.09 C8902* S MRA w/o fol w/cont, abd 0337 8.7945 $521.89 $208.75 $104.38 C8903* S MRI w/cont, breast, uni 0284 6.4201 $380.99 $152.39 $76.20 C8904* S MRI w/o cont, breast, uni 0336 6.0742 $360.46 $144.18 $72.09 C8905* S MRI w/o fol w/cont, brst, un 0337 8.7945 $521.89 $208.75 $104.38 C8906* S MRI w/cont, breast, bi 0284 6.4201 $380.99 $152.39 $76.20 C8907* S MRI w/o cont, breast, bi 0336 6.0742 $360.46 $144.18 $72.09 C8908* S MRI w/o fol w/cont, breast, 0337 8.7945 $521.89 $208.75 $104.38 C8909* S MRA w/cont, chest 0284 6.4201 $380.99 $152.39 $76.20 Start Printed Page 50836 C8910* S MRA w/o cont, chest 0336 6.0742 $360.46 $144.18 $72.09 C8911* S MRA w/o fol w/cont, chest 0337 8.7945 $521.89 $208.75 $104.38 C8912* S MRA w/cont, lwr ext 0284 6.4201 $380.99 $152.39 $76.20 C8913* S MRA w/o cont, lwr ext 0336 6.0742 $360.46 $144.18 $72.09 C8914* S MRA w/o fol w/cont, lwr ext 0337 8.7945 $521.89 $208.75 $104.38 C8918* S MRA w/cont, pelvis 0284 6.4201 $380.99 $152.39 $76.20 C8919* S MRA w/o cont, pelvis 0336 6.0742 $360.46 $144.18 $72.09 C8920* S MRA w/o fol w/cont, pelvis 0337 8.7945 $521.89 $208.75 $104.38 C9000 H Na chromateCr51, per 0.25mCi 9130 C9003 K Palivizumab, per 50 mg 9003 4.1491 $246.22 $49.24 C9007 K Baclofen Intrathecal kit-1am 9152 0.8562 $50.81 $10.16 C9008 K Baclofen Refill Kit-500mcg 9008 0.2447 $14.52 $2.90 C9009 K Baclofen Refill Kit-2000mcg 9009 0.7209 $42.78 $8.56 C9013 N Co 57 cobaltous chloride C9102 H 51 Na Chromate, 50mCi 9132 C9103 H Na Iothalamate I-125, 10 uCi 9153 C9105 K Hep B imm glob, per 1 ml 9105 1.8813 $111.64 $22.33 C9112 D Perflutren lipid micro, 2ml C9113 N Inj pantoprazole sodium, via C9121 K Injection, argatroban 9121 0.1897 $11.26 $2.25 C9123 K Transcyte, 247cm2 9123 $719.41 $143.88 C9127 K Paclitaxel protein pr 9127 $8.59 $1.72 C9128 K Inj pegaptanib sodium 9128 $1,074.27 $214.85 C9200 K Orcel, 36 cm2 9200 2.6893 $159.59 $31.92 C9201 K Dermagraft, 37.5cm2 9201 6.2066 $368.32 $73.66 C9202 D Octafluoropropane C9203 D Perflexane lipid micro C9205 K Oxaliplatin 9205 $84.06 $16.81 C9206 K Integra, per cm2 9206 $9.23 $1.85 C9211 K Inj, alefacept, IV 9211 $571.01 $114.20 C9212 K Inj, alefacept, IM 9212 $402.00 $80.40 C9218 K Injection, Azacitidine 9218 $4.03 $0.81 C9220 G Sodium hyaluronate 9220 $203.84 $40.77 C9221 G Graftjacket Reg Matrix 9221 $1,234.36 $246.87 C9222 G Graftjacket SftTis 9222 $890.74 $178.15 C9223 D Inj adenosine, tx dx C9399 A Unclass drugs/biologicals C9400 D Thallous chloride, brand C9401 D Strontium-89 chloride, brand C9402 D Th I131 so iodide cap, brand C9403 D Dx I131 so iodide cap, brand C9404 D Dx I131 so iodide sol, brand C9405 D Th I131 so iodide sol, brand C9410 D Dexrazoxane HCl inj, brand C9411 D Pamidronate disodium, brand C9413 D Na hyaluronate bran C9414 D Etoposide oral, brand C9415 D Doxorubic hcl chemo, brand C9417 D Bleomycin sulfate inj, brand C9418 D Cisplatin inj, brand C9419 D Inj cladribine, brand C9420 D Cyclophosphamide inj, brand C9421 D Cyclophosphamide lyo, brand C9422 D Cytarabine hcl inj, brand C9423 D Dacarbazine inj, brand C9424 D Daunorubicin, brand C9425 D Etoposide inj, brand C9426 D Floxuridine inj, brand C9427 D Ifosfomide inj, brand C9428 D Mesna injection, brand C9429 D Idarubicin hcl inj, brand C9430 D Leuprolide acetate bran C9431 D Paclitaxel inj, brand C9432 D Mitomycin inj, brand C9433 D Thiotepa inj, brand C9435 D Gonadorelin hydroch, brand Start Printed Page 50837 C9436 D Azathioprine parenteral,brnd C9437 D Carmus bischl nitro inj C9438 D Cyclosporine oral, brand C9439 D Diethylstilbestrol injection C9440 D Vinorelbine tar,brand C9704 T Inj inert subs upper GI 1556 $1,750.00 $350.00 C9713 T Non-contact laser vap prosta 0429 42.3147 $2,511.08 $502.22 C9716 S RF Energy to Anus 1519 $1,750.00 $350.00 C9718 T Kyphoplasty, first vertebra 0051 36.5271 $2,167.63 $433.53 C9719 T Kyphoplasty, each addl 0051 36.5271 $2,167.63 $433.53 C9720 T HE ESW tx, tennis elbow 1547 $850.00 $170.00 C9721 T HE ESW tx, plantar fasciitis 1547 $850.00 $170.00 C9722 S KV imaging w/IR tracking 1502 $75.00 $15.00 C9723 S Dyn IR Perf Img 1502 $75.00 $15.00 C9724 T EPS gast cardia plic 0422 22.9647 $1,362.79 $448.81 $272.56 D0120 E Periodic oral evaluation D0140 E Limit oral eval problm focus D0150 S Comprehensve oral evaluation 0330 7.1756 $425.82 $85.16 D0160 E Extensv oral eval prob focus D0170 E Re-eval,est pt,problem focus D0180 E Comp periodontal evaluation D0210 E Intraor complete film series D0220 E Intraoral periapical first f D0230 E Intraoral periapical ea add D0240 S Intraoral occlusal film 0330 7.1756 $425.82 $85.16 D0250 S Extraoral first film 0330 7.1756 $425.82 $85.16 D0260 S Extraoral ea additional film 0330 7.1756 $425.82 $85.16 D0270 S Dental bitewing single film 0330 7.1756 $425.82 $85.16 D0272 S Dental bitewings two films 0330 7.1756 $425.82 $85.16 D0274 S Dental bitewings four films 0330 7.1756 $425.82 $85.16 D0277 S Vert bitewings-sev to eight 0330 7.1756 $425.82 $85.16 D0290 E Dental film skull/facial bon D0310 E Dental saliography D0320 E Dental tmj arthrogram incl i D0321 E Dental other tmj films D0322 E Dental tomographic survey D0330 E Dental panoramic film D0340 E Dental cephalometric film D0350 E Oral/facial images D0415 E Bacteriologic study D0416 B Viral culture D0421 B Gen tst suscept oral disease D0425 E Caries susceptibility test D0431 B Diag tst detect mucos abnorm D0460 S Pulp vitality test 0330 7.1756 $425.82 $85.16 D0470 E Diagnostic casts D0472 B Gross exam, prep & report D0473 B Micro exam, prep & report D0474 B Micro w exam of surg margins D0475 B Decalcification procedure D0476 B Spec stains for microorganis D0477 B Spec stains not for microorg D0478 B Immunohistochemical stains D0479 B Tissue in-situ hybridization D0480 B Cytopath smear prep & report D0481 B Electron microscopy diagnost D0482 B Direct immunofluorescence D0483 B Indirect immunofluorescence D0484 B Consult slides prep elsewher D0485 B Consult inc prep of slides D0502 B Other oral pathology procedu D0999 B Unspecified diagnostic proce D1110 E Dental prophylaxis adult D1120 E Dental prophylaxis child D1201 E Topical fluor w prophy child D1203 E Topical fluor w/o prophy chi Start Printed Page 50838 D1204 E Topical fluor w/o prophy adu D1205 E Topical fluoride w/ prophy a D1310 E Nutri counsel-control caries D1320 E Tobacco counseling D1330 E Oral hygiene instruction D1351 E Dental sealant per tooth D1510 S Space maintainer fxd unilat 0330 7.1756 $425.82 $85.16 D1515 S Fixed bilat space maintainer 0330 7.1756 $425.82 $85.16 D1520 S Remove unilat space maintain 0330 7.1756 $425.82 $85.16 D1525 S Remove bilat space maintain 0330 7.1756 $425.82 $85.16 D1550 S Recement space maintainer 0330 7.1756 $425.82 $85.16 D2140 E Amalgam one surface permanen D2150 E Amalgam two surfaces permane D2160 E Amalgam three surfaces perma D2161 E Amalgam 4 or > surfaces perm D2330 E Resin one surface-anterior D2331 E Resin two surfaces-anterior D2332 E Resin three surfaces-anterio D2335 E Resin 4/> surf or w incis an D2390 E Ant resin-based cmpst crown D2391 E Post 1 srfc resinbased cmpst D2392 E Post 2 srfc resinbased cmpst D2393 E Post 3 srfc resinbased cmpst D2394 E Post >=4srfc resinbase cmpst D2410 E Dental gold foil one surface D2420 E Dental gold foil two surface D2430 E Dental gold foil three surfa D2510 E Dental inlay metalic 1 surf D2520 E Dental inlay metallic 2 surf D2530 E Dental inlay metl 3/more sur D2542 E Dental onlay metallic 2 surf D2543 E Dental onlay metallic 3 surf D2544 E Dental onlay metl 4/more sur D2610 E Inlay porcelain/ceramic 1 su D2620 E Inlay porcelain/ceramic 2 su D2630 E Dental onlay porc 3/more sur D2642 E Dental onlay porcelin 2 surf D2643 E Dental onlay porcelin 3 surf D2644 E Dental onlay porc 4/more sur D2650 E Inlay composite/resin one su D2651 E Inlay composite/resin two su D2652 E Dental inlay resin 3/mre sur D2662 E Dental onlay resin 2 surface D2663 E Dental onlay resin 3 surface D2664 E Dental onlay resin 4/mre sur D2710 E Crown resin laboratory D2712 E Crown 3/4 resin-based compos D2720 E Crown resin w/ high noble me D2721 E Crown resin w/ base metal D2722 E Crown resin w/ noble metal D2740 E Crown porcelain/ceramic subs D2750 E Crown porcelain w/ h noble m D2751 E Crown porcelain fused base m D2752 E Crown porcelain w/ noble met D2780 E Crown 3/4 cast hi noble met D2781 E Crown 3/4 cast base metal D2782 E Crown 3/4 cast noble metal D2783 E Crown 3/4 porcelain/ceramic D2790 E Crown full cast high noble m D2791 E Crown full cast base metal D2792 E Crown full cast noble metal D2794 E Crown-titanium D2799 E Provisional crown D2910 E Dental recement inlay D2915 E Recement cast or prefab post D2920 E Dental recement crown Start Printed Page 50839 D2930 E Prefab stnlss steel crwn pri D2931 E Prefab stnlss steel crown pe D2932 E Prefabricated resin crown D2933 E Prefab stainless steel crown D2934 E Prefab steel crown primary D2940 E Dental sedative filling D2950 E Core build-up incl any pins D2951 E Tooth pin retention D2952 E Post and core cast + crown D2953 E Each addtnl cast post D2954 E Prefab post/core + crown D2955 E Post removal D2957 E Each addtnl prefab post D2960 E Laminate labial veneer D2961 E Lab labial veneer resin D2962 E Lab labial veneer porcelain D2971 E Add proc construct new crown D2975 E Coping D2980 E Crown repair D2999 S Dental unspec restorative pr 0330 7.1756 $425.82 $85.16 D3110 E Pulp cap direct D3120 E Pulp cap indirect D3220 E Therapeutic pulpotomy D3221 E Gross pulpal debridement D3230 E Pulpal therapy anterior prim D3240 E Pulpal therapy posterior pri D3310 E Anterior D3320 E Root canal therapy 2 canals D3330 E Root canal therapy 3 canals D3331 E Non-surg tx root canal obs D3332 E Incomplete endodontic tx D3333 E Internal root repair D3346 E Retreat root canal anterior D3347 E Retreat root canal bicuspid D3348 E Retreat root canal molar D3351 E Apexification/recalc initial D3352 E Apexification/recalc interim D3353 E Apexification/recalc final D3410 E Apicoect/perirad surg anter D3421 E Root surgery bicuspid D3425 E Root surgery molar D3426 E Root surgery ea add root D3430 E Retrograde filling D3450 E Root amputation D3460 S Endodontic endosseous implan 0330 7.1756 $425.82 $85.16 D3470 E Intentional replantation D3910 E Isolation- tooth w rubb dam D3920 E Tooth splitting D3950 E Canal prep/fitting of dowel D3999 S Endodontic procedure 0330 7.1756 $425.82 $85.16 D4210 E Gingivectomy/plasty per quad D4211 E Gingivectomy/plasty per toot D4240 E Gingival flap proc w/ planin D4241 E Gngvl flap w rootplan 1-3 th D4245 E Apically positioned flap D4249 E Crown lengthen hard tissue D4260 S Osseous surgery per quadrant 0330 7.1756 $425.82 $85.16 D4261 E Osseous surgl-3teethperquad D4263 S Bone replce graft first site 0330 7.1756 $425.82 $85.16 D4264 S Bone replce graft each add 0330 7.1756 $425.82 $85.16 D4265 E Bio mtrls to aid soft/os reg D4266 E Guided tiss regen resorble D4267 E Guided tiss regen nonresorb D4268 S Surgical revision procedure 0330 7.1756 $425.82 $85.16 D4270 S Pedicle soft tissue graft pr 0330 7.1756 $425.82 $85.16 D4271 S Free soft tissue graft proc 0330 7.1756 $425.82 $85.16 Start Printed Page 50840 D4273 S Subepithelial tissue graft 0330 7.1756 $425.82 $85.16 D4274 E Distal/proximal wedge proc D4275 E Soft tissue allograft D4276 E Con tissue w dble ped graft D4320 E Provision splnt intracoronal D4321 E Provisional splint extracoro D4341 E Periodontal scaling & root D4342 E Periodontal scaling 1-3teeth D4355 S Full mouth debridement 0330 7.1756 $425.82 $85.16 D4381 S Localized chemo delivery 0330 7.1756 $425.82 $85.16 D4910 E Periodontal maint procedures D4920 E Unscheduled dressing change D4999 E Unspecified periodontal proc D5110 E Dentures complete maxillary D5120 E Dentures complete mandible D5130 E Dentures immediat maxillary D5140 E Dentures immediat mandible D5211 E Dentures maxill part resin D5212 E Dentures mand part resin D5213 E Dentures maxill part metal D5214 E Dentures mandibl part metal D5225 E Maxillary part denture flex D5226 E Mandibular part denture flex D5281 E Removable partial denture D5410 E Dentures adjust cmplt maxil D5411 E Dentures adjust cmplt mand D5421 E Dentures adjust part maxill D5422 E Dentures adjust part mandbl D5510 E Dentur repr broken compl bas D5520 E Replace denture teeth complt D5610 E Dentures repair resin base D5620 E Rep part denture cast frame D5630 E Rep partial denture clasp D5640 E Replace part denture teeth D5650 E Add tooth to partial denture D5660 E Add clasp to partial denture D5670 E Replc tth&acrlc on mtl frmwk D5671 E Replc tth&acrlc mandibular D5710 E Dentures rebase cmplt maxil D5711 E Dentures rebase cmplt mand D5720 E Dentures rebase part maxill D5721 E Dentures rebase part mandbl D5730 E Denture reln cmplt maxil ch D5731 E Denture reln cmplt mand chr D5740 E Denture reln part maxil chr D5741 E Denture reln part mand chr D5750 E Denture reln cmplt max lab D5751 E Denture reln cmplt mand lab D5760 E Denture reln part maxil lab D5761 E Denture reln part mand lab D5810 E Denture interm cmplt maxill D5811 E Denture interm cmplt mandbl D5820 E Denture interm part maxill D5821 E Denture interm part mandbl D5850 E Denture tiss conditn maxill D5851 E Denture tiss condtin mandbl D5860 E Overdenture complete D5861 E Overdenture partial D5862 E Precision attachment D5867 E Replacement of precision att D5875 E Prosthesis modification D5899 E Removable prosthodontic proc D5911 S Facial moulage sectional 0330 7.1756 $425.82 $85.16 D5912 S Facial moulage complete 0330 7.1756 $425.82 $85.16 D5913 E Nasal prosthesis D5914 E Auricular prosthesis Start Printed Page 50841 D5915 E Orbital prosthesis D5916 E Ocular prosthesis D5919 E Facial prosthesis D5922 E Nasal septal prosthesis D5923 E Ocular prosthesis interim D5924 E Cranial prosthesis D5925 E Facial augmentation implant D5926 E Replacement nasal prosthesis D5927 E Auricular replacement D5928 E Orbital replacement D5929 E Facial replacement D5931 E Surgical obturator D5932 E Postsurgical obturator D5933 E Refitting of obturator D5934 E Mandibular flange prosthesis D5935 E Mandibular denture prosth D5936 E Temp obturator prosthesis D5937 E Trismus appliance D5951 E Feeding aid D5952 E Pediatric speech aid D5953 E Adult speech aid D5954 E Superimposed prosthesis D5955 E Palatal lift prosthesis D5958 E Intraoral con def inter plt D5959 E Intraoral con def mod palat D5960 E Modify speech aid prosthesis D5982 E Surgical stent D5983 S Radiation applicator 0330 7.1756 $425.82 $85.16 D5984 S Radiation shield 0330 7.1756 $425.82 $85.16 D5985 S Radiation cone locator 0330 7.1756 $425.82 $85.16 D5986 E Fluoride applicator D5987 S Commissure splint 0330 7.1756 $425.82 $85.16 D5988 E Surgical splint D5999 E Maxillofacial prosthesis D6010 E Odontics endosteal implant D6040 E Odontics eposteal implant D6050 E Odontics transosteal implnt D6053 E Implnt/abtmnt spprt remv dnt D6054 E Implnt/abtmnt spprt remvprtl D6055 E Implant connecting bar D6056 E Prefabricated abutment D6057 E Custom abutment D6058 E Abutment supported crown D6059 E Abutment supported mtl crown D6060 E Abutment supported mtl crown D6061 E Abutment supported mtl crown D6062 E Abutment supported mtl crown D6063 E Abutment supported mtl crown D6064 E Abutment supported mtl crown D6065 E Implant supported crown D6066 E Implant supported mtl crown D6067 E Implant supported mtl crown D6068 E Abutment supported retainer D6069 E Abutment supported retainer D6070 E Abutment supported retainer D6071 E Abutment supported