02-20146. Medicare Program; Changes to the Hospital Outpatient Prospective Payment System and Calendar Year 2003 Payment Rates; and Changes to Payment Suspension for Unfiled Cost Reports
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AGENCY:
Centers for Medicare & Medicaid Services (CMS), HHS.
ACTION:
Proposed rule.
SUMMARY:
This proposed rule would revise the Medicare hospital outpatient prospective payment system to implement applicable statutory requirements and changes arising from our continuing experience with this system. In addition, it would describe proposed changes to the amounts and factors used to determine the payment rates for Medicare hospital outpatient services paid under the prospective payment system. These changes would be applicable to services furnished on or after January 1, 2003. In addition, this rule proposes to allow the Secretary to suspend Medicare payments “in whole or in part” if a provider fails to file a timely and acceptable cost report.
DATES:
We will consider comments if we receive them at the appropriate address, as provided below, no later than 5 p.m. on October 8, 2002.
ADDRESSES:
In commenting, please refer to file code CMS-1206-P. Because of staff and resource limitations, we cannot accept comments by facsimile (FAX) transmission. Mail written comments (one original and two copies) to the following address ONLY: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS-1206-P, P.O. Box 8018, Baltimore, MD 21244-8018.
Please allow sufficient time for mailed comments to be timely received in the event of delivery delays.
If you prefer, you may deliver (by hand or courier) your written comments (one original and two copies) to one of the following addresses:
Room 445-G, Hubert H. Humphrey Building, 200 Independence Avenue, SW., Washington, DC 20201, or
Room C5-14-03, 7500 Security Boulevard, Baltimore, MD 21244-1850.
(Because access to the interior of the HHH Building is not readily available to persons without Federal Government identification, commenters are encouraged to leave their comments in the CMS drop slots located in the main lobby of the building. A stamp-in clock is available for persons wishing to retain a proof of filing by stamping in and retaining an extra copy of the comments being filed.)
Comments mailed to the addresses indicated as appropriate for hand or courier delivery may be delayed and could be considered late.
For information on viewing public comments, see the beginning of the SUPPLEMENTARY INFORMATION section.
Start Further InfoFOR FURTHER INFORMATION CONTACT:
Anita Heygster, (410) 786-0378—outpatient prospective payment issues; Lana Price, (410) 786-4533—partial hospitalization and ESRD; Gerald Walters, (410) 786-2070—payment suspension issues.
End Further Info End Preamble Start Supplemental InformationSUPPLEMENTARY INFORMATION:
Inspection of Public Comments: Comments received timely will be available for public inspection as they are received, generally beginning approximately 3 weeks after publication of a document, at the headquarters of the Centers for Medicare & Medicaid Services, 7500 Security Boulevard, Baltimore, Maryland 21244, Monday through Friday of each week from 8:30 a.m. to 4 p.m. To schedule an appointment to view public comments, call (410) 786-7197.
Availability of Copies and Electronic Access
Copies: To order copies of the Federal Register containing this document, send your request to: New Orders, Superintendent of Documents, P.O. Box 371954, Pittsburgh, PA 15250-7954. Specify the date of the issue requested and enclose a check or money order payable to the Superintendent of Documents, or enclose your Visa or Master Card number and expiration date. Credit card orders can also be placed by calling the order desk at (202) 512-1800 (or toll-free at 1-888-293-6498) or by faxing to (202) 512-2250. The cost for each copy is $9. As an alternative, you can view and photocopy the Federal Register document at most libraries designated as Federal Depository Libraries and at many other public and academic libraries throughout the country that receive the Federal Register.
This Federal Register document is also available from the Federal Register online database through GPO Access, a service of the U.S. Government Printing Office. The web site address is: http://www.access.gpo.gov/nara/index.html.
To assist readers in referencing sections contained in this document, we are providing the following table of contents.
Outline of Contents
Comparison of Proposed 2003 Payment Rates to 2002 Payment Rates
I. Background
A. Authority for the Outpatient Prospective Payment System
B. Summary of Rulemaking for the Outpatient Prospective Payment