retainer D6072 E Abutment supported retainer D6073 E Abutment supported retainer D6074 E Abutment supported retainer D6075 E Implant supported retainer D6076 E Implant supported retainer D6077 E Implant supported retainer D6078 E Implnt/abut suprtd fixd dent D6079 E Implnt/abut suprtd fixd dent D6080 E Implant maintenance D6090 E Repair implant Start Printed Page 50842 D6094 E Abut support crown titanium D6095 E Odontics repr abutment D6100 E Removal of implant D6190 E Radio/surgical implant index D6194 E Abut support retainer titani D6199 E Implant procedure D6205 E Pontic-indirect resin based D6210 E Prosthodont high noble metal D6211 E Bridge base metal cast D6212 E Bridge noble metal cast D6214 E Pontic titanium D6240 E Bridge porcelain high noble D6241 E Bridge porcelain base metal D6242 E Bridge porcelain nobel metal D6245 E Bridge porcelain/ceramic D6250 E Bridge resin w/high noble D6251 E Bridge resin base metal D6252 E Bridge resin w/noble metal D6253 E Provisional pontic D6545 E Dental retainr cast metl D6548 E Porcelain/ceramic retainer D6600 E Porcelain/ceramic inlay 2srf D6601 E Porc/ceram inlay >= 3 surfac D6602 E Cst hgh nble mtl inlay 2 srf D6603 E Cst hgh nble mtl inlay >=3sr D6604 E Cst bse mtl inlay 2 surfaces D6605 E Cst bse mtl inlay >= 3 surfa D6606 E Cast noble metal inlay 2 sur D6607 E Cst noble mtl inlay >=3 surf D6608 E Onlay porc/crmc 2 surfaces D6609 E Onlay porc/crmc >=3 surfaces D6610 E Onlay cst hgh nbl mtl 2 srfc D6611 E Onlay cst hgh nbl mtl >=3srf D6612 E Onlay cst base mtl 2 surface D6613 E Onlay cst base mtl >=3 surfa D6614 E Onlay cst nbl mtl 2 surfaces D6615 E Onlay cst nbl mtl >=3 surfac D6624 E Inlay titanium D6634 E Onlay titanium D6710 E Crown-indirect resin based D6720 E Retain crown resin w hi nble D6721 E Crown resin w/base metal D6722 E Crown resin w/noble metal D6740 E Crown porcelain/ceramic D6750 E Crown porcelain high noble D6751 E Crown porcelain base metal D6752 E Crown porcelain noble metal D6780 E Crown 3/4 high noble metal D6781 E Crown 3/4 cast based metal D6782 E Crown 3/4 cast noble metal D6783 E Crown 3/4 porcelain/ceramic D6790 E Crown full high noble metal D6791 E Crown full base metal cast D6792 E Crown full noble metal cast D6793 E Provisional retainer crown D6794 E Crown titanium D6920 S Dental connector bar 0330 7.1756 $425.82 $85.16 D6930 E Dental recement bridge D6940 E Stress breaker D6950 E Precision attachment D6970 E Post & core plus retainer D6971 E Cast post bridge retainer D6972 E Prefab post & core plus reta D6973 E Core build up for retainer D6975 E Coping metal D6976 E Each addtnl cast post Start Printed Page 50843 D6977 E Each addtl prefab post D6980 E Bridge repair D6985 E Pediatric partial denture fx D6999 E Fixed prosthodontic proc D7111 S Coronal remnants deciduous t 0330 7.1756 $425.82 $85.16 D7140 S Extraction erupted tooth/exr 0330 7.1756 $425.82 $85.16 D7210 S Rem imp tooth w mucoper flp 0330 7.1756 $425.82 $85.16 D7220 S Impact tooth remov soft tiss 0330 7.1756 $425.82 $85.16 D7230 S Impact tooth remov part bony 0330 7.1756 $425.82 $85.16 D7240 S Impact tooth remov comp bony 0330 7.1756 $425.82 $85.16 D7241 S Impact tooth rem bony w/comp 0330 7.1756 $425.82 $85.16 D7250 S Tooth root removal 0330 7.1756 $425.82 $85.16 D7260 S Oral antral fistula closure 0330 7.1756 $425.82 $85.16 D7261 S Primary closure sinus perf 0330 7.1756 $425.82 $85.16 D7270 E Tooth reimplantation D7272 E Tooth transplantation D7280 E Exposure impact tooth orthod D7282 E Mobilize erupted/malpos toot D7283 B Place device impacted tooth D7285 E Biopsy of oral tissue hard D7286 E Biopsy of oral tissue soft D7287 E Cytology sample collection D7288 B Brush biopsy D7290 E Repositioning of teeth D7291 S Transseptal fiberotomy 0330 7.1756 $425.82 $85.16 D7310 E Alveoplasty w/ extraction D7311 E Alveoloplasty w/extract 1-3 D7320 E Alveoplasty w/o extraction D7321 B Alveoloplasty not w/extracts D7340 E Vestibuloplasty ridge extens D7350 E Vestibuloplasty exten graft D7410 E Rad exc lesion up to 1.25 cm D7411 E Excision benign lesion>1.25c D7412 E Excision benign lesion compl D7413 E Excision malig lesion < =1.25c D7414 E Excision malig lesion > 1.25cm D7415 E Excision malig les complicat D7440 E Malig tumor exc to 1.25 cm D7441 E Malig tumor > 1.25 cm D7450 E Rem odontogen cyst to 1.25cm D7451 E Rem odontogen cyst > 1.25 cm D7460 E Rem nonodonto cyst to 1.25cm D7461 E Rem nonodonto cyst > 1.25 cm D7465 E Lesion destruction D7471 E Rem exostosis any site D7472 E Removal of torus palatinus D7473 E Remove torus mandibularis D7485 E Surg reduct osseoustuberosit D7490 E Mandible resection D7510 E I&d absc intraoral soft tiss D7511 B Incision/drain abscess intra D7520 E I&d abscess extraoral D7521 B Incision/drain abscess extra D7530 E Removal fb skin/areolar tiss D7540 E Removal of fb reaction D7550 E Removal of sloughed off bone D7560 E Maxillary sinusotomy D7610 E Maxilla open reduct simple D7620 E Clsd reduct simpl maxilla fx D7630 E Open red simpl mandible fx D7640 E Clsd red simpl mandible fx D7650 E Open red simp malar/zygom fx D7660 E Clsd red simp malar/zygom fx D7670 E Closd rductn splint alveolus D7671 E Alveolus open reduction D7680 E Reduct simple facial bone fx Start Printed Page 50844 D7710 E Maxilla open reduct compound D7720 E Clsd reduct compd maxilla fx D7730 E Open reduct compd mandble fx D7740 E Clsd reduct compd mandble fx D7750 E Open red comp malar/zygma fx D7760 E Clsd red comp malar/zygma fx D7770 E Open reduc compd alveolus fx D7771 E Alveolus clsd reduc stblz te D7780 E Reduct compnd facial bone fx D7810 E Tmj open reduct-dislocation D7820 E Closed tmp manipulation D7830 E Tmj manipulation under anest D7840 E Removal of tmj condyle D7850 E Tmj meniscectomy D7852 E Tmj repair of joint disc D7854 E Tmj excisn of joint membrane D7856 E Tmj cutting of a muscle D7858 E Tmj reconstruction D7860 E Tmj cutting into joint D7865 E Tmj reshaping components D7870 E Tmj aspiration joint fluid D7871 E Lysis + lavage w catheters D7872 E Tmj diagnostic arthroscopy D7873 E Tmj arthroscopy lysis adhesn D7874 E Tmj arthroscopy disc reposit D7875 E Tmj arthroscopy synovectomy D7876 E Tmj arthroscopy discectomy D7877 E Tmj arthroscopy debridement D7880 E Occlusal orthotic appliance D7899 E Tmj unspecified therapy D7910 E Dent sutur recent wnd to 5cm D7911 E Dental suture wound to 5 cm D7912 E Suture complicate wnd > 5 cm D7920 E Dental skin graft D7940 S Reshaping bone orthognathic 0330 7.1756 $425.82 $85.16 D7941 E Bone cutting ramus closed D7943 E Cutting ramus open w/graft D7944 E Bone cutting segmented D7945 E Bone cutting body mandible D7946 E Reconstruction maxilla total D7947 E Reconstruct maxilla segment D7948 E Reconstruct midface no graft D7949 E Reconstruct midface w/graft D7950 E Mandible graft D7953 E Bone replacement graft D7955 E Repair maxillofacial defects D7960 E Frenulectomy/frenulotomy D7963 E Frenuloplasty D7970 E Excision hyperplastic tissue D7971 E Excision pericoronal gingiva D7972 E Surg redct fibrous tuberosit D7980 E Sialolithotomy D7981 E Excision of salivary gland D7982 E Sialodochoplasty D7983 E Closure of salivary fistula D7990 E Emergency tracheotomy D7991 E Dental coronoidectomy D7995 E Synthetic graft facial bones D7996 E Implant mandible for augment D7997 E Appliance removal D7999 E Oral surgery procedure D8010 E Limited dental tx primary D8020 E Limited dental tx transition D8030 E Limited dental tx adolescent D8040 E Limited dental tx adult D8050 E Intercep dental tx primary Start Printed Page 50845 D8060 E Intercep dental tx transitn D8070 E Compre dental tx transition D8080 E Compre dental tx adolescent D8090 E Compre dental tx adult D8210 E Orthodontic rem appliance tx D8220 E Fixed appliance therapy habt D8660 E Preorthodontic tx visit D8670 E Periodic orthodontc tx visit D8680 E Orthodontic retention D8690 E Orthodontic treatment D8691 E Repair ortho appliance D8692 E Replacement retainer D8999 E Orthodontic procedure D9110 N Tx dental pain minor proc D9210 E Dent anesthesia w/o surgery D9211 E Regional block anesthesia D9212 E Trigeminal block anesthesia D9215 E Local anesthesia D9220 E General anesthesia D9221 E General anesthesia ea ad 15m D9230 N Analgesia D9241 E Intravenous sedation D9242 E IV sedation ea ad 30 m D9248 N Sedation (non-iv) D9310 E Dental consultation D9410 E Dental house call D9420 E Hospital call D9430 E Office visit during hours D9440 E Office visit after hours D9450 E Case presentation tx plan D9610 E Dent therapeutic drug inject D9630 S Other drugs/medicaments 0330 7.1756 $425.82 $85.16 D9910 E Dent appl desensitizing med D9911 E Appl desensitizing resin D9920 E Behavior management D9930 S Treatment of complications 0330 7.1756 $425.82 $85.16 D9940 S Dental occlusal guard 0330 7.1756 $425.82 $85.16 D9941 E Fabrication athletic guard D9942 E Repair/reline occlusal guard D9950 S Occlusion analysis 0330 7.1756 $425.82 $85.16 D9951 S Limited occlusal adjustment 0330 7.1756 $425.82 $85.16 D9952 S Complete occlusal adjustment 0330 7.1756 $425.82 $85.16 D9970 E Enamel microabrasion D9971 E Odontoplasty 1-2 teeth D9972 E Extrnl bleaching per arch D9973 E Extrnl bleaching per tooth D9974 E Intrnl bleaching per tooth D9999 E Adjunctive procedure E0100 Y Cane adjust/fixed with tip E0105 Y Cane adjust/fixed quad/3 pro E0110 Y Crutch forearm pair E0111 Y Crutch forearm each E0112 Y Crutch underarm pair wood E0113 Y Crutch underarm each wood E0114 Y Crutch underarm pair no wood E0116 Y Crutch underarm each no wood E0117 Y Underarm springassist crutch E0118 E Crutch substitute E0130 Y Walker rigid adjust/fixed ht E0135 Y Walker folding adjust/fixed E0140 Y Walker w trunk support E0141 Y Rigid wheeled walker adj/fix E0143 Y Walker folding wheeled w/o s E0144 Y Enclosed walker w rear seat E0147 Y Walker variable wheel resist E0148 Y Heavyduty walker no wheels Start Printed Page 50846 E0149 Y Heavy duty wheeled walker E0153 Y Forearm crutch platform atta E0154 Y Walker platform attachment E0155 Y Walker wheel attachment,pair E0156 Y Walker seat attachment E0157 Y Walker crutch attachment E0158 Y Walker leg extenders set of4 E0159 Y Brake for wheeled walker E0160 Y Sitz type bath or equipment E0161 Y Sitz bath/equipment w/faucet E0162 Y Sitz bath chair E0163 Y Commode chair stationry fxd E0164 Y Commode chair mobile fixed a E0166 Y Commode chair mobile detach E0167 Y Commode chair pail or pan E0168 Y Heavyduty/wide commode chair E0169 Y Seatlift incorp commodechair E0175 Y Commode chair foot rest E0180 Y Press pad alternating w pump E0181 Y Press pad alternating w/ pum E0182 Y Pressure pad alternating pum E0184 Y Dry pressure mattress E0185 Y Gel pressure mattress pad E0186 Y Air pressure mattress E0187 Y Water pressure mattress E0188 Y Synthetic sheepskin pad E0189 Y Lambswool sheepskin pad E0190 E Positioning cushion E0191 Y Protector heel or elbow E0193 Y Powered air flotation bed E0194 Y Air fluidized bed E0196 Y Gel pressure mattress E0197 Y Air pressure pad for mattres E0198 Y Water pressure pad for mattr E0199 Y Dry pressure pad for mattres E0200 Y Heat lamp without stand E0202 Y Phototherapy light w/ photom E0203 E Therapeutic lightbox tabletp E0205 Y Heat lamp with stand E0210 Y Electric heat pad standard E0215 Y Electric heat pad moist E0217 Y Water circ heat pad w pump E0218 Y Water circ cold pad w pump E0220 Y Hot water bottle E0221 E Infrared heating pad system E0225 Y Hydrocollator unit E0230 Y Ice cap or collar E0231 E Wound warming device E0232 E Warming card for NWT E0235 Y Paraffin bath unit portable E0236 Y Pump for water circulating p E0238 Y Heat pad non-electric moist E0239 Y Hydrocollator unit portable E0240 E Bath/shower chair E0241 E Bath tub wall rail E0242 E Bath tub rail floor E0243 E Toilet rail E0244 E Toilet seat raised E0245 E Tub stool or bench E0246 E Transfer tub rail attachment E0247 E Trans bench w/wo comm open E0248 E HDtrans bench w/wo comm open E0249 Y Pad water circulating heat u E0250 Y Hosp bed fixed ht w/ mattres E0251 Y Hosp bed fixd ht w/o mattres E0255 Y Hospital bed var ht w/ mattr Start Printed Page 50847 E0256 Y Hospital bed var ht w/o matt E0260 Y Hosp bed semi-electr w/ matt E0261 Y Hosp bed semi-electr w/o mat E0265 Y Hosp bed total electr w/ mat E0266 Y Hosp bed total elec w/o matt E0270 E Hospital bed institutional t E0271 Y Mattress innerspring E0272 Y Mattress foam rubber E0273 E Bed board E0274 E Over-bed table E0275 Y Bed pan standard E0276 Y Bed pan fracture E0277 Y Powered pres-redu air mattrs E0280 Y Bed cradle E0290 Y Hosp bed fx ht w/o rails w/m E0291 Y Hosp bed fx ht w/o rail w/o E0292 Y Hosp bed var ht w/o rail w/o E0293 Y Hosp bed var ht w/o rail w/ E0294 Y Hosp bed semi-elect w/ mattr E0295 Y Hosp bed semi-elect w/o matt E0296 Y Hosp bed total elect w/ matt E0297 Y Hosp bed total elect w/o mat E0300 Y Enclosed ped crib hosp grade E0301 Y HD hosp bed, 350-600 lbs E0302 Y Ex hd hosp bed > 600 lbs E0303 Y Hosp bed hvy dty xtra wide E0304 Y Hosp bed xtra hvy dty × wide E0305 Y Rails bed side half length E0310 Y Rails bed side full length E0315 E Bed accessory brd/tbl/supprt E0316 Y Bed safety enclosure E0325 Y Urinal male jug-type E0326 Y Urinal female jug-type E0350 E Control unit bowel system E0352 E Disposable pack w/bowel syst E0370 E Air elevator for heel E0371 Y Nonpower mattress overlay E0372 Y Powered air mattress overlay E0373 Y Nonpowered pressure mattress E0424 Y Stationary compressed gas 02 E0425 E Gas system stationary compre E0430 E Oxygen system gas portable E0431 Y Portable gaseous 02 E0434 Y Portable liquid 02 E0435 E Oxygen system liquid portabl E0439 Y Stationary liquid 02 E0440 E Oxygen system liquid station E0441 Y Oxygen contents, gaseous E0442 Y Oxygen contents, liquid E0443 Y Portable 02 contents, gas E0444 Y Portable 02 contents, liquid E0445 A Oximeter non-invasive E0450 Y Volume vent stationary/porta E0455 Y Oxygen tent excl croup/ped t E0457 Y Chest shell E0459 Y Chest wrap E0460 Y Neg press vent portabl/statn E0461 Y Vol vent noninvasive interfa E0462 Y Rocking bed w/ or w/o side r E0463 Y Press supp vent invasive int E0464 Y Press supp vent noninv int E0470 Y RAD w/o backup non-inv intfc E0471 Y RAD w/backup non inv intrfc E0472 Y RAD w backup invasive intrfc E0480 Y Percussor elect/pneum home m E0481 E Intrpulmnry percuss vent sys Start Printed Page 50848 E0482 Y Cough stimulating device E0483 Y Chest compression gen system E0484 Y Non-elec oscillatory pep dvc E0500 Y Ippb all types E0550 Y Humidif extens supple w ippb E0555 Y Humidifier for use w/ regula E0560 Y Humidifier supplemental w/ i E0561 Y Humidifier nonheated w PAP E0562 Y Humidifier heated used w PAP E0565 Y Compressor air power source E0570 Y Nebulizer with compression E0571 Y Aerosol compressor for svneb E0572 Y Aerosol compressor adjust pr E0574 Y Ultrasonic generator w svneb E0575 Y Nebulizer ultrasonic E0580 Y Nebulizer for use w/ regulat E0585 Y Nebulizer w/ compressor & he E0590 Y Dispensing fee dme neb drug E0600 Y Suction pump portab hom modl E0601 Y Cont airway pressure device E0602 Y Manual breast pump E0603 A Electric breast pump E0604 A Hosp grade elec breast pump E0605 Y Vaporizer room type E0606 Y Drainage board postural E0607 Y Blood glucose monitor home E0610 Y Pacemaker monitr audible/vis E0615 Y Pacemaker monitr digital/vis E0616 N Cardiac event recorder E0617 Y Automatic ext defibrillator E0618 A Apnea monitor E0619 A Apnea monitor w recorder E0620 Y Cap bld skin piercing laser E0621 Y Patient lift sling or seat E0625 E Patient lift bathroom or toi E0627 Y Seat lift incorp lift-chair E0628 Y Seat lift for pt furn-electr E0629 Y Seat lift for pt furn-non-el E0630 Y Patient lift hydraulic E0635 Y Patient lift electric E0636 Y PT support & positioning sys E0637 E Sit-stand w seatlift wheeled E0638 E Standing frame sys wheeled E0639 E Moveable patient lift system E0640 E Fixed patient lift system E0650 Y Pneuma compresor non-segment E0651 Y Pneum compressor segmental E0652 Y Pneum compres w/cal pressure E0655 Y Pneumatic appliance half arm E0660 Y Pneumatic appliance full leg E0665 Y Pneumatic appliance full arm E0666 Y Pneumatic appliance half leg E0667 Y Seg pneumatic appl full leg E0668 Y Seg pneumatic appl full arm E0669 Y Seg pneumatic appli half leg E0671 Y Pressure pneum appl full leg E0672 Y Pressure pneum appl full arm E0673 Y Pressure pneum appl half leg E0675 Y Pneumatic compression device E0691 Y Uvl pnl 2 sq ft or less E0692 Y Uvl sys panel 4 ft E0693 Y Uvl sys panel 6 ft E0694 Y Uvl md cabinet sys 6 ft E0700 E Safety equipment E0701 Y Helmet w face guard prefab E0710 E Restraints any type Start Printed Page 50849 E0720 Y Tens two lead E0730 Y Tens four lead E0731 Y Conductive garment for tens/ E0740 Y Incontinence treatment systm E0744 Y Neuromuscular stim for scoli E0745 Y Neuromuscular stim for shock E0746 E Electromyograph biofeedback E0747 Y Elec osteogen stim not spine E0748 Y Elec osteogen stim spinal E0749 N Elec osteogen stim implanted E0752 B Neurostimulator electrode E0754 A Pulsegenerator pt programmer E0755 E Electronic salivary reflex s E0756 B Implantable pulse generator E0757 N Implantable RF receiver E0758 A External RF transmitter E0759 A Replace rdfrquncy transmittr E0760 Y Osteogen ultrasound stimltor E0761 E Nontherm electromgntc device E0765 Y Nerve stimulator for tx n&v E0769 B Electric wound treatment dev E0776 Y Iv pole E0779 Y Amb infusion pump mechanical E0780 Y Mech amb infusion pump <8hrs E0781 Y External ambulatory infus pu E0782 N Non-programble infusion pump E0783 N Programmable infusion pump E0784 Y Ext amb infusn pump insulin E0785 N Replacement impl pump cathet E0786 N Implantable pump replacement E0791 Y Parenteral infusion pump sta E0830 N Ambulatory traction device E0840 Y Tract frame attach headboard E0849 Y Cervical pneum trac equip E0850 Y Traction stand free standing E0855 Y Cervical traction equipment E0860 Y Tract equip cervical tract E0870 Y Tract frame attach footboard E0880 Y Trac stand free stand extrem E0890 Y Traction frame attach pelvic E0900 Y Trac stand free stand pelvic E0910 Y Trapeze bar attached to bed E0920 Y Fracture frame attached to b E0930 Y Fracture frame free standing E0935 Y Exercise device passive moti E0940 Y Trapeze bar free standing E0941 Y Gravity assisted traction de E0942 Y Cervical head harness/halter E0944 Y Pelvic belt/harness/boot E0945 Y Belt/harness extremity E0946 Y Fracture frame dual w cross E0947 Y Fracture frame attachmnts pe E0948 Y Fracture frame attachmnts ce E0950 E Tray E0951 E Loop heel E0952 E Toe loop/holder, each E0953 E Pneumatic tire E0954 E Wheelchair semi-pneumatic ca E0955 Y Cushioned headrest E0956 Y W/c lateral trunk/hip suppor E0957 Y W/c medial thigh support E0958 A Whlchr att- conv 1 arm drive E0959 B Amputee adapter E0960 Y W/c shoulder harness/straps E0961 B Wheelchair brake extension E0966 B Wheelchair head rest extensi Start Printed Page 50850 E0967 Y Wheelchair hand rims E0968 Y Wheelchair commode seat E0969 Y Wheelchair narrowing device E0970 B Wheelchair no. 2 footplates E0971 B Wheelchair anti-tipping devi E0972 A Transfer board or device E0973 B W/Ch access det adj armrest E0974 B W/Ch access anti-rollback E0977 Y Wheelchair wedge cushion E0978 B W/C acc,saf belt pelv strap E0980 Y Wheelchair safety vest E0981 Y Seat upholstery, replacement E0982 Y Back upholstery, replacement E0983 Y Add pwr joystick E0984 Y Add pwr tiller E0985 Y W/c seat lift mechanism E0986 Y Man w/c push-rim pow assist E0990 B Whellchair elevating leg res E0992 B Wheelchair solid seat insert E0994 Y Wheelchair arm rest E0995 B Wheelchair calf rest E0996 B Wheelchair tire solid E0997 Y Wheelchair caster w/ a fork E0998 Y Wheelchair caster w/o a fork E0999 Y Wheelchr pneumatic tire w/wh E1000 B Wheelchair tire pneumatic ca E1001 Y Wheelchair wheel E1002 Y Pwr seat tilt E1003 Y Pwr seat recline E1004 Y Pwr seat recline mech E1005 Y Pwr seat recline pwr E1006 Y Pwr seat combo w/o shear E1007 Y Pwr seat combo w/shear E1008 Y Pwr seat combo pwr shear E1009 Y Add mech leg elevation E1010 Y Add pwr leg elevation E1011 Y Ped wc modify width adjustm E1014 Y Reclining back add ped w/c E1015 Y Shock absorber for man w/c E1016 Y Shock absorber for power w/c E1017 Y HD shck absrbr for hd man wc E1018 Y HD shck absrber for hd powwc E1019 E HD feature power seat E1020 Y Residual limb support system E1021 E Ex hd feature power seat E1025 E Pedwc lat/thor sup nocontour E1026 E Pedwc contoured lat/thor sup E1027 E Ped wc lat/ant support E1028 Y W/c manual swingaway E1029 Y W/c vent tray fixed E1030 Y W/c vent tray gimbaled E1031 Y Rollabout chair with casters E1035 Y Patient transfer system E1037 Y Transport chair, ped size E1038 Y Transport chair, adult size E1039 Y Transport chair pt wt>=250lb E1050 A Whelchr fxd full length arms E1060 A Wheelchair detachable arms E1070 A Wheelchair detachable foot r E1083 A Hemi-wheelchair fixed arms E1084 A Hemi-wheelchair detachable a E1085 A Hemi-wheelchair fixed arms E1086 A Hemi-wheelchair detachable a E1087 A Wheelchair lightwt fixed arm E1088 A Wheelchair lightweight det a E1089 A Wheelchair lightwt fixed arm Start Printed Page 50851 E1090 A Wheelchair lightweight det a E1092 A Wheelchair wide w/ leg rests E1093 A Wheelchair wide w/ foot rest E1100 A Whchr s-recl fxd arm leg res E1110 A Wheelchair semi-recl detach E1130 A Whlchr stand fxd arm ft rest E1140 A Wheelchair standard detach a E1150 Y Wheelchair standard w/ leg r E1160 A Wheelchair fixed arms E1161 A Manual adult wc w tiltinspac E1170 A Whlchr ampu fxd arm leg rest E1171 A Wheelchair amputee w/o leg r E1172 A Wheelchair amputee detach ar E1180 A Wheelchair amputee w/ foot r E1190 A Wheelchair amputee w/ leg re E1195 A Wheelchair amputee heavy dut E1200 A Wheelchair amputee fixed arm E1210 Y Whlchr moto ful arm leg rest E1211 Y Wheelchair motorized w/ det E1212 A Wheelchair motorized w full E1213 A Wheelchair motorized w/ det E1220 A Whlchr special size/constrc E1221 A Wheelchair spec size w foot E1222 A Wheelchair spec size w/ leg E1223 A Wheelchair spec size w foot E1224 A Wheelchair spec size w/ leg E1225 Y Wheelchair spec sz semi-recl E1226 B W/C access fully reclineback E1227 Y Wheelchair spec sz spec ht a E1228 Y Wheelchair spec sz spec ht b E1229 Y Pediatric wheelchair NOS E1230 Y Power operated vehicle E1231 Y Rigid ped w/c tilt-in-space E1232 Y Folding ped wc tilt-in-space E1233 Y Rig ped wc tltnspc w/o seat E1234 Y Fld ped wc tltnspc w/o seat E1235 Y Rigid ped wc adjustable E1236 Y Folding ped wc adjustable E1237 Y Rgd ped wc adjstabl w/o seat E1238 Y Fld ped wc adjstabl w/o seat E1239 Y Ped power wheelchair NOS E1240 A Whchr litwt det arm leg rest E1250 A Wheelchair lightwt fixed arm E1260 A Wheelchair lightwt foot rest E1270 A Wheelchair lightweight leg r E1280 A Whchr h-duty det arm leg res E1285 A Wheelchair heavy duty fixed E1290 A Wheelchair hvy duty detach a E1295 A Wheelchair heavy duty fixed E1296 Y Wheelchair special seat heig E1297 Y Wheelchair special seat dept E1298 Y Wheelchair spec seat depth/w E1300 E Whirlpool portable E1310 Y Whirlpool non-portable E1340 Y Repair for DME, per 15 min E1353 Y Oxygen supplies regulator E1355 Y Oxygen supplies stand/rack E1372 Y Oxy suppl heater for nebuliz E1390 Y Oxygen concentrator E1391 Y Oxygen concentrator, dual E1399 N Durable medical equipment mi E1405 Y O2/water vapor enrich w/heat E1406 Y O2/water vapor enrich w/o he E1500 A Centrifuge E1510 A Kidney dialysate delivry sys E1520 A Heparin infusion pump Start Printed Page 50852 E1530 A Replacement air bubble detec E1540 A Replacement pressure alarm E1550 A Bath conductivity meter E1560 A Replace blood leak detector E1570 A Adjustable chair for esrd pt E1575 A Transducer protect/fld bar E1580 A Unipuncture control system E1590 A Hemodialysis machine E1592 A Auto interm peritoneal dialy E1594 A Cycler dialysis machine E1600 A Deli/install chrg hemo equip E1610 A Reverse osmosis h2o puri sys E1615 A Deionizer H2O puri system E1620 A Replacement blood pump E1625 A Water softening system E1630 A Reciprocating peritoneal dia E1632 A Wearable artificial kidney E1634 B Peritoneal dialysis clamp E1635 A Compact travel hemodialyzer E1636 A Sorbent cartridges per 10 E1637 A Hemostats for dialysis, each E1639 A Dialysis scale E1699 A Dialysis equipment noc E1700 Y Jaw motion rehab system E1701 Y Repl cushions for jaw motion E1702 Y Repl measr scales jaw motion E1800 Y Adjust elbow ext/flex device E1801 Y SPS elbow device E1802 Y Adjst forearm pro/sup device E1805 Y Adjust wrist ext/flex device E1806 Y SPS wrist device E1810 Y Adjust knee ext/flex device E1811 Y SPS knee device E1815 Y Adjust ankle ext/flex device E1816 Y SPS ankle device E1818 Y SPS forearm device E1820 Y Soft interface material E1821 Y Replacement interface SPSD E1825 Y Adjust finger ext/flex devc E1830 Y Adjust toe ext/flex device E1840 Y Adj shoulder ext/flex device E1841 Y Static str shldr dev rom adj E1902 A AAC non-electronic board E2000 Y Gastric suction pump hme mdl E2100 Y Bld glucose monitor w voice E2101 Y Bld glucose monitor w lance E2120 Y Pulse gen sys tx endolymp fl E2201 Y Man w/ch acc seat w>=20÷<24÷ E2202 Y Seat width 24-27 in E2203 Y Frame depth less than 22 in E2204 Y Frame depth 22 to 25 in E2205 Y Manual wc accessory, handrim E2206 Y Complete wheel lock assembly E2291 E Planar back for ped size wc E2292 E Planar seat for ped size wc E2293 E Contour back for ped size wc E2294 E Contour seat for ped size wc E2300 Y Pwr seat elevation sys E2301 Y Pwr standing E2310 Y Electro connect btw control E2311 Y Electro connect btw 2 sys E2320 Y Hand chin control E2321 Y Hand interface joystick E2322 Y Mult mech switches E2323 Y Special joystick handle E2324 Y Chin cup interface Start Printed Page 50853 E2325 Y Sip and puff interface E2326 Y Breath tube kit E2327 Y Head control interface mech E2328 Y Head/extremity control inter E2329 Y Head control nonproportional E2330 Y Head control proximity switc E2331 Y Attendant control E2340 Y W/c wdth 20-23 in seat frame E2341 Y W/c wdth 24-27 in seat frame E2342 Y W/c dpth 20-21 in seat frame E2343 Y W/c dpth 22-25 in seat frame E2351 Y Electronic SGD interface E2360 Y 22nf nonsealed leadacid E2361 Y 22nf sealed leadacid battery E2362 Y Gr24 nonsealed leadacid E2363 Y Gr24 sealed leadacid battery E2364 Y U1nonsealed leadacid battery E2365 Y U1 sealed leadacid battery E2366 Y Battery charger, single mode E2367 Y Battery charger, dual mode E2368 Y Power wc motor replacement E2369 Y Pwr wc gear box replacement E2370 Y Pwr wc motor/gear box combo E2399 Y Noc interface E2402 Y Neg press wound therapy pump E2500 Y SGD digitized pre-rec <=8min E2502 Y SGD prerec msg >8min <=20min E2504 Y SGD prerec msg>20min <=40min E2506 Y SGD prerec msg > 40 min E2508 Y SGD spelling phys contact E2510 Y SGD w multi methods msg/accs E2511 Y SGD sftwre prgrm for PC/PDA E2512 Y SGD accessory, mounting sys E2599 Y SGD accessory noc E2601 Y Gen w/c cushion wdth < 22 in E2602 Y Gen w/c cushion wdth >=22 in E2603 Y Skin protect wc cus wd <22in E2604 Y Skin protect wc cus wd>=22in E2605 Y Position wc cush wdth <22 in E2606 Y Position wc cush wdth>=22 in E2607 Y Skin pro/pos wc cus wd <22in E2608 Y Skin pro/pos wc cus wd>=22in E2609 Y Custom fabricate w/c cushion E2610 B Powered w/c cushion E2611 Y Gen use back cush wdth <22in E2612 Y Gen use back cush wdth>=22in E2613 Y Position back cush wd <22in E2614 Y Position back cush wd>=22in E2615 Y Pos back post/lat wdth <22in E2616 Y Pos back post/lat wdth>=22in E2617 Y Custom fab w/c back cushion E2618 Y Wc acc solid seat supp base E2619 Y Replace cover w/c seat cush E2620 Y WC planar back cush wd <22in E2621 Y WC planar back cush wd>=22in E8000 E Posterior gait trainer E8001 E Upright gait trainer E8002 E Anterior gait trainer G0008 X Admin influenza virus vac 0350 0.3954 $23.46 $0.00 $0.00 G0009 X Admin pneumococcal vaccine 0350 0.3954 $23.46 $0.00 $0.00 G0010 B Admin hepatitis b vaccine G0027 A Semen analysis G0101 V CA screen pelvic/breast exam 0600 0.8688 $51.56 $10.31 G0102 N Prostate ca screening dre G0103 A Psa, total screening G0104 S CA screen flexi sigmoidscope 0159 3.1455 $186.66 $46.67 Start Printed Page 50854 G0105 T Colorectal scrn hi risk ind 0158 7.6588 $454.50 $113.63 G0106 S Colon CA screen barium enema 0157 2.2904 $135.92 $27.18 G0107 A CA screen fecal blood test G0108 A Diab manage trn per indiv G0109 A Diab manage trn ind/group G0110 A Nett pulm-rehab educ ind G0111 A Nett pulm-rehab educ group G0112 A Nett nutrition guid, initial G0113 A Nett nutrition guid,subseqnt G0114 A Nett psychosocial consult G0115 A Nett psychological testing G0116 A Nett psychosocial counsel G0117 S Glaucoma scrn hgh risk direc 0230 0.7858 $46.63 $14.97 $9.33 G0118 S Glaucoma scrn hgh risk direc 0230 0.7858 $46.63 $14.97 $9.33 G0120 S Colon ca scrn barium enema 0157 2.2904 $135.92 $27.18 G0121 T Colon ca scrn not hi rsk ind 0158 7.6588 $454.50 $113.63 G0122 E Colon ca scrn barium enema G0123 A Screen cerv/vag thin layer G0124 A Screen c/v thin layer by MD G0127 T Trim nail(s) 0009 0.668 $39.64 $8.34 $7.93 G0128 B CORF skilled nursing service G0129 P Partial hosp prog service 0033 4.0708 $241.57 $48.31 G0130 X Single energy x-ray study 0260 0.7555 $44.83 $17.93 $8.97 G0141 E Scr c/v cyto,autosys and md G0143 A Scr c/v cyto,thinlayer,rescr G0144 A Scr c/v cyto,thinlayer,rescr G0145 A Scr c/v cyto,thinlayer,rescr G0147 A Scr c/v cyto, automated sys G0148 A Scr c/v cyto, autosys, rescr G0151 B HHCP-serv of pt,ea 15 min G0152 B HHCP-serv of ot,ea 15 min G0153 B HHCP-svs of s/l path,ea 15mn G0154 B HHCP-svs of rn,ea 15 min G0155 B HHCP-svs of csw,ea 15 min G0156 B HHCP-svs of aide,ea 15 min G0166 T Extrnl counterpulse, per tx 0678 1.7276 $102.52 $20.50 G0168 N Wound closure by adhesive G0173 S Linear acc stereo radsur com 1528 $5,250.00 $1,050.00 G0175 V OPPS Service,sched team conf 0602 1.4284 $84.77 $16.95 G0176 P OPPS/PHP activity therapy 0033 4.0708 $241.57 $48.31 G0177 P OPPS/PHP train & educ serv 0033 4.0708 $241.57 $48.31 G0179 E MD recertification HHA PT G0180 E MD certification HHA patient G0181 E Home health care supervision G0182 E Hospice care supervision G0186 T Dstry eye lesn,fdr vssl tech 0235 4.6593 $276.50 $67.40 $55.30 G0202 A Screeningmammographydigital G0204 A Diagnosticmammographydigital G0206 A Diagnosticmammographydigital G0219 E PET img whbd ring noncov ind G0235 E PET not otherwise specified G0237 S Therapeutic procd strg endur 0411 0.3869 $22.96 $4.59 G0238 S Oth resp proc, indiv 0411 0.3869 $22.96 $4.59 G0239 S Oth resp proc, group 0411 0.3869 $22.96 $4.59 G0243 S Multisour photon stero treat 1528 $5,250.00 $1,050.00 G0244 B Observ care by facility topt G0245 V Initial Foot Exam PTLOPS 0600 0.8688 $51.56 $10.31 G0246 V Followup eval of foot pt lop 0600 0.8688 $51.56 $10.31 G0247 T Routine footcare pt w lops 0009 0.668 $39.64 $8.34 $7.93 G0248 S Demonstrate use home inr mon 1503 $150.00 $30.00 G0249 S Provide test material,equipm 1503 $150.00 $30.00 G0250 E MD review interpret of test G0251 S Linear acc based stero radio 1513 $1,150.00 $230.00 G0252 E PET imaging initial dx G0255 E Current percep threshold tst G0257 S Unsched dialysis ESRD pt hos 0170 5.8994 $350.09 $70.02 Start Printed Page 50855 G0258 X IV infusion during obs stay 0340 0.6384 $37.88 $7.58 G0259 N Inject for sacroiliac joint G0260 T Inj for sacroiliac jt anesth 0206 5.492 $325.91 $75.55 $65.18 G0263 B Adm with CHF, CP, asthma G0264 B Assmt otr CHF, CP, asthma G0265 A Cryopresevation Freeze+stora G0266 A Thawing + expansion froz cel G0267 S Bone marrow or psc harvest 0110 3.6594 $217.16 $43.43 G0268 X Removal of impacted wax md 0340 0.6384 $37.88 $7.58 G0269 N Occlusive device in vein art G0270 A MNT subs tx for change dx G0271 A Group MNT 2 or more 30 mins G0275 N Renal angio, cardiac cath G0278 N Iliac art angio,cardiac cath G0279 A Excorp shock tx, elbow epi G0280 A Excorp shock tx other than G0281 A Elec stim unattend for press G0282 E Elect stim wound care not pd G0283 A Elec stim other than wound G0288 S Recon, CTA for pre & post su 0417 4.075 $241.82 $48.36 G0289 N Arthro, loose body + chondro G0290 T Drug-eluting stents, single 0656 109.9237 $6,523.20 $1,304.64 G0291 T Drug-eluting stents,each add 0656 109.9237 $6,523.20 $1,304.64 G0293 S Non-cov surg proc,clin trial 1505 $350.00 $70.00 G0294 S Non-cov proc, clinical trial 1502 $75.00 $15.00 G0295 E Electromagnetic therapy onc G0297 T Insert single chamber/cd 0107 260.0295 $15,430.93 $3,103.22 $3,086.19 G0298 T Insert dual chamber/cd 0107 260.0295 $15,430.93 $3,103.22 $3,086.19 G0299 T Inser/repos single icd+leads 0108 349.1681 $20,720.68 $4,144.14 G0300 T Insert reposit lead dual+gen 0108 349.1681 $20,720.68 $4,144.14 G0302 S Pre-op service LVRS complete 1509 $750.00 $150.00 G0303 S Pre-op service LVRS 10-15dos 507 $550.00 $110.00 G0304 S Pre-op service LVRS 1-9 dos 1504 $250.00 $50.00 G0305 S Post op service LVRS min 6 1504 $250.00 $50.00 G0306 A CBC/diffwbc w/o platelet G0307 A CBC without platelet G0308 A ESRD related svc 4+mo<2yrs G0309 A ESRD related svc 2-3mo<2yrs G0310 A ESRD related svc 1vst<2yr G0311 A ESRD related svs 4+mo 2-11yr G0312 A ESRD relate svs 2-3 mo 2-11y G0313 A ESRD related svs 1 mon 2-11y G0314 A ESRD relate svs 4+mo 12-19 G0315 A ESRD related svs 2-3 mo 12-1 G0316 A ESRD related svs 1 vis/12-19 G0317 A ESRD related svs 4+mo 20+yrs G0318 A ESRD related svs 2-3 mo 20+y G0319 A ESRD related svs 1visit 20+y G0320 A ESRD related svs home under G0321 A ESRDrelatedsvs home mo 2-11y G0322 A ESRD related svs home mo 12-1 G0323 A ESRD related svs home mo 20+ G0324 A ESRD related svs home/dy/2y G0325 A ESRD relate home/dy 2-11yr G0326 A ESRD relate home/dy 12-19y G0327 A ESRD relate home/dy 20+yrs G0328 A Fecal blood scrn immunoassay G0329 A Electromagntic tx for ulcers G0337 A Hospice evaluation preelecti G0339 S Robot lin-radsurg com, first 1528 $5,250.00 $1,050.00 G0340 S Robt lin-radsurg fractx 2-5 1525 $3,750.00 $750.00 G0341 C Percutaneous islet celltrans G0342 C Laparoscopy Islet cell Trans G0343 C Laparotomy Islet cell tranp G0344 V Initial preventive exam 0601 1.0038 $59.57 $11.91 G0345 M IV infuse hydration initial Start Printed Page 50856 G0346 M Each additional infuse hours G0347 M IV infusion therapy/diagnost G0348 M each additional hr up to 8hr G0349 M additional sequential infuse G0350 M concurrent infusion G0351 M therapeutic/diagnostic injec G0353 M IV push,single orinitial dru G0354 M each addition sequential IV G0355 M chemo administrate subcut/IM G0356 M hormonal anti-neoplastic G0357 M IV push single/initial subst G0358 M IV push each additional drug G0359 M chemotherapy IV one hr initi G0360 M each additional hr 1-8 hrs G0361 M prolong chemo Infuse>8hrs pu G0362 M each add sequential infusion G0363 M irrigate implanted venous de G0364 X Bone marrow aspirate & biops 0342 0.156 $9.26 $3.70 $1.85 G0365 S Vessel mapping hemo access 0267 2.6327 $156.23 $62.18 $31.25 G0366 B EKG for initial prevent exam G0367 S EKG tracing for initial prev 0099 0.3821 $22.67 $4.53 G0368 M EKG interpret & report preve G0369 M Pharm fee 1st month transpla G0370 M Pharmacy fee oral cancer etc G0371 M Pharm dispense inhalation 30 G0374 M Pharm dispense inhalation 90 G0375 S Smoke/Tobacco counseling 3-1 1491 $5.00 $1.00 G0376 S Smoke/Tobacco counseling >10 1491 $5.00 $1.00 G3001 S Admin + supply, tositumomab 1522 $2,250.00 $450.00 G9001 B MCCD, initial rate G9002 B MCCD,maintenance rate G9003 B MCCD, risk adj hi, initial G9004 B MCCD, risk adj lo, initial G9005 B MCCD, risk adj, maintenance G9006 B MCCD, Home monitoring G9007 B MCCD, sch team conf G9008 B Mccd,phys coor-care ovrsght G9009 E MCCD, risk adj, level 3 G9010 E MCCD, risk adj, level 4 G9011 E MCCD, risk adj, level 5 G9012 E Other Specified Case Mgmt G9013 E ESRD demo bundle level I G9014 E ESRD demo bundle-level II G9016 E Demo-smoking cessation coun G9017 A Amantadine HCL,oral G9018 A Zanamivir, inh pwdr G9019 A Oseltamivir phosp G9020 A Rimantadine HCL G9021 M Chemo assess nausea vomit L1 G9022 M Chemo assess nausea vomit L2 G9023 M Chemo assess nausea vomit L3 G9024 M Chemo assess nausea vomit L4 G9025 M Chemo assessment pain level1 G9026 M Chemo assessment pain level2 G9027 M Chemo assessment pain level3 G9028 M Chemo assessment pain level4 G9029 M Chemo assess for fatigue L1 G9030 M Chemo assess for fatigue L2 G9031 M Chemo assess for fatigue L3 G9032 M Chemo assess for fatigue L4 G9033 A Amantadine HCL, oral, brand G9034 A Zanamivir, inh pwdr, brand G9035 A Oseltamivir phosp, brand G9036 A Rimantadine HCL, brand G9041 A Low vision serv occupational G9042 A Low vision orient/mobility Start Printed Page 50857 G9043 A Low vision rehab therapist G9044 A Low vision rehab teacher J0120 N Tetracyclin injection J0128 G Abarelix injection 9216 $66.96 $13.39 J0130 K Abciximab injection 1605 $450.60 $90.12 J0135 K Adalimumab injection 1083 $300.10 $60.02 J0150 K Injection adenosine 6 MG 0379 $33.45 $6.69 J0152 K Adenosine injection 0917 $71.53 $14.31 J0170 N Adrenalin epinephrin inject J0180 K Agalsidase beta injection 9208 $123.35 $24.67 J0190 N Inj biperiden lactate/5 mg J0200 N Alatrofloxacin mesylate J0205 K Alglucerase injection 0900 $39.94 $7.99 J0207 K Amifostine 7000 $436.01 $87.20 J0210 K Methyldopate hcl injection 2210 $9.58 $1.92 J0215 B Alefacept J0256 K Alpha 1 proteinase inhibitor 0901 $3.30 $0.66 J0270 B Alprostadil for injection J0275 B Alprostadil urethral suppos J0280 N Aminophyllin 250 MG inj J0282 N Amiodarone HCl J0285 K Amphotericin B 9030 $30.70 $6.14 J0287 K Amphotericin b lipid complex 9024 $11.95 $2.39 J0288 K Ampho b cholesteryl sulfate 0735 $12.24 $2.45 J0289 K Amphotericin b liposome inj 0736 $21.91 $4.38 J0290 N Ampicillin 500 MG inj J0295 N Ampicillin sodium per 1.5 gm J0300 N Amobarbital 125 MG inj J0330 N Succinycholine chloride inj J0350 N Injection anistreplase 30 u J0360 N Hydralazine hcl injection J0380 N Inj metaraminol bitartrate J0390 N Chloroquine injection J0395 K Arbutamine HCl injection 9031 $163.15 $32.63 J0456 N Azithromycin J0460 N Atropine sulfate injection J0470 N Dimecaprol injection J0475 K Baclofen 10 MG injection 9032 $188.01 $37.60 J0476 B Baclofen intrathecal trial J0500 N Dicyclomine injection J0515 N Inj benztropine mesylate J0520 N Bethanechol chloride inject J0530 N Penicillin g benzathine inj J0540 N Penicillin g benzathine inj J0550 N Penicillin g benzathine inj J0560 N Penicillin g benzathine inj J0570 N Penicillin g benzathine inj J0580 K Penicillin g benzathine inj 0880 $72.26 $14.45 J0583 N Bivalirudin J0585 K Botulinum toxin a per unit 0902 $4.80 $0.96 J0587 K Botulinum toxin type B 9018 $7.89 $1.58 J0592 N Buprenorphine hydrochloride J0595 N Butorphanol tartrate 1 mg J0600 K Edetate calcium disodium inj 0892 $40.34 $8.07 J0610 N Calcium gluconate injection J0620 N Calcium glycer & lact/10 ML J0630 K Calcitonin salmon injection 0893 $35.68 $7.14 J0636 N Inj calcitriol per 0.1 mcg J0637 K Caspofungin acetate 9019 $32.35 $6.47 J0640 N Leucovorin calcium injection J0670 N Inj mepivacaine HCL/10 ml J0690 N Cefazolin sodium injection J0692 N Cefepime HCl for injection J0694 N Cefoxitin sodium injection J0696 N Ceftriaxone sodium injection J0697 N Sterile cefuroxime injection Start Printed Page 50858 J0698 N Cefotaxime sodium injection J0702 N Betamethasone acet&sod phosp J0704 N Betamethasone sod phosp/4 MG J0706 K Caffeine citrate injection 0876 $3.34 $0.67 J0710 N Cephapirin sodium injection J0713 N Inj ceftazidime per 500 mg J0715 N Ceftizoxime sodium / 500 MG J0720 N Chloramphenicol sodium injec J0725 N Chorionic gonadotropin/1000u J0735 K Clonidine hydrochloride 0935 $57.47 $11.49 J0740 K Cidofovir injection 9033 $782.98 $156.60 J0743 N Cilastatin sodium injection J0744 N Ciprofloxacin iv J0745 N Inj codeine phosphate /30 MG J0760 N Colchicine injection J0770 N Colistimethate sodium inj J0780 N Prochlorperazine injection J0800 K Corticotropin injection 1280 $95.44 $19.09 J0835 K Inj cosyntropin per 0.25 MG 0835 $69.27 $13.85 J0850 K Cytomegalovirus imm IV /vial 0903 $683.07 $136.61 J0878 G Daptomycin injection 9124 $0.30 $0.06 J0880 E Darbepoetin alfa injection J0895 K Deferoxamine mesylate inj 0895 $14.91 $2.98 J0900 N Testosterone enanthate inj J0945 N Brompheniramine maleate inj J0970 N Estradiol valerate injection J1000 N Depo-estradiol cypionate inj J1020 N Methylprednisolone 20 MG inj J1030 N Methylprednisolone 40 MG inj J1040 N Methylprednisolone 80 MG inj J1051 N Medroxyprogesterone inj J1055 E Medrxyprogester acetate inj J1056 E MA/EC contraceptiveinjection J1060 N Testosterone cypionate 1 ML J1070 N Testosterone cypionat 100 MG J1080 N Testosterone cypionat 200 MG J1094 N Inj dexamethasone acetate J1100 N Dexamethasone sodium phos J1110 K Inj dihydroergotamine mesylt 1210 $27.82 $5.56 J1120 N Acetazolamid sodium injectio J1160 N Digoxin injection J1165 N Phenytoin sodium injection J1170 N Hydromorphone injection J1180 K Dyphylline injection 9166 $7.74 $1.55 J1190 K Dexrazoxane HCl injection 0726 $216.39 $43.28 J1200 N Diphenhydramine hcl injectio J1205 N Chlorothiazide sodium inj J1212 N Dimethyl sulfoxide 50% 50 ML J1230 N Methadone injection J1240 N Dimenhydrinate injection J1245 N Dipyridamole injection J1250 N Inj dobutamine HCL/250 mg J1260 K Dolasetron mesylate 0750 $6.55 $1.31 J1270 N Injection, doxercalciferol J1320 N Amitriptyline injection J1325 N Epoprostenol injection J1327 K Eptifibatide injection 1607 $12.73 $2.55 J1330 K Ergonovine maleate injection 1330 0.5263 $31.23 $6.25 J1335 N Ertapenem injection J1364 N Erythro lactobionate /500 MG J1380 N Estradiol valerate 10 MG inj J1390 N Estradiol valerate 20 MG inj J1410 K Inj estrogen conjugate 25 MG 9038 $57.77 $11.55 J1435 N Injection estrone per 1 MG J1436 K Etidronate disodium inj 1436 $68.69 $13.74 J1438 K Etanercept injection 1608 $152.11 $30.42 Start Printed Page 50859 J1440 K Filgrastim 300 mcg injection 0728 $178.39 $35.68 J1441 K Filgrastim 480 mcg injection 7049 $282.29 $56.46 J1450 N Fluconazole J1452 K Intraocular Fomivirsen na 9040 $203.93 $40.79 J1455 N Foscarnet sodium injection J1457 K Gallium nitrate injection 1085 $1.30 $0.26 J1460 N Gamma globulin 1 CC inj J1470 B Gamma globulin 2 CC inj J1480 B Gamma globulin 3 CC inj J1490 B Gamma globulin 4 CC inj J1500 B Gamma globulin 5 CC inj J1510 B Gamma globulin 6 CC inj J1520 B Gamma globulin 7 CC inj J1530 B Gamma globulin 8 CC inj J1540 B Gamma globulin 9 CC inj J1550 B Gamma globulin 10 CC inj J1560 B Gamma globulin > 10 CC inj J1563 E IV immune globulin J1564 E Immune globulin 10 mg J1565 K RSV-ivig 0906 $15.56 $3.11 J1570 N Ganciclovir sodium injection J1580 N Garamycin gentamicin inj J1590 N Gatifloxacin injection J1595 N Injection glatiramer acetate J1600 N Gold sodium thiomaleate inj J1610 K Glucagon hydrochloride/1 MG 9042 $62.16 $12.43 J1620 K Gonadorelin hydroch/ 100 mcg 7005 $173.44 $34.69 J1626 K Granisetron HCl injection 0764 $7.24 $1.45 J1630 N Haloperidol injection J1631 N Haloperidol decanoate inj J1642 N Inj heparin sodium per 10 u J1644 N Inj heparin sodium per 1000u J1645 N Dalteparin sodium J1650 N Inj enoxaparin sodium J1652 N Fondaparinux sodium J1655 K Tinzaparin sodium injection 1655 $2.53 $0.51 J1670 K Tetanus immune globulin inj 1670 $76.90 $15.38 J1700 N Hydrocortisone acetate inj J1710 N Hydrocortisone sodium ph inj J1720 N Hydrocortisone sodium succ i J1730 K Diazoxide injection 1740 $113.86 $22.77 J1742 K Ibutilide fumarate injection 9044 $243.34 $48.67 J1745 K Infliximab injection 7043 $54.20 $10.84 J1750 K Iron dextran 9045 $11.43 $2.29 J1756 K Iron sucrose injection 9046 $0.38 $0.08 J1785 K Injection imiglucerase /unit 0916 $3.98 $0.80 J1790 N Droperidol injection J1800 N Propranolol injection J1810 E Droperidol/fentanyl inj J1815 N Insulin injection J1817 N Insulin for insulin pump use J1825 E Interferon beta-1a J1830 K Interferon beta-1b / .25 MG 0910 $81.95 $16.39 J1835 K Itraconazole injection 9047 $36.93 $7.39 J1840 N Kanamycin sulfate 500 MG inj J1850 N Kanamycin sulfate 75 MG inj J1885 N Ketorolac tromethamine inj J1890 N Cephalothin sodium injection J1931 K Laronidase injection 9209 $23.16 $4.63 J1940 N Furosemide injection J1950 K Leuprolide acetate /3.75 MG 0800 $441.78 $88.36 J1955 B Inj levocarnitine per 1 gm J1956 N Levofloxacin injection J1960 N Levorphanol tartrate inj J1980 N Hyoscyamine sulfate inj J1990 N Chlordiazepoxide injection Start Printed Page 50860 J2001 N Lidocaine injection J2010 N Lincomycin injection J2020 K Linezolid injection 9001 $24.15 $4.83 J2060 N Lorazepam injection J2150 N Mannitol injection J2175 N Meperidine hydrochl /100 MG J2180 N Meperidine/promethazine inj J2185 N Meropenem J2210 N Methylergonovin maleate inj J2250 N Inj midazolam hydrochloride J2260 N Inj milrinone lactate / 5 MG J2270 N Morphine sulfate injection J2271 N Morphine so4 injection 100mg J2275 N Morphine sulfate injection J2280 N Inj, moxifloxacin 100 mg J2300 N Inj nalbuphine hydrochloride J2310 N Inj naloxone hydrochloride J2320 N Nandrolone decanoate 50 MG J2321 N Nandrolone decanoate 100 MG J2322 N Nandrolone decanoate 200 MG J2324 K Nesiritide 9114 $75.19 $15.04 J2353 K Octreotide injection, depot 1207 $87.40 $17.48 J2354 N Octreotide inj, non-depot J2355 K Oprelvekin injection 7011 $249.06 $49.81 J2357 G Omalizumab injection 9300 $15.98 $3.20 J2360 N Orphenadrine injection J2370 N Phenylephrine hcl injection J2400 N Chloroprocaine hcl injection J2405 K Ondansetron hcl injection 0768 $3.80 $0.76 J2410 N Oxymorphone hcl injection J2430 K Pamidronate disodium /30 MG 0730 $58.42 $11.68 J2440 N Papaverin hcl injection J2460 N Oxytetracycline injection J2469 K Palonosetron HCl 9210 $18.42 $3.68 J2501 N Paricalcitol J2505 K Injection, pegfilgrastim 6mg 9119 $2,178.28 $435.66 J2510 N Penicillin g procaine inj J2515 N Pentobarbital sodium inj J2540 N Penicillin g potassium inj J2543 N Piperacillin/tazobactam J2545 Y Pentamidine isethionte/300mg J2550 N Promethazine hcl injection J2560 N Phenobarbital sodium inj J2590 N Oxytocin injection J2597 N Inj desmopressin acetate J2650 N Prednisolone acetate inj J2670 N Totazoline hcl injection J2675 N Inj progesterone per 50 MG J2680 N Fluphenazine decanoate 25 MG J2690 N Procainamide hcl injection J2700 N Oxacillin sodium injeciton J2710 N Neostigmine methylslfte inj J2720 N Inj protamine sulfate/10 MG J2725 N Inj protirelin per 250 mcg J2730 K Pralidoxime chloride inj 2730 $76.68 $15.34 J2760 N Phentolaine mesylate inj J2765 N Metoclopramide hcl injection J2770 K Quinupristin/dalfopristin 2770 $105.48 $21.10 J2780 N Ranitidine hydrochloride inj J2783 G Rasburicase 0738 $109.18 $21.84 J2788 K Rho d immune globulin 50 mcg 9023 $25.08 $5.02 J2790 K Rho d immune globulin inj 0884 $113.91 $22.78 J2792 K Rho(D) immune globulin h, sd 1609 $12.04 $2.41 J2794 G Risperidone, long acting 9125 $4.71 $0.94 J2795 N Ropivacaine HCl injection J2800 N Methocarbamol injection Start Printed Page 50861 J2810 N Inj theophylline per 40 MG J2820 K Sargramostim injection 0731 $21.11 $4.22 J2910 N Aurothioglucose injeciton J2912 N Sodium chloride injection J2916 N Na ferric gluconate complex J2920 N Methylprednisolone injection J2930 N Methylprednisolone injection J2940 K Somatrem injection 2940 $43.14 $8.63 J2941 K Somatropin injection 7034 $42.93 $8.59 J2950 N Promazine hcl injection J2993 K Reteplase injection 9005 $898.81 $179.76 J2995 K Inj streptokinase /250000 IU 0911 $83.36 $16.67 J2997 K Alteplase recombinant 7048 $30.65 $6.13 J3000 N Streptomycin injection J3010 N Fentanyl citrate injeciton J3030 K Sumatriptan succinate / 6 MG 3030 $51.03 $10.21 J3070 N Pentazocine hcl injection J3100 K Tenecteplase injection 9002 $2,052.77 $410.55 J3105 N Terbutaline sulfate inj J3110 B Teriparatide injection J3120 N Testosterone enanthate inj J3130 N Testosterone enanthate inj J3140 N Testosterone suspension inj J3150 N Testosteron propionate inj J3230 N Chlorpromazine hcl injection J3240 K Thyrotropin injection 9108 $712.58 $142.52 J3246 K Tirofiban HCl 7041 $7.89 $1.58 J3250 N Trimethobenzamide hcl inj J3260 N Tobramycin sulfate injection J3265 N Injection torsemide 10 mg/ml J3280 N Thiethylperazine maleate inj J3301 N Triamcinolone acetonide inj J3302 N Triamcinolone diacetate inj J3303 N Triamcinolone hexacetonl inj J3305 K Inj trimetrexate glucoronate 7045 $139.85 $27.97 J3310 N Perphenazine injeciton J3315 K Triptorelin pamoate 9122 $369.98 $74.00 J3320 N Spectinomycn di-hcl inj J3350 K Urea injection 9051 1.0454 $62.04 $12.41 J3360 N Diazepam injection J3364 N Urokinase 5000 IU injection J3365 K Urokinase 250,000 IU inj 7036 $415.69 $83.14 J3370 N Vancomycin hcl injection J3396 K Verteporfin injection 1203 $9.16 $1.83 J3400 N Triflupromazine hcl inj J3410 N Hydroxyzine hcl injection J3411 N Thiamine hcl 100 mg J3415 N Pyridoxine hcl 100 mg J3420 N Vitamin b12 injection J3430 N Vitamin k phytonadione inj J3465 K Injection, voriconazole 1052 $4.63 $0.93 J3470 N Hyaluronidase injection J3475 N Inj magnesium sulfate J3480 N Inj potassium chloride J3485 N Zidovudine J3486 N Ziprasidone mesylate J3487 K Zoledronic acid 9115 $202.41 $40.48 J3490 N Drugs unclassified injection J3520 E Edetate disodium per 150 mg J3530 N Nasal vaccine inhalation J3535 E Metered dose inhaler drug J3570 E Laetrile amygdalin vit B17 J3590 N Unclassified biologics J7030 N Normal saline solution infus J7040 N Normal saline solution infus J7042 N 5% dextrose/normal saline Start Printed Page 50862 J7050 N Normal saline solution infus J7051 N Sterile saline/water J7060 N 5% dextrose/water J7070 N D5w infusion J7100 N Dextran 40 infusion J7110 N Dextran 75 infusion J7120 N Ringers lactate infusion J7130 N Hypertonic saline solution J7190 K Factor viii 0925 $0.51 $0.10 J7191 K Factor VIII (porcine) 0926 $1.75 $0.35 J7192 K Factor viii recombinant 0927 $0.94 $0.19 J7193 K Factor IX non-recombinant 0931 $0.75 $0.15 J7194 K Factor ix complex 0928 $0.52 $0.10 J7195 K Factor IX recombinant 0932 $0.86 $0.17 J7197 N Antithrombin iii injection J7198 K Anti-inhibitor 0929 $1.12 $0.22 J7199 B Hemophilia clot factor noc J7300 E Intraut copper contraceptive J7302 E Levonorgestrel iu contracept J7303 E Contraceptive vaginal ring J7304 E Contraceptive hormone patch J7308 K Aminolevulinic acid hcl top 7308 $96.79 $19.36 J7310 K Ganciclovir long act implant 0913 $4,318.68 $863.74 J7317 K Sodium hyaluronate injection 7316 $110.65 $22.13 J7320 K Hylan G-F 20 injection 1611 $203.15 $40.63 J7330 B Cultured chondrocytes implnt J7340 E Metabolic active D/E tissue J7342 K Metabolically active tissue 9054 $15.69 $3.14 J7343 B Nonmetabolic act d/e tissue J7344 K Nonmetabolic active tissue 9156 $53.76 $10.75 J7350 K Injectable human tissue 9055 $3.54 $0.71 J7500 N Azathioprine oral 50mg J7501 K Azathioprine parenteral 0887 $47.40 $9.48 J7502 K Cyclosporine oral 100 mg 0888 $3.94 $0.79 J7504 K Lymphocyte immune globulin 0890 $290.30 $58.06 J7505 K Monoclonal antibodies 7038 $885.36 77.07 J7506 N Prednisone oral J7507 K Tacrolimus oral per 1 MG 0891 $3.37 $0.67 J7509 N Methylprednisolone oral J7510 N Prednisolone oral per 5 mg J7511 K Antithymocyte globuln rabbit 9104 $299.47 $59.89 J7513 K Daclizumab, parenteral 1612 $381.48 $76.30 J7515 K Cyclosporine oral 25 mg 7515 $1.00 $0.20 J7516 N Cyclosporin parenteral 250mg J7517 K Mycophenolate mofetil oral 9015 $2.50 $0.50 J7518 G Mycophenolic acid 9219 $2.47 $0.49 J7520 K Sirolimus, oral 9020 $6.85 $1.37 J7525 K Tacrolimus injection 9006 $126.61 $25.32 J7599 N Immunosuppressive drug noc J7608 Y Acetylcysteine inh sol u d J7611 Y Albuterol concentrated form J7612 Y Levalbuterol concentrated J7613 Y Albuterol unit dose J7614 Y Levalbuterol unit dose J7616 Y Albuterol compound solution J7617 Y Levalbuterol compounded sol J7622 A Beclomethasone inhalatn sol J7624 A Betamethasone inhalation sol J7626 A Budesonide inhalation sol J7628 Y Bitolterol mes inhal sol con J7629 Y Bitolterol mes inh sol u d J7631 Y Cromolyn sodium inh sol u d J7633 N Budesonide concentrated sol J7635 Y Atropine inhal sol con J7636 Y Atropine inhal sol unit dose J7637 Y Dexamethasone inhal sol con Start Printed Page 50863 J7638 Y Dexamethasone inhal sol u d J7639 Y Dornase alpha inhal sol u d J7641 A Flunisolide, inhalation sol J7642 Y Glycopyrrolate inhal sol con J7643 Y Glycopyrrolate inhal sol u d J7644 Y Ipratropium brom inh sol u d J7648 Y Isoetharine hcl inh sol con J7649 Y Isoetharine hcl inh sol u d J7658 Y Isoproterenolhcl inh sol con J7659 Y Isoproterenol hcl inh sol ud J7668 Y Metaproterenol inh sol con J7669 Y Metaproterenol inh sol u d J7674 N Methacholine chloride, neb J7680 Y Terbutaline so4 inh sol con J7681 Y Terbutaline so4 inh sol u d J7682 Y Tobramycin inhalation sol J7683 Y Triamcinolone inh sol con J7684 Y Triamcinolone inh sol u d J7699 Y Inhalation solution for DME J7799 Y Non-inhalation drug for DME J8499 E Oral prescrip drug non chemo J8501 G Oral aprepitant 0868 $4.75 $0.95 J8510 K Oral busulfan 7015 $1.98 $0.40 J8520 K Capecitabine, oral, 150 mg 7042 $3.30 $0.66 J8521 E Capecitabine, oral, 500 mg J8530 N Cyclophosphamide oral 25 MG J8560 K Etoposide oral 50 MG 0802 $41.12 $8.22 J8565 E Gefitinib oral J8600 N Melphalan oral 2 MG J8610 N Methotrexate oral 2.5 MG J8700 K Temozolomide 1086 $7.28 $1.46 J8999 B Oral prescription drug chemo J9000 N Doxorubic hcl 10 MG vl chemo J9001 K Doxorubicin hcl liposome inj 7046 $365.64 $73.13 J9010 K Alemtuzumab injection 9110 $516.87 $103.37 J9015 K Aldesleukin/single use vial 0807 $701.76 $140.35 J9017 K Arsenic trioxide 9012 $33.76 $6.75 J9020 K Asparaginase injection 0814 $55.42 $11.08 J9031 K Bcg live intravesical vac 0809 $121.74 $24.35 J9035 G Bevacizumab injection 9214 $58.17 $11.63 J9040 K Bleomycin sulfate injection 0857 $54.18 $10.84 J9041 K Bortezomib injection 9207 $28.90 $5.78 J9045 K Carboplatin injection 0811 $77.16 $15.43 J9050 K Carmus bischl nitro inj 0812 $141.29 $28.26 J9055 G Cetuximab injection 9215 $50.59 $10.12 J9060 N Cisplatin 10 MG injection J9062 B Cisplatin 50 MG injection J9065 K Inj cladribine per 1 MG 0858 $39.37 $7.87 J9070 N Cyclophosphamide 100 MG inj J9080 B Cyclophosphamide 200 MG inj J9090 B Cyclophosphamide 500 MG inj J9091 B Cyclophosphamide 1.0 grm inj J9092 B Cyclophosphamide 2.0 grm inj J9093 N Cyclophosphamide lyophilized J9094 B Cyclophosphamide lyophilized J9095 B Cyclophosphamide lyophilized J9096 B Cyclophosphamide lyophilized J9097 B Cyclophosphamide lyophilized J9098 K Cytarabine liposome 1166 $366.43 $73.29 J9100 N Cytarabine hcl 100 MG inj J9110 B Cytarabine hcl 500 MG inj J9120 N Dactinomycin actinomycin d J9130 K Dacarbazine 100 mg inj 0819 $6.20 $1.24 J9140 B Dacarbazine 200 MG inj J9150 K Daunorubicin 0820 $35.28 $7.06 J9151 K Daunorubicin citrate liposom 0821 $57.56 $11.51 Start Printed Page 50864 J9160 K Denileukin diftitox, 300 mcg 1084 $1,235.33 $247.07 J9165 N Diethylstilbestrol injection J9170 K Docetaxel 0823 $301.17 $60.23 J9178 K Inj, epirubicin hcl, 2 mg 1167 $25.15 $5.03 J9181 N Etoposide 10 MG inj J9182 B Etoposide 100 MG inj J9185 K Fludarabine phosphate inj 0842 $262.41 $52.48 J9190 N Fluorouracil injection J9200 K Floxuridine injection 0827 $60.17 $12.03 J9201 K Gemcitabine HCl 0828 $117.45 $23.49 J9202 K Goserelin acetate implant 0810 $196.25 $39.25 J9206 K Irinotecan injection 0830 $129.08 $25.82 J9208 K Ifosfomide injection 0831 $53.54 $10.71 J9209 K Mesna injection 0732 $13.68 $2.74 J9211 K Idarubicin hcl injection 0832 $314.00 $62.80 J9212 K Interferon alfacon-1 0912 $3.91 $0.78 J9213 K Interferon alfa-2a inj 0834 $31.75 $6.35 J9214 K Interferon alfa-2b inj 0836 $13.22 $2.64 J9215 K Interferon alfa-n3 inj 0865 $8.77 $1.75 J9216 K Interferon gamma 1-b inj 0838 $277.79 $55.56 J9217 K Leuprolide acetate suspnsion 9217 $230.87 $46.17 J9218 K Leuprolide acetate injeciton 0861 $10.96 $2.19 J9219 K Leuprolide acetate implant 7051 $2,262.19 $452.44 J9230 N Mechlorethamine hcl inj J9245 K Inj melphalan hydrochl 50 MG 0840 $523.22 $104.64 J9250 N Methotrexate sodium inj J9260 B Methotrexate sodium inj J9263 B Oxaliplatin J9265 K Paclitaxel injection 0863 $19.11 $3.82 J9266 K Pegaspargase/singl dose vial 0843 $1,528.80 $305.76 J9268 K Pentostatin injection 0844 $1,868.91 $373.78 J9270 K Plicamycin (mithramycin) inj 0860 $80.54 $16.11 J9280 K Mitomycin 5 MG inj 0862 $26.36 $5.27 J9290 B Mitomycin 20 MG inj J9291 B Mitomycin 40 MG inj J9293 K Mitoxantrone hydrochl / 5 MG 0864 $329.69 $65.94 J9300 K Gemtuzumab ozogamicin 9004 $2,245.04 $449.01 J9305 G Pemetrexed injection 9213 $41.29 $8.26 J9310 K Rituximab cancer treatment 0849 $447.97 $89.59 J9320 K Streptozocin injection 0850 $153.33 $30.67 J9340 K Thiotepa injection 0851 $44.55 $8.91 J9350 K Topotecan 0852 $755.51 $151.10 J9355 K Trastuzumab 1613 $53.98 $10.80 J9357 K Valrubicin, 200 mg 9167 $376.87 $75.37 J9360 N Vinblastine sulfate inj J9370 N Vincristine sulfate 1 MG inj J9375 B Vincristine sulfate 2 MG inj J9380 B Vincristine sulfate 5 MG inj J9390 K Vinorelbine tartrate/10 mg 0855 $62.85 $12.57 J9395 K Injection, Fulvestrant 9120 $82.90 $16.58 J9600 K Porfimer sodium 0856 $2,457.97 $491.59 J9999 N Chemotherapy drug K0001 Y Standard wheelchair K0002 Y Stnd hemi (low seat) whlchr K0003 Y Lightweight wheelchair K0004 Y High strength ltwt whlchr K0005 Y Ultralightweight wheelchair K0006 Y Heavy duty wheelchair K0007 Y Extra heavy duty wheelchair K0009 Y Other manual wheelchair/base K0010 Y Stnd wt frame power whlchr K0011 Y Stnd wt pwr whlchr w control K0012 Y Ltwt portbl power whlchr K0014 Y Other power whlchr base K0015 Y Detach non-adjus hght armrst K0017 Y Detach adjust armrest base Start Printed Page 50865 K0018 Y Detach adjust armrst upper K0019 Y Arm pad each K0020 Y Fixed adjust armrest pair K0037 Y High mount flip-up footrest K0038 Y Leg strap each K0039 Y Leg strap h style each K0040 Y Adjustable angle footplate K0041 Y Large size footplate each K0042 Y Standard size footplate each K0043 Y Ftrst lower extension tube K0044 Y Ftrst upper hanger bracket K0045 Y Footrest complete assembly K0046 Y Elevat legrst low extension K0047 Y Elevat legrst up hangr brack K0050 Y Ratchet assembly K0051 Y Cam relese assem ftrst/lgrst K0052 Y Swingaway detach footrest K0053 Y Elevate footrest articulate K0056 Y Seat ht <17 or >=21 ltwt wc K0064 Y Zero pressure tube flat free K0065 Y Spoke protectors K0066 Y Solid tire any size each K0067 Y Pneumatic tire any size each K0068 Y Pneumatic tire tube each K0069 Y Rear whl complete solid tire K0070 Y Rear whl compl pneum tire K0071 Y Front castr compl pneum tire K0072 Y Frnt cstr cmpl sem-pneum tir K0073 Y Caster pin lock each K0074 Y Pneumatic caster tire each K0075 Y Semi-pneumatic caster tire K0076 Y Solid caster tire each K0077 Y Front caster assem complete K0078 Y Pneumatic caster tire tube K0090 Y Rear tire power wheelchair K0091 Y Rear tire tube power whlchr K0092 Y Rear assem cmplt powr whlchr K0093 Y Rear zero pressure tire tube K0094 Y Wheel tire for power base K0095 Y Wheel tire tube each base K0096 Y Wheel assem powr base complt K0097 Y Wheel zero presure tire tube K0098 Y Drive belt power wheelchair K0099 Y Pwr wheelchair front caster K0102 Y Crutch and cane holder K0104 Y Cylinder tank carrier K0105 Y Iv hanger K0106 Y Arm trough each K0108 Y W/c component-accessory NOS K0195 Y Elevating whlchair leg rests K0415 B RX antiemetic drg, oral NOS K0416 B Rx antiemetic drg,rectal NOS K0452 Y Wheelchair bearings K0455 Y Pump uninterrupted infusion K0462 Y Temporary replacement eqpmnt K0552 Y Supply/Ext inf pump syr type K0600 Y Functional neuromuscularstim K0601 Y Repl batt silver oxide 1.5 v K0602 Y Repl batt silver oxide 3 v K0603 Y Repl batt alkaline 1.5 v K0604 Y Repl batt lithium 3.6 v K0605 Y Repl batt lithium 4.5 v K0606 Y AED garment w/elec analysis K0607 Y Repl batt for AED K0608 Y Repl garment for AED K0609 Y Repl electrode for AED Start Printed Page 50866 K0618 A TLSO 2 piece rigid shell K0619 A TLSO 3 piece rigid shell K0620 A Tubular elastic dressing K0628 Y Mult dens insert direct form K0629 Y Mult dens insert custom mold K0630 Y SIO flex pelvisacral prefab K0631 Y SIO flex pelvisacral custom K0632 Y SIO panel prefab K0633 Y SIO panel custom K0634 Y LO flexibl L1 - below L5 pre K0635 Y LO sag stays/panels pre-fab K0636 Y LO sagitt rigid panel prefab K0637 Y LO flex w/o rigid stays pre K0638 Y LSO flex w/rigid stays cust K0639 Y LSO post rigid panel pre K0640 Y LSO sag-coro rigid frame pre K0641 Y LSO sag-cor rigid frame cust K0642 Y LSO flexion control prefab K0643 Y LSO flexion control custom K0644 Y LSO sagit rigid panel prefab K0645 Y LSO sagittal rigid panel cus K0646 Y LSO sag-coronal panel prefab K0647 Y LSO sag-coronal panel custom K0648 Y LSO s/c shell/panel prefab K0649 Y LSO s/c shell/panel custom K0669 Y W/c seat/back no CVR SADMERC K0670 A Stance phase only K0671 Y Portable oxygen concentrator L0100 A Cranial orthosis/helmet mold L0110 A Cranial orthosis/helmet nonm L0112 A Cranial cervical orthosis L0120 A Cerv flexible non-adjustable L0130 A Flex thermoplastic collar mo L0140 A Cervical semi-rigid adjustab L0150 A Cerv semi-rig adj molded chn L0160 A Cerv semi-rig wire occ/mand L0170 A Cervical collar molded to pt L0172 A Cerv col thermplas foam 2 pi L0174 A Cerv col foam 2 piece w thor L0180 A Cer post col occ/man sup adj L0190 A Cerv collar supp adj cerv ba L0200 A Cerv col supp adj bar & thor L0210 A Thoracic rib belt L0220 A Thor rib belt custom fabrica L0430 A Dewall posture protector L0450 A TLSO flex prefab thoracic L0452 A tlso flex custom fab thoraci L0454 A TLSO flex prefab sacrococ-T9 L0456 A TLSO flex prefab L0458 A TLSO 2Mod symphis-xipho pre L0460 A TLSO2Mod symphysis-stern pre L0462 A TLSO 3Mod sacro-scap pre L0464 A TLSO 4Mod sacro-scap pre L0466 A TLSO rigid frame pre soft ap L0468 A TLSO rigid frame prefab pelv L0470 A TLSO rigid frame pre subclav L0472 A TLSO rigid frame hyperex pre L0480 A TLSO rigid plastic custom fa L0482 A TLSO rigid lined custom fab L0484 A TLSO rigid plastic cust fab L0486 A TLSO rigidlined cust fab two L0488 A TLSO rigid lined pre one pie L0490 A TLSO rigid plastic pre one L0700 A Ctlso a-p-l control molded L0710 A Ctlso a-p-l control w/ inter L0810 A Halo cervical into jckt vest Start Printed Page 50867 L0820 A Halo cervical into body jack L0830 A Halo cerv into milwaukee typ L0860 A Magnetic resonanc image comp L0861 A Halo repl liner/interface L0960 E Post surgical support pads L0970 A Tlso corset front L0972 A Lso corset front L0974 A Tlso full corset L0976 A Lso full corset L0978 A Axillary crutch extension L0980 A Peroneal straps pair L0982 A Stocking supp grips set of f L0984 A Protective body sock each L0999 A Add to spinal orthosis NOS L1000 A Ctlso milwauke initial model L1005 A Tension based scoliosis orth L1010 A Ctlso axilla sling L1020 A Kyphosis pad L1025 A Kyphosis pad floating L1030 A Lumbar bolster pad L1040 A Lumbar or lumbar rib pad L1050 A Sternal pad L1060 A Thoracic pad L1070 A Trapezius sling L1080 A Outrigger L1085 A Outrigger bil w/ vert extens L1090 A Lumbar sling L1100 A Ring flange plastic/leather L1110 A Ring flange plas/leather mol L1120 A Covers for upright each L1200 A Furnsh initial orthosis only L1210 A Lateral thoracic extension L1220 A Anterior thoracic extension L1230 A Milwaukee type superstructur L1240 A Lumbar derotation pad L1250 A Anterior asis pad L1260 A Anterior thoracic derotation L1270 A Abdominal pad L1280 A Rib gusset (elastic) each L1290 A Lateral trochanteric pad L1300 A Body jacket mold to patient L1310 A Post-operative body jacket L1499 A Spinal orthosis NOS L1500 A Thkao mobility frame L1510 A Thkao standing frame L1520 A Thkao swivel walker L1600 A Abduct hip flex frejka w cvr L1610 A Abduct hip flex frejka covr L1620 A Abduct hip flex pavlik harne L1630 A Abduct control hip semi-flex L1640 A Pelv band/spread bar thigh c L1650 A HO abduction hip adjustable L1652 A HO bi thighcuffs w sprdr bar L1660 A HO abduction static plastic L1680 A Pelvic & hip control thigh c L1685 A Post-op hip abduct custom fa L1686 A HO post-op hip abduction L1690 A Combination bilateral HO L1700 A Leg perthes orth toronto typ L1710 A Legg perthes orth newington L1720 A Legg perthes orthosis trilat L1730 A Legg perthes orth scottish r L1750 A Legg perthes sling L1755 A Legg perthes patten bottom t L1800 A Knee orthoses elas w stays L1810 A Ko elastic with joints Start Printed Page 50868 L1815 A Elastic with condylar pads L1820 A Ko elas w/ condyle pads & jo L1825 A Ko elastic knee cap L1830 A Ko immobilizer canvas longit L1831 A Knee orth pos locking joint L1832 A KO adj jnt pos rigid support L1834 A Ko w/0 joint rigid molded to L1836 A Rigid KO wo joints L1840 A Ko derot ant cruciate custom L1843 A KO single upright custom fit L1844 A Ko w/adj jt rot cntrl molded L1845 A Ko w/ adj flex/ext rotat cus L1846 A Ko w adj flex/ext rotat mold L1847 A KO adjustable w air chambers L1850 A Ko swedish type L1855 A Ko plas doub upright jnt mol L1858 A Ko polycentric pneumatic pad L1860 A Ko supracondylar socket mold L1870 A Ko doub upright lacers molde L1880 A Ko doub upright cuffs/lacers L1900 A Afo sprng wir drsflx calf bd L1901 A Prefab ankle orthosis L1902 A Afo ankle gauntlet L1904 A Afo molded ankle gauntlet L1906 A Afo multiligamentus ankle su L1907 A AFO supramalleolar custom L1910 A Afo sing bar clasp attach sh L1920 A Afo sing upright w/ adjust s L1930 A Afo plastic L1932 A Afo rig ant tib prefab TCF/= L1940 A Afo molded to patient plasti L1945 A Afo molded plas rig ant tib L1950 A Afo spiral molded to pt plas L1951 A AFO spiral prefabricated L1960 A Afo pos solid ank plastic mo L1970 A Afo plastic molded w/ankle j L1971 A AFO w/ankle joint, prefab L1980 A Afo sing solid stirrup calf L1990 A Afo doub solid stirrup calf L2000 A Kafo sing fre stirr thi/calf L2005 A KAFO sng/dbl mechanical act L2010 A Kafo sng solid stirrup w/o j L2020 A Kafo dbl solid stirrup band/ L2030 A Kafo dbl solid stirrup w/o j L2035 A KAFO plastic pediatric size L2036 A Kafo plas doub free knee mol L2037 A Kafo plas sing free knee mol L2038 A Kafo w/o joint multi-axis an L2039 A KAFO,plstic,medlat rotat con L2040 A Hkafo torsion bil rot straps L2050 A Hkafo torsion cable hip pelv L2060 A Hkafo torsion ball bearing j L2070 A Hkafo torsion unilat rot str L2080 A Hkafo unilat torsion cable L2090 A Hkafo unilat torsion ball br L2106 A Afo tib fx cast plaster mold L2108 A Afo tib fx cast molded to pt L2112 A Afo tibial fracture soft L2114 A Afo tib fx semi-rigid L2116 A Afo tibial fracture rigid L2126 A Kafo fem fx cast thermoplas L2128 A Kafo fem fx cast molded to p L2132 A Kafo femoral fx cast soft L2134 A Kafo fem fx cast semi-rigid L2136 A Kafo femoral fx cast rigid L2180 A Plas shoe insert w ank joint Start Printed Page 50869 L2182 A Drop lock knee L2184 A Limited motion knee joint L2186 A Adj motion knee jnt lerman t L2188 A Quadrilateral brim L2190 A Waist belt L2192 A Pelvic band & belt thigh fla L2200 A Limited ankle motion ea jnt L2210 A Dorsiflexion assist each joi L2220 A Dorsi & plantar flex ass/res L2230 A Split flat caliper stirr & p L2232 A Rocker bottom, contact AFO L2240 A Round caliper and plate atta L2250 A Foot plate molded stirrup at L2260 A Reinforced solid stirrup L2265 A Long tongue stirrup L2270 A Varus/valgus strap padded/li L2275 A Plastic mod low ext pad/line L2280 A Molded inner boot L2300 A Abduction bar jointed adjust L2310 A Abduction bar-straight L2320 A Non-molded lacer L2330 A Lacer molded to patient mode L2335 A Anterior swing band L2340 A Pre-tibial shell molded to p L2350 A Prosthetic type socket molde L2360 A Extended steel shank L2370 A Patten bottom L2375 A Torsion ank & half solid sti L2380 A Torsion straight knee joint L2385 A Straight knee joint heavy du L2390 A Offset knee joint each L2395 A Offset knee joint heavy duty L2397 A Suspension sleeve lower ext L2405 A Knee joint drop lock ea jnt L2415 A Knee joint cam lock each joi L2425 A Knee disc/dial lock/adj flex L2430 A Knee jnt ratchet lock ea jnt L2492 A Knee lift loop drop lock rin L2500 A Thi/glut/ischia wgt bearing L2510 A Th/wght bear quad-lat brim m L2520 A Th/wght bear quad-lat brim c L2525 A Th/wght bear nar m-l brim mo L2526 A Th/wght bear nar m-l brim cu L2530 A Thigh/wght bear lacer non-mo L2540 A Thigh/wght bear lacer molded L2550 A Thigh/wght bear high roll cu L2570 A Hip clevis type 2 posit jnt L2580 A Pelvic control pelvic sling L2600 A Hip clevis/thrust bearing fr L2610 A Hip clevis/thrust bearing lo L2620 A Pelvic control hip heavy dut L2622 A Hip joint adjustable flexion L2624 A Hip adj flex ext abduct cont L2627 A Plastic mold recipro hip & c L2628 A Metal frame recipro hip & ca L2630 A Pelvic control band & belt u L2640 A Pelvic control band & belt b L2650 A Pelv & thor control gluteal L2660 A Thoracic control thoracic ba L2670 A Thorac cont paraspinal uprig L2680 A Thorac cont lat support upri L2750 A Plating chrome/nickel pr bar L2755 A Carbon graphite lamination L2760 A Extension per extension per L2768 A Ortho sidebar disconnect L2770 A Low ext orthosis per bar/jnt Start Printed Page 50870 L2780 A Non-corrosive finish L2785 A Drop lock retainer each L2795 A Knee control full kneecap L2800 A Knee cap medial or lateral p L2810 A Knee control condylar pad L2820 A Soft interface below knee se L2830 A Soft interface above knee se L2840 A Tibial length sock fx or equ L2850 A Femoral lgth sock fx or equa L2860 A Torsion mechanism knee/ankle L2999 A Lower extremity orthosis NOS L3000 B Ft insert ucb berkeley shell L3001 B Foot insert remov molded spe L3002 B Foot insert plastazote or eq L3003 B Foot insert silicone gel eac L3010 B Foot longitudinal arch suppo L3020 B Foot longitud/metatarsal sup L3030 B Foot arch support remov prem L3031 E Foot lamin/prepreg composite L3040 B Ft arch suprt premold longit L3050 B Foot arch supp premold metat L3060 B Foot arch supp longitud/meta L3070 B Arch suprt att to sho longit L3080 B Arch supp att to shoe metata L3090 B Arch supp att to shoe long/m L3100 B Hallus-valgus nght dynamic s L3140 B Abduction rotation bar shoe L3150 B Abduct rotation bar w/o shoe L3160 B Shoe styled positioning dev L3170 B Foot plastic heel stabilizer L3201 B Oxford w supinat/pronat inf L3202 B Oxford w/ supinat/pronator c L3203 B Oxford w/ supinator/pronator L3204 B Hightop w/ supp/pronator inf L3206 B Hightop w/ supp/pronator chi L3207 B Hightop w/ supp/pronator jun L3208 B Surgical boot each infant L3209 B Surgical boot each child L3211 B Surgical boot each junior L3212 B Benesch boot pair infant L3213 B Benesch boot pair child L3214 B Benesch boot pair junior L3215 B Orthopedic ftwear ladies oxf L3216 B Orthoped ladies shoes dpth i L3217 B Ladies shoes hightop depth i L3219 B Orthopedic mens shoes oxford L3221 B Orthopedic mens shoes dpth i L3222 B Mens shoes hightop depth inl L3224 A Womans shoe oxford brace L3225 A Mans shoe oxford brace L3230 B Custom shoes depth inlay L3250 B Custom mold shoe remov prost L3251 B Shoe molded to pt silicone s L3252 B Shoe molded plastazote cust L3253 B Shoe molded plastazote cust L3254 B Orth foot non-stndard size/w L3255 B Orth foot non-standard size/ L3257 B Orth foot add charge split s L3260 B Ambulatory surgical boot eac L3265 B Plastazote sandal each L3300 B Sho lift taper to metatarsal L3310 B Shoe lift elev heel/sole neo L3320 B Shoe lift elev heel/sole cor L3330 B Lifts elevation metal extens L3332 B Shoe lifts tapered to one-ha L3334 B Shoe lifts elevation heel /i Start Printed Page 50871 L3340 B Shoe wedge sach L3350 B Shoe heel wedge L3360 B Shoe sole wedge outside sole L3370 B Shoe sole wedge between sole L3380 B Shoe clubfoot wedge L3390 B Shoe outflare wedge L3400 B Shoe metatarsal bar wedge ro L3410 B Shoe metatarsal bar between L3420 B Full sole/heel wedge btween L3430 B Sho heel count plast reinfor L3440 B Heel leather reinforced L3450 B Shoe heel sach cushion type L3455 B Shoe heel new leather standa L3460 B Shoe heel new rubber standar L3465 B Shoe heel thomas with wedge L3470 B Shoe heel thomas extend to b L3480 B Shoe heel pad & depress for L3485 B Shoe heel pad removable for L3500 B Ortho shoe add leather insol L3510 B Orthopedic shoe add rub insl L3520 B O shoe add felt w leath insl L3530 B Ortho shoe add half sole L3540 B Ortho shoe add full sole L3550 B O shoe add standard toe tap L3560 B O shoe add horseshoe toe tap L3570 B O shoe add instep extension L3580 B O shoe add instep velcro clo L3590 B O shoe convert to sof counte L3595 B Ortho shoe add march bar L3600 B Trans shoe calip plate exist L3610 B Trans shoe caliper plate new L3620 B Trans shoe solid stirrup exi L3630 B Trans shoe solid stirrup new L3640 B Shoe dennis browne splint bo L3649 B Orthopedic shoe modifica NOS L3650 A Shlder fig 8 abduct restrain L3651 A Prefab shoulder orthosis L3652 A Prefab dbl shoulder orthosis L3660 A Abduct restrainer canvas&web L3670 A Acromio/clavicular canvas&we L3675 A Canvas vest SO L3677 E SO hard plastic stabilizer L3700 A Elbow orthoses elas w stays L3701 A Prefab elbow orthosis L3710 A Elbow elastic with metal joi L3720 A Forearm/arm cuffs free motio L3730 A Forearm/arm cuffs ext/flex a L3740 A Cuffs adj lock w/ active con L3760 A EO withjoint, Prefabricated L3762 A Rigid EO wo joints L3800 A Whfo short opponen no attach L3805 A Whfo long opponens no attach L3807 A WHFO,no joint, prefabricated L3810 A Whfo thumb abduction bar L3815 A Whfo second m.p. abduction a L3820 A Whfo ip ext asst w/ mp ext s L3825 A Whfo m.p. extension stop L3830 A Whfo m.p. extension assist L3835 A Whfo m.p. spring extension a L3840 A Whfo spring swivel thumb L3845 A Whfo thumb ip ext ass w/ mp L3850 A Action wrist w/ dorsiflex as L3855 A Whfo adj m.p. flexion contro L3860 A Whfo adj m.p. flex ctrl & i L3890 B Torsion mechanism wrist/elbo L3900 A Hinge extension/flex wrist/f Start Printed Page 50872 L3901 A Hinge ext/flex wrist finger L3902 E Whfo ext power compress gas L3904 A Whfo electric custom fitted L3906 A Wrist gauntlet molded to pt L3907 A Whfo wrst gauntlt thmb spica L3908 A Wrist cock-up non-molded L3909 A Prefab wrist orthosis L3910 A Whfo swanson design L3911 A Prefab hand finger orthosis L3912 A Flex glove w/elastic finger L3914 A WHO wrist extension cock-up L3916 A Whfo wrist extens w/ outrigg L3917 A Prefab metacarpl fx orthosis L3918 A HFO knuckle bender L3920 A Knuckle bender with outrigge L3922 A Knuckle bend 2 seg to flex j L3923 A HFO, no joint, prefabricated L3924 A Oppenheimer L3926 A Thomas suspension L3928 A Finger extension w/ clock sp L3930 A Finger extension with wrist L3932 A Safety pin spring wire L3934 A Safety pin modified L3936 A Palmer L3938 A Dorsal wrist L3940 A Dorsal wrist w/ outrigger at L3942 A Reverse knuckle bender L3944 A Reverse knuckle bend w/ outr L3946 A HFO composite elastic L3948 A Finger knuckle bender L3950 A Oppenheimer w/ knuckle bend L3952 A Oppenheimer w/ rev knuckle 2 L3954 A Spreading hand L3956 A Add joint upper ext orthosis L3960 A Sewho airplan desig abdu pos L3962 A Sewho erbs palsey design abd L3963 A Molded w/ articulating elbow L3964 Y Seo mobile arm sup att to wc L3965 Y Arm supp att to wc rancho ty L3966 Y Mobile arm supports reclinin L3968 Y Friction dampening arm supp L3969 Y Monosuspension arm/hand supp L3970 Y Elevat proximal arm support L3972 Y Offset/lat rocker arm w/ ela L3974 Y Mobile arm support supinator L3980 A Upp ext fx orthosis humeral L3982 A Upper ext fx orthosis rad/ul L3984 A Upper ext fx orthosis wrist L3985 A Forearm hand fx orth w/ wr h L3986 A Humeral rad/ulna wrist fx or L3995 A Sock fracture or equal each L3999 A Upper limb orthosis NOS L4000 A Repl girdle milwaukee orth L4002 A Replace strap, any orthosis L4010 A Replace trilateral socket br L4020 A Replace quadlat socket brim L4030 A Replace socket brim cust fit L4040 A Replace molded thigh lacer L4045 A Replace non-molded thigh lac L4050 A Replace molded calf lacer L4055 A Replace non-molded calf lace L4060 A Replace high roll cuff L4070 A Replace prox & dist upright L4080 A Repl met band kafo-afo prox L4090 A Repl met band kafo-afo calf/ L4100 A Repl leath cuff kafo prox th Start Printed Page 50873 L4110 A Repl leath cuff kafo-afo cal L4130 A Replace pretibial shell L4205 A Ortho dvc repair per 15 min L4210 A Orth dev repair/repl minor p L4350 A Ankle control orthosi prefab L4360 A Pneumati walking boot prefab L4370 A Pneumatic full leg splint L4380 A Pneumatic knee splint L4386 A Non-pneum walk boot prefab L4392 A Replace AFO soft interface L4394 A Replace foot drop spint L4396 A Static AFO L4398 A Foot drop splint recumbent L5000 A Sho insert w arch toe filler L5010 A Mold socket ank hgt w/ toe f L5020 A Tibial tubercle hgt w/ toe f L5050 A Ank symes mold sckt sach ft L5060 A Symes met fr leath socket ar L5100 A Molded socket shin sach foot L5105 A Plast socket jts/thgh lacer L5150 A Mold sckt ext knee shin sach L5160 A Mold socket bent knee shin s L5200 A Kne sing axis fric shin sach L5210 A No knee/ankle joints w/ ft b L5220 A No knee joint with artic ali L5230 A Fem focal defic constant fri L5250 A Hip canad sing axi cons fric L5270 A Tilt table locking hip sing L5280 A Hemipelvect canad sing axis L5301 A BK mold socket SACH ft endo L5311 A Knee disart, SACH ft, endo L5321 A AK open end SACH L5331 A Hip disart canadian SACH ft L5341 A Hemipelvectomy canadian SACH L5400 A Postop dress & 1 cast chg bk L5410 A Postop dsg bk ea add cast ch L5420 A Postop dsg & 1 cast chg ak/d L5430 A Postop dsg ak ea add cast ch L5450 A Postop app non-wgt bear dsg L5460 A Postop app non-wgt bear dsg L5500 A Init bk ptb plaster direct L5505 A Init ak ischal plstr direct L5510 A Prep BK ptb plaster molded L5520 A Perp BK ptb thermopls direct L5530 A Prep BK ptb thermopls molded L5535 A Prep BK ptb open end socket L5540 A Prep BK ptb laminated socket L5560 A Prep AK ischial plast molded L5570 A Prep AK ischial direct form L5580 A Prep AK ischial thermo mold L5585 A Prep AK ischial open end L5590 A Prep AK ischial laminated L5595 A Hip disartic sach thermopls L5600 A Hip disart sach laminat mold L5610 A Above knee hydracadence L5611 A Ak 4 bar link w/fric swing L5613 A Ak 4 bar ling w/hydraul swig L5614 A 4-bar link above knee w/swng L5616 A Ak univ multiplex sys frict L5617 A AK/BK self-aligning unit ea L5618 A Test socket symes L5620 A Test socket below knee L5622 A Test socket knee disarticula L5624 A Test socket above knee L5626 A Test socket hip disarticulat L5628 A Test socket hemipelvectomy Start Printed Page 50874 L5629 A Below knee acrylic socket L5630 A Syme typ expandabl wall sckt L5631 A Ak/knee disartic acrylic soc L5632 A Symes type ptb brim design s L5634 A Symes type poster opening so L5636 A Symes type medial opening so L5637 A Below knee total contact L5638 A Below knee leather socket L5639 A Below knee wood socket L5640 A Knee disarticulat leather so L5642 A Above knee leather socket L5643 A Hip flex inner socket ext fr L5644 A Above knee wood socket L5645 A Bk flex inner socket ext fra L5646 A Below knee cushion socket L5647 A Below knee suction socket L5648 A Above knee cushion socket L5649 A Isch containmt/narrow m-l so L5650 A Tot contact ak/knee disart s L5651 A Ak flex inner socket ext fra L5652 A Suction susp ak/knee disart L5653 A Knee disart expand wall sock L5654 A Socket insert symes L5655 A Socket insert below knee L5656 A Socket insert knee articulat L5658 A Socket insert above knee L5661 A Multi-durometer symes L5665 A Multi-durometer below knee L5666 A Below knee cuff suspension L5668 A Socket insert w/o lock lower L5670 A Bk molded supracondylar susp L5671 A BK/AK locking mechanism L5672 A Bk removable medial brim sus L5673 A Socket insert w lock mech L5676 A Bk knee joints single axis p L5677 A Bk knee joints polycentric p L5678 A Bk joint covers pair L5679 A Socket insert w/o lock mech L5680 A Bk thigh lacer non-molded L5681 A Intl custm cong/latyp insert L5682 A Bk thigh lacer glut/ischia m L5683 A Initial custom socket insert L5684 A Bk fork strap L5685 A Below knee sus/seal sleeve L5686 A Bk back check L5688 A Bk waist belt webbing L5690 A Bk waist belt padded and lin L5692 A Ak pelvic control belt light L5694 A Ak pelvic control belt pad/l L5695 A Ak sleeve susp neoprene/equa L5696 A Ak/knee disartic pelvic join L5697 A Ak/knee disartic pelvic band L5698 A Ak/knee disartic silesian ba L5699 A Shoulder harness L5700 A Replace socket below knee L5701 A Replace socket above knee L5702 A Replace socket hip L5704 A Custom shape cover BK L5705 A Custom shape cover AK L5706 A Custom shape cvr knee disart L5707 A Custom shape cvr hip disart L5710 A Kne-shin exo sng axi mnl loc L5711 A Knee-shin exo mnl lock ultra L5712 A Knee-shin exo frict swg & st L5714 A Knee-shin exo variable frict L5716 A Knee-shin exo mech stance ph Start Printed Page 50875 L5718 A Knee-shin exo frct swg & sta L5722 A Knee-shin pneum swg frct exo L5724 A Knee-shin exo fluid swing ph L5726 A Knee-shin ext jnts fld swg e L5728 A Knee-shin fluid swg & stance L5780 A Knee-shin pneum/hydra pneum L5781 A Lower limb pros vacuum pump L5782 A HD low limb pros vacuum pump L5785 A Exoskeletal bk ultralt mater L5790 A Exoskeletal ak ultra-light m L5795 A Exoskel hip ultra-light mate L5810 A Endoskel knee-shin mnl lock L5811 A Endo knee-shin mnl lck ultra L5812 A Endo knee-shin frct swg & st L5814 A Endo knee-shin hydral swg ph L5816 A Endo knee-shin polyc mch sta L5818 A Endo knee-shin frct swg & st L5822 A Endo knee-shin pneum swg frc L5824 A Endo knee-shin fluid swing p L5826 A Miniature knee joint L5828 A Endo knee-shin fluid swg/sta L5830 A Endo knee-shin pneum/swg pha L5840 A Multi-axial knee/shin system L5845 A Knee-shin sys stance flexion L5848 A Knee-shin sys hydraul stance L5850 A Endo ak/hip knee extens assi L5855 A Mech hip extension assist L5856 A Elec knee-shin swing/stance L5857 A Elec knee-shin swing only L5910 A Endo below knee alignable sy L5920 A Endo ak/hip alignable system L5925 A Above knee manual lock L5930 A High activity knee frame L5940 A Endo bk ultra-light material L5950 A Endo ak ultra-light material L5960 A Endo hip ultra-light materia L5962 A Below knee flex cover system L5964 A Above knee flex cover system L5966 A Hip flexible cover system L5968 A Multiaxial ankle w dorsiflex L5970 A Foot external keel sach foot L5972 A Flexible keel foot L5974 A Foot single axis ankle/foot L5975 A Combo ankle/foot prosthesis L5976 A Energy storing foot L5978 A Ft prosth multiaxial ankl/ft L5979 A Multi-axial ankle/ft prosth L5980 A Flex foot system L5981 A Flex-walk sys low ext prosth L5982 A Exoskeletal axial rotation u L5984 A Endoskeletal axial rotation L5985 A Lwr ext dynamic prosth pylon L5986 A Multi-axial rotation unit L5987 A Shank ft w vert load pylon L5988 A Vertical shock reducing pylo L5990 A User adjustable heel height L5995 A Lower ext pros heavyduty fea L5999 A Lowr extremity prosthes NOS L6000 A Par hand robin-aids thum rem L6010 A Hand robin-aids little/ring L6020 A Part hand robin-aids no fing L6025 A Part hand disart myoelectric L6050 A Wrst MLd sck flx hng tri pad L6055 A Wrst mold sock w/exp interfa L6100 A Elb mold sock flex hinge pad L6110 A Elbow mold sock suspension t Start Printed Page 50876 L6120 A Elbow mold doub splt soc ste L6130 A Elbow stump activated lock h L6200 A Elbow mold outsid lock hinge L6205 A Elbow molded w/ expand inter L6250 A Elbow inter loc elbow forarm L6300 A Shlder disart int lock elbow L6310 A Shoulder passive restor comp L6320 A Shoulder passive restor cap L6350 A Thoracic intern lock elbow L6360 A Thoracic passive restor comp L6370 A Thoracic passive restor cap L6380 A Postop dsg cast chg wrst/elb L6382 A Postop dsg cast chg elb dis/ L6384 A Postop dsg cast chg shlder/t L6386 A Postop ea cast chg & realign L6388 A Postop applicat rigid dsg on L6400 A Below elbow prosth tiss shap L6450 A Elb disart prosth tiss shap L6500 A Above elbow prosth tiss shap L6550 A Shldr disar prosth tiss shap L6570 A Scap thorac prosth tiss shap L6580 A Wrist/elbow bowden cable mol L6582 A Wrist/elbow bowden cbl dir f L6584 A Elbow fair lead cable molded L6586 A Elbow fair lead cable dir fo L6588 A Shdr fair lead cable molded L6590 A Shdr fair lead cable direct L6600 A Polycentric hinge pair L6605 A Single pivot hinge pair L6610 A Flexible metal hinge pair L6615 A Disconnect locking wrist uni L6616 A Disconnect insert locking wr L6620 A Flexion/extension wrist unit L6623 A Spring-ass rot wrst w/ latch L6625 A Rotation wrst w/ cable lock L6628 A Quick disconn hook adapter o L6629 A Lamination collar w/ couplin L6630 A Stainless steel any wrist L6632 A Latex suspension sleeve each L6635 A Lift assist for elbow L6637 A Nudge control elbow lock L6638 A Elec lock on manual pw elbow L6640 A Shoulder abduction joint pai L6641 A Excursion amplifier pulley t L6642 A Excursion amplifier lever ty L6645 A Shoulder flexion-abduction j L6646 A Multipo locking shoulder jnt L6647 A Shoulder lock actuator L6648 A Ext pwrd shlder lock/unlock L6650 A Shoulder universal joint L6655 A Standard control cable extra L6660 A Heavy duty control cable L6665 A Teflon or equal cable lining L6670 A Hook to hand cable adapter L6672 A Harness chest/shlder saddle L6675 A Harness figure of 8 sing con L6676 A Harness figure of 8 dual con L6680 A Test sock wrist disart/bel e L6682 A Test sock elbw disart/above L6684 A Test socket shldr disart/tho L6686 A Suction socket L6687 A Frame typ socket bel elbow/w L6688 A Frame typ sock above elb/dis L6689 A Frame typ socket shoulder di L6690 A Frame typ sock interscap-tho L6691 A Removable insert each Start Printed Page 50877 L6692 A Silicone gel insert or equal L6693 A Lockingelbow forearm cntrbal L6694 A Elbow socket ins use w/lock L6695 A Elbow socket ins use w/o lck L6696 A Cus elbo skt in for con/atyp L6697 A Cus elbo skt in not con/atyp L6698 A Below/above elbow lock mech L6700 A Terminal device model #3 L6705 A Terminal device model #5 L6710 A Terminal device model #5x L6715 A Terminal device model #5xa L6720 A Terminal device model #6 L6725 A Terminal device model #7 L6730 A Terminal device model #7lo L6735 A Terminal device model #8 L6740 A Terminal device model #8x L6745 A Terminal device model #88x L6750 A Terminal device model #10p L6755 A Terminal device model #10x L6765 A Terminal device model #12p L6770 A Terminal device model #99x L6775 A Terminal device model #555 L6780 A Terminal device model #ss555 L6790 A Hooks-accu hook or equal L6795 A Hooks-2 load or equal L6800 A Hooks-aprl vc or equal L6805 A Modifier wrist flexion unit L6806 A Trs grip vc or equal L6807 A Term device grip1/2 or equal L6808 A Term device infant or child L6809 A Trs super sport passive L6810 A Pincher tool otto bock or eq L6825 A Hands dorrance vo L6830 A Hand aprl vc L6835 A Hand sierra vo L6840 A Hand becker imperial L6845 A Hand becker lock grip L6850 A Term dvc-hand becker plylite L6855 A Hand robin-aids vo L6860 A Hand robin-aids vo soft L6865 A Hand passive hand L6867 A Hand detroit infant hand L6868 A Passive inf hand steeper/hos L6870 A Hand child mitt L6872 A Hand nyu child hand L6873 A Hand mech inf steeper or equ L6875 A Hand bock vc L6880 A Hand bock vo L6881 A Autograsp feature ul term dv L6882 A Microprocessor control uplmb L6890 A Production glove L6895 A Custom glove L6900 A Hand restorat thumb/1 finger L6905 A Hand restoration multiple fi L6910 A Hand restoration no fingers L6915 A Hand restoration replacmnt g L6920 A Wrist disarticul switch ctrl L6925 A Wrist disart myoelectronic c L6930 A Below elbow switch control L6935 A Below elbow myoelectronic ct L6940 A Elbow disarticulation switch L6945 A Elbow disart myoelectronic c L6950 A Above elbow switch control L6955 A Above elbow myoelectronic ct L6960 A Shldr disartic switch contro L6965 A Shldr disartic myoelectronic Start Printed Page 50878 L6970 A Interscapular-thor switch ct L6975 A Interscap-thor myoelectronic L7010 A Hand otto back steeper/eq sw L7015 A Hand sys teknik village swit L7020 A Electronic greifer switch ct L7025 A Electron hand myoelectronic L7030 A Hand sys teknik vill myoelec L7035 A Electron greifer myoelectro L7040 A Prehensile actuator hosmer s L7045 A Electron hook child michigan L7170 A Electronic elbow hosmer swit L7180 A Electronic elbow utah myoele L7181 A Electronic elbo simultaneous L7185 A Electron elbow adolescent sw L7186 A Electron elbow child switch L7190 A Elbow adolescent myoelectron L7191 A Elbow child myoelectronic ct L7260 A Electron wrist rotator otto L7261 A Electron wrist rotator utah L7266 A Servo control steeper or equ L7272 A Analogue control unb or equa L7274 A Proportional ctl 12 volt uta L7360 A Six volt bat otto bock/eq ea L7362 A Battery chrgr six volt otto L7364 A Twelve volt battery utah/equ L7366 A Battery chrgr 12 volt utah/e L7367 A Replacemnt lithium ionbatter L7368 A Lithium ion battery charger L7499 A Upper extremity prosthes NOS L7500 A Prosthetic dvc repair hourly L7510 A Prosthetic device repair rep L7520 A Repair prosthesis per 15 min L7900 A Male vacuum erection system L8000 A Mastectomy bra L8001 A Breast prosthesis bra & form L8002 A Brst prsth bra & bilat form L8010 A Mastectomy sleeve L8015 A Ext breastprosthesis garment L8020 A Mastectomy form L8030 A Breast prosthesis silicone/e L8035 A Custom breast prosthesis L8039 A Breast prosthesis NOS L8040 A Nasal prosthesis L8041 A Midfacial prosthesis L8042 A Orbital prosthesis L8043 A Upper facial prosthesis L8044 A Hemi-facial prosthesis L8045 A Auricular prosthesis L8046 A Partial facial prosthesis L8047 A Nasal septal prosthesis L8048 A Unspec maxillofacial prosth L8049 A Repair maxillofacial prosth L8100 E Compression stocking BK18-30 L8110 A Compression stocking BK30-40 L8120 A Compression stocking BK40-50 L8130 E Gc stocking thighlngth 18-30 L8140 E Gc stocking thighlngth 30-40 L8150 E Gc stocking thighlngth 40-50 L8160 E Gc stocking full lngth 18-30 L8170 E Gc stocking full lngth 30-40 L8180 E Gc stocking full lngth 40-50 L8190 E Gc stocking waistlngth 18-30 L8195 E Gc stocking waistlngth 30-40 L8200 E Gc stocking waistlngth 40-50 L8210 E Gc stocking custom made L8220 E Gc stocking lymphedema Start Printed Page 50879 L8230 E Gc stocking garter belt L8239 E G compression stocking NOS L8300 A Truss single w/ standard pad L8310 A Truss double w/ standard pad L8320 A Truss addition to std pad wa L8330 A Truss add to std pad scrotal L8400 A Sheath below knee L8410 A Sheath above knee L8415 A Sheath upper limb L8417 A Pros sheath/sock w gel cushn L8420 A Prosthetic sock multi ply BK L8430 A Prosthetic sock multi ply AK L8435 A Pros sock multi ply upper lm L8440 A Shrinker below knee L8460 A Shrinker above knee L8465 A Shrinker upper limb L8470 A Pros sock single ply BK L8480 A Pros sock single ply AK L8485 A Pros sock single ply upper l L8499 A Unlisted misc prosthetic ser L8500 A Artificial larynx L8501 A Tracheostomy speaking valve L8505 A Artificial larynx, accessory L8507 A Trach-esoph voice pros pt in L8509 A Trach-esoph voice pros md in L8510 A Voice amplifier L8511 A Indwelling trach insert L8512 A Gel cap for trach voice pros L8513 A Trach pros cleaning device L8514 A Repl trach puncture dilator L8515 A Gel cap app device for trach L8600 N Implant breast silicone/eq L8603 N Collagen imp urinary 2.5 ml L8606 N Synthetic implnt urinary 1ml L8610 N Ocular implant L8612 N Aqueous shunt prosthesis L8613 N Ossicular implant L8614 N Cochlear device/system L8615 A Coch implant headset replace L8616 A Coch implant microphone repl L8617 A Coch implant trans coil repl L8618 A Coch implant tran cable repl L8619 A Replace cochlear processor L8620 A Repl lithium ion battery L8621 A Repl zinc air battery L8622 A Repl alkaline battery L8630 N Metacarpophalangeal implant L8631 N MCP joint repl 2 pc or more L8641 N Metatarsal joint implant L8642 N Hallux implant L8658 N Interphalangeal joint spacer L8659 N Interphalangeal joint repl L8670 N Vascular graft, synthetic L8699 N Prosthetic implant NOS L9900 A O&P supply/accessory/service M0064 X Visit for drug monitoring 0374 1.0414 $61.80 $12.36 M0075 E Cellular therapy M0076 E Prolotherapy M0100 E Intragastric hypothermia M0300 E IV chelationtherapy M0301 E Fabric wrapping of aneurysm P2028 A Cephalin floculation test P2029 A Congo red blood test P2031 E Hair analysis P2033 A Blood thymol turbidity P2038 A Blood mucoprotein Start Printed Page 50880 P3000 A Screen pap by tech w md supv P3001 B Screening pap smear by phys P7001 E Culture bacterial urine P9010 K Whole blood for transfusion 0950 2.0123 $119.42 $23.88 P9011 K Blood split unit 0967 1.2698 $75.35 $15.07 P9012 K Cryoprecipitate each unit 0952 0.7395 $43.88 $8.78 P9016 K RBC leukocytes reduced 0954 2.7370 $162.42 $32.48 P9017 K Plasma 1 donor frz w/in 8 hr 9508 1.2038 $71.44 $14.29 P9019 K Platelets, each unit 0957 0.8317 $49.36 $9.87 P9020 K Plaelet rich plasma unit 0958 5.1815 $307.49 $61.50 P9021 K Red blood cells unit 0959 2.0301 $120.47 $24.09 P9022 K Washed red blood cells unit 0960 2.9707 $176.29 $35.26 P9023 K Frozen plasma, pooled, sd 0949 1.1956 $70.95 $14.19 P9031 K Platelets leukocytes reduced 1013 1.6023 $95.09 $19.02 P9032 K Platelets, irradiated 9500 1.3589 $80.64 $16.13 P9033 K Platelets leukoreduced irrad 0968 2.3639 $140.28 $28.06 P9034 K Platelets, pheresis 9507 6.8988 $409.40 $81.88 P9035 K Platelet pheres leukoreduced 9501 8.1495 $483.62 $96.72 P9036 K Platelet pheresis irradiated 9502 5.1895 $307.96 $61.59 P9037 K Plate pheres leukoredu irrad 1019 9.5131 $564.54 $112.91 P9038 K RBC irradiated 9505 2.3876 $141.69 $28.34 P9039 K RBC deglycerolized 9504 6.4314 $381.66 $76.33 P9040 K RBC leukoreduced irradiated 0969 3.6451 $216.31 $43.26 P9041 K Albumin (human),5%, 50ml 0961 0.5119 $30.38 $6.08 P9043 K Plasma protein fract,5%,50ml 0956 1.1226 $66.62 $13.32 P9044 K Cryoprecipitatereducedplasma 1009 1.3062 $77.51 $15.50 P9045 K Albumin (human), 5%, 250 ml 0963 1.3869 $82.30 $16.46 P9046 K Albumin (human), 25%, 20 ml 0964 0.4878 $28.95 $5.79 P9047 K Albumin (human), 25%, 50ml 0965 1.1117 $65.97 $13.19 P9048 K Plasmaprotein fract,5%,250ml 0966 4.9564 $294.13 $58.83 P9050 K Granulocytes, pheresis unit 9506 15.6155 $926.67 $185.33 P9051 K Blood, l/r, cmv-neg 1010 2.9692 $176.20 $35.24 P9052 K Platelets, hla-m, l/r, unit 1011 10.9690 $650.93 $130.19 P9053 K Plt, pher, l/r cmv-neg, irr 1020 10.1551 $602.63 $120.53 P9054 K Blood, l/r, froz/degly/wash 1016 5.2631 $312.33 $62.47 P9055 K Plt, aph/pher, l/r, cmv-neg 1017 8.5998 $510.34 $102.07 P9056 K Blood, l/r, irradiated 1018 2.8004 $166.18 $33.24 P9057 K RBC, frz/deg/wsh, l/r, irrad 1021 4.8787 $289.52 $57.90 P9058 K RBC, l/r, cmv-neg, irrad 1022 4.2901 $254.59 $50.92 P9059 K Plasma, frz between 8-24hour 0955 1.2934 $76.75 $15.35 P9060 K Fr frz plasma donor retested 9503 1.6241 $96.38 $19.28 P9603 A One-way allow prorated miles P9604 A One-way allow prorated trip P9612 N Catheterize for urine spec P9615 N Urine specimen collect mult Q0035 X Cardiokymography 0100 2.4968 $148.17 $41.44 $29.63 Q0081 B Infusion ther other than che Q0083 B Chemo by other than infusion Q0084 B Chemotherapy by infusion Q0085 B Chemo by both infusion and o Q0091 T Obtaining screen pap smear 0191 0.167 $9.91 $2.78 $1.98 Q0092 N Set up port xray equipment Q0111 A Wet mounts/ w preparations Q0112 A Potassium hydroxide preps Q0113 A Pinworm examinations Q0114 A Fern test Q0115 A Post-coital mucous exam Q0136 K Non esrd epoetin alpha inj 0733 $9.99 $2.00 Q0137 K Darbepoetin alfa, non esrd 0734 $3.28 $0.66 Q0144 E Azithromycin dihydrate, oral Q0163 N Diphenhydramine HCl 50mg Q0164 N Prochlorperazine maleate 5mg Q0165 B Prochlorperazine maleate10mg Q0166 K Granisetron HCl 1 mg oral 0765 $33.51 $6.70 Q0167 N Dronabinol 2.5mg oral Q0168 B Dronabinol 5mg oral Start Printed Page 50881 Q0169 N Promethazine HCl 12.5mg oral Q0170 B Promethazine HCl 25 mg oral Q0171 N a Chlorpromazine HCl 10mg oral Q0172 B Chlorpromazine HCl 25mg oral Q0173 N Trimethobenzamide HCl 250mg Q0174 N Thiethylperazine maleate10mg Q0175 N Perphenazine 4mg oral Q0176 B Perphenazine 8mg oral Q0177 N Hydroxyzine pamoate 25mg Q0178 B Hydroxyzine pamoate 50mg Q0179 K Ondansetron HCl 8mg oral 0769 $32.02 $6.40 Q0180 K Dolasetron mesylate oral 0763 $48.54 $9.71 Q0181 E Unspecified oral anti-emetic Q0187 K Factor viia recombinant 1409 $1,080.11 $216.02 Q1001 N Ntiol category 1 Q1002 N Ntiol category 2 Q1003 N Ntiol category 3 Q1004 N Ntiol category 4 Q1005 N Ntiol category 5 Q2001 E Oral cabergoline 0.5 mg Q2002 N Elliotts b solution per ml Q2003 K Aprotinin, 10,000 kiu 7019 $2.20 $0.44 Q2004 N Bladder calculi irrig sol Q2005 K Corticorelin ovine triflutat 7024 $386.53 $77.31 Q2006 K Digoxin immune fab (ovine) 7025 $552.18 $110.44 Q2007 K Ethanolamine oleate 100 mg 7026 $64.53 $12.91 Q2008 K Fomepizole, 15 mg 7027 $12.31 $2.46 Q2009 K Fosphenytoin, 50 mg 7028 $5.19 $1.04 Q2011 K Hemin, per 1 mg 7030 $6.51 $1.30 Q2012 K Pegademase bovine, 25 iu 9168 $161.16 $32.23 Q2013 K Pentastarch 10% solution 7040 $12.45 $2.49 Q2014 N Sermorelin acetate, 0.5 mg Q2017 K Teniposide, 50 mg 7035 $266.23 $53.25 Q2018 K Urofollitropin, 75 iu 7037 $44.74 $8.95 Q2019 K Basiliximab 1615 $1,473.57 $294.71 Q2020 E Histrelin acetate Q2021 K Lepirudin 9057 $128.17 $25.63 Q2022 K VonWillebrandFactrCmplxperIU 1618 $0.74 $0.15 Q3000 H Rubidium-Rb-82 9025 Q3001 B Brachytherapy Radioelements Q3002 H Gallium ga 67 1619 Q3003 H Technetium tc99m bicisate 1620 Q3004 N Xenon xe 133 Q3005 H Technetium tc99m mertiatide 1622 Q3006 H Technetium tc99m glucepatate 9154 Q3007 H Sodium phosphate p32 1624 Q3008 H Indium 111-in pentetreotide 1625 Q3009 N Technetium tc99m oxidronate Q3010 H Technetium tc99m labeledrbcs 9155 Q3011 H Chromic phosphate p32 1628 Q3012 N Cyanocobalamin cobalt co57 Q3014 A Telehealth facility fee Q3019 A ALS emer trans no ALS serv Q3020 A ALS nonemer trans no ALS se Q3025 K IM inj interferon beta 1-a 9022 $89.10 $17.82 Q3026 E Subc inj interferon beta-1a Q3031 N Collagen skin test Q4001 B Cast sup body cast plaster Q4002 B Cast sup body cast fiberglas Q4003 B Cast sup shoulder cast plstr Q4004 B Cast sup shoulder cast fbrgl Q4005 B Cast sup long arm adult plst Q4006 B Cast sup long arm adult fbrg Q4007 B Cast sup long arm ped plster Q4008 B Cast sup long arm ped fbrgls Q4009 B Cast sup sht arm adult plstr Start Printed Page 50882 Q4010 B Cast sup sht arm adult fbrgl Q4011 B Cast sup sht arm ped plaster 012 B Cast sup sht arm ped fbrglas Q4013 B Cast sup gauntlet plaster Q4014 B Cast sup gauntlet fiberglass Q4015 B Cast sup gauntlet ped plster Q4016 B Cast sup gauntlet ped fbrgls Q4017 B Cast sup lng arm splint plst Q4018 B Cast sup lng arm splint fbrg Q4019 B Cast sup lng arm splnt ped p Q4020 B Cast sup lng arm splnt ped f Q4021 B Cast sup sht arm splint plst Q4022 B Cast sup sht arm splint fbrg Q4023 B Cast sup sht arm splnt ped p Q4024 B Cast sup sht arm splnt ped f Q4025 B Cast sup hip spica plaster Q4026 B Cast sup hip spica fiberglas Q4027 B Cast sup hip spica ped plstr Q4028 B Cast sup hip spica ped fbrgl Q4029 B Cast sup long leg plaster Q4030 B Cast sup long leg fiberglass Q4031 B Cast sup lng leg ped plaster Q4032 B Cast sup lng leg ped fbrgls Q4033 B Cast sup lng leg cylinder pl Q4034 B Cast sup lng leg cylinder fb Q4035 B Cast sup lngleg cylndr ped p Q4036 B Cast sup lngleg cylndr ped f Q4037 B Cast sup shrt leg plaster Q4038 B Cast sup shrt leg fiberglass Q4039 B Cast sup shrt leg ped plster Q4040 B Cast sup shrt leg ped fbrgls Q4041 B Cast sup lng leg splnt plstr Q4042 B Cast sup lng leg splnt fbrgl Q4043 B Cast sup lng leg splnt ped p Q4044 B Cast sup lng leg splnt ped f Q4045 B Cast sup sht leg splnt plstr Q4046 B Cast sup sht leg splnt fbrgl Q4047 B Cast sup sht leg splnt ped p Q4048 B Cast sup sht leg splnt ped f Q4049 B Finger splint, static Q4050 B Cast supplies unlisted Q4051 B Splint supplies misc Q4054 A Darbepoetin alfa, esrd use Q4055 A Epoetin alfa, esrd use Q4075 N Acyclovir, 5 mg Q4076 N Dopamine hcl, 40 mg Q4077 K Treprostinil, 1 mg 1082 $55.02 $11.00 Q4079 G Injection, natalizumab 9126 $6.51 $1.30 Q9941 K IVIG lyophil 1g 0869 $39.46 $7.89 Q9942 K IVIG lyophil 10 mg 0870 $0.40 $0.08 Q9943 K IVIG non-lyophil 1g 0871 $57.26 $11.45 Q9944 K IVIG non-lyophil 10 mg 0872 $0.57 $0.11 Q9945 K LOCM <=149 mg/ml iodine, 1ml 9157 $0.51 $0.10 Q9946 K LOCM 150-199mg/ml iodine,1ml 9158 $2.00 $0.40 Q9947 K LOCM 200-249mg/ml iodine,1ml 9159 $0.78 $0.16 Q9948 K LOCM 250-299mg/ml iodine,1ml 9160 $0.66 $0.13 Q9949 K LOCM 300-349mg/ml iodine,1ml 9161 $0.41 $0.08 Q9950 K LOCM 350-399mg/ml iodine,1ml 9162 $0.27 $0.05 Q9951 K LOCM >= 400 mg/ml iodine,1ml 19163 $0.20 $0.04 Q9952 K Inj Gad-base MR contrast, ml 9164 $3.01 $0.60 Q9953 N Inj Fe-based MR contrast, ml Q9954 K Oral MR contrast, 100 ml 9165 $9.01 $1.80 Q9955 K Inj perflexane lip micros, m 9203 $13.49 $2.70 Q9956 K Inj octafluoropropane mic,ml 9202 $41.42 $8.28 Q9957 K Inj perflutren lip micros, m 9112 $63.51 $12.70 R0070 N Transport portable x-ray Start Printed Page 50883 R0075 N Transport port x-ray multipl R0076 N Transport portable EKG V2020 A Vision svcs frames purchases V2025 E Eyeglasses delux frames V2100 A Lens spher single plano 4.00 V2101 A Single visn sphere 4.12-7.00 V2102 A Singl visn sphere 7.12-20.00 V2103 A Spherocylindr 4.00d/12-2.00d V2104 A Spherocylindr 4.00d/2.12-4d V2105 A Spherocylinder 4.00d/4.25-6d V2106 A Spherocylinder 4.00d/>6.00d V2107 A Spherocylinder 4.25d/12-2d V2108 A Spherocylinder 4.25d/2.12-4d V2109 A Spherocylinder 4.25d/4.25-6d V2110 A Spherocylinder 4.25d/over 6d V2111 A Spherocylindr 7.25d/.25-2.25 V2112 A Spherocylindr 7.25d/2.25-4d V2113 A Spherocylindr 7.25d/4.25-6d V2114 A Spherocylinder over 12.00d V2115 A Lens lenticular bifocal V2118 A Lens aniseikonic single V2121 A Lenticular lens, single V2199 A Lens single vision not oth c V2200 A Lens spher bifoc plano 4.00d V2201 A Lens sphere bifocal 4.12-7.0 V2202 A Lens sphere bifocal 7.12-20 V2203 A Lens sphcyl bifocal 4.00d/.1 V2204 A Lens sphcy bifocal 4.00d/2.1 V2205 A Lens sphcy bifocal 4.00d/4.2 V2206 A Lens sphcy bifocal 4.00d/ove V2207 A Lens sphcy bifocal 4.25-7d/ V2208 A Lens sphcy bifocal 4.25-7/2 V2209 A Lens sphcy bifocal 4.25-7/4 V2210 A Lens sphcy bifocal 4.25-7/ov V2211 A Lens sphcy bifo 7.25-12/.25- V2212 A Lens sphcyl bifo 7.25-12/2.2 V2213 A Lens sphcyl bifo 7.25-12/4.2 V2214 A Lens sphcyl bifocal over 12 V2215 A Lens lenticular bifocal V2218 A Lens aniseikonic bifocal V2219 A Lens bifocal seg width over V2220 A Lens bifocal add over 3.25d V2221 A Lenticular lens, bifocal V2299 A Lens bifocal speciality V2300 A Lens sphere trifocal 4.00d V2301 A Lens sphere trifocal 4.12-7 V2302 A Lens sphere trifocal 7.12-20 V2303 A Lens sphcy trifocal 4.0/.12- V2304 A Lens sphcy trifocal 4.0/2.25 V2305 A Lens sphcy trifocal 4.0/4.25 V2306 A Lens sphcyl trifocal 4.00/>6 V2307 A Lens sphcy trifocal 4.25-7/ V2308 A Lens sphc trifocal 4.25-7/2 V2309 A Lens sphc trifocal 4.25-7/4 V2310 A Lens sphc trifocal 4.25-7/>6 V2311 A Lens sphc trifo 7.25-12/.25- V2312 A Lens sphc trifo 7.25-12/2.25 V2313 A Lens sphc trifo 7.25-12/4.25 V2314 A Lens sphcyl trifocal over 12 V2315 A Lens lenticular trifocal V2318 A Lens aniseikonic trifocal V2319 A Lens trifocal seg width > 28 V2320 A Lens trifocal add over 3.25d V2321 A Lenticular lens, trifocal V2399 A Lens trifocal speciality V2410 A Lens variab asphericity sing Start Printed Page 50884 V2430 A Lens variable asphericity bi V2499 A Variable asphericity lens V2500 A Contact lens pmma spherical V2501 A Cntct lens pmma-toric/prism V2502 A Contact lens pmma bifocal V2503 A Cntct lens pmma color vision V2510 A Cntct gas permeable sphericl V2511 A Cntct toric prism ballast V2512 A Cntct lens gas permbl bifocl V2513 A Contact lens extended wear V2520 A Contact lens hydrophilic V2521 A Cntct lens hydrophilic toric V2522 A Cntct lens hydrophil bifocl V2523 A Cntct lens hydrophil extend V2530 A Contact lens gas impermeable V2531 A Contact lens gas permeable V2599 A Contact lens/es other type V2600 A Hand held low vision aids V2610 A Single lens spectacle mount V2615 A Telescop/othr compound lens V2623 A Plastic eye prosth custom V2624 A Polishing artifical eye V2625 A Enlargemnt of eye prosthesis V2626 A Reduction of eye prosthesis V2627 A Scleral cover shell V2628 A Fabrication & fitting V2629 A Prosthetic eye other type V2630 N Anter chamber intraocul lens V2631 N Iris support intraoclr lens V2632 N Post chmbr intraocular lens V2700 A Balance lens V2702 E Deluxe lens feature V2710 A Glass/plastic slab off prism V2715 A Prism lens/es V2718 A Fresnell prism press-on lens V2730 A Special base curve V2744 A Tint photochromatic lens/es V2745 A Tint, any color/solid/grad V2750 A Anti-reflective coating V2755 A UV lens/es V2756 E Eye glass case V2760 A Scratch resistant coating V2761 B Mirror coating V2762 A Polarization, any lens V2770 A Occluder lens/es V2780 A Oversize lens/es V2781 B Progressive lens per lens V2782 A Lens, 1.54-1.65 p/1.60-1.79g V2783 A Lens, >= 1.66 p/>=1.80 g V2784 A Lens polycarb or equal V2785 F Corneal tissue processing V2786 A Occupational multifocal lens V2790 N Amniotic membrane V2797 A Vis item/svc in other code V2799 A Miscellaneous vision service V5008 E Hearing screening V5010 E Assessment for hearing aid V5011 E Hearing aid fitting/checking V5014 E Hearing aid repair/modifying V5020 E Conformity evaluation V5030 E Body-worn hearing aid air V5040 E Body-worn hearing aid bone V5050 E Hearing aid monaural in ear V5060 E Behind ear hearing aid V5070 E Glasses air conduction V5080 E Glasses bone conduction Start Printed Page 50885 V5090 E Hearing aid dispensing fee V5095 E Implant mid ear hearing pros V5100 E Body-worn bilat hearing aid V5110 E Hearing aid dispensing fee V5120 E Body-worn binaur hearing aid V5130 E In ear binaural hearing aid V5140 E Behind ear binaur hearing ai V5150 E Glasses binaural hearing aid V5160 E Dispensing fee binaural V5170 E Within ear cros hearing aid V5180 E Behind ear cros hearing aid V5190 E Glasses cros hearing aid V5200 E Cros hearing aid dispens fee V5210 E In ear bicros hearing aid V5220 E Behind ear bicros hearing ai V5230 E Glasses bicros hearing aid V5240 E Dispensing fee bicros V5241 E Dispensing fee, monaural V5242 E Hearing aid, monaural, cic V5243 E Hearing aid, monaural, itc V5244 E Hearing aid, prog, mon, cic V5245 E Hearing aid, prog, mon, itc V5246 E Hearing aid, prog, mon, ite V5247 E Hearing aid, prog, mon, bte V5248 E Hearing aid, binaural, cic V5249 E Hearing aid, binaural, itc V5250 E Hearing aid, prog, bin, cic V5251 E Hearing aid, prog, bin, itc V5252 E Hearing aid, prog, bin, ite V5253 E Hearing aid, prog, bin, bte V5254 E Hearing id, digit, mon, cic V5255 E Hearing aid, digit, mon, itc V5256 E Hearing aid, digit, mon, ite V5257 E Hearing aid, digit, mon, bte V5258 E Hearing aid, digit, bin, cic V5259 E Hearing aid, digit, bin, itc V5260 E Hearing aid, digit, bin, ite V5261 E Hearing aid, digit, bin, bte V5262 E Hearing aid, disp, monaural V5263 E Hearing aid, disp, binaural V5264 E Ear mold/insert V5265 E Ear mold/insert, disp V5266 E Battery for hearing device V5267 E Hearing aid supply/accessory V5268 E ALD Telephone Amplifier V5269 E Alerting device, any type V5270 E ALD, TV amplifier, any type V5271 E ALD, TV caption decoder V5272 E Tdd V5273 E ALD for cochlear implant V5274 E ALD unspecified V5275 E Ear impression V5298 E Hearing aid noc V5299 B Hearing service V5336 E Repair communication device V5362 E Speech screening V5363 E Language screening V5364 E Dysphagia screening * Code is subject to contiguous body area imaging discount policy discussed in Section XIV of this proposed rule. CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All Rights Reserved. (Catalog of Federal Domestic Assistance Program No. 93.773, Medicare_Hospital Insurance; and Program No. 93.774, Medicare_Supplementary Medical Insurance Program)
Dated: August 17, 2005
Ann C. Agnew,
Executive Secretary to the Department
[FR Doc. 05-16699 Filed 8-18-05; 2:44 pm]
BILLING CODE 4120-01-P
Document Information
- Published:
- 08/26/2005
- Department:
- Centers for Medicare & Medicaid Services
- Entry Type:
- Proposed Rule
- Action:
- Proposed rule; correction.
- Document Number:
- 05-16699
- Pages:
- 50679-50886 (208 pages)
- Docket Numbers:
- CMS-1501-CN
- RINs:
- 0938-AN46: Changes to the Hospital Outpatient Prospective Payment System and Calendar Year 2006 Payment Rates (CMS-1501-P)
- RIN Links:
- https://www.federalregister.gov/regulations/0938-AN46/changes-to-the-hospital-outpatient-prospective-payment-system-and-calendar-year-2006-payment-rates-c
- PDF File:
- 05-16699.pdf
- CFR: (2)
- 42 CFR 419
- 42 CFR 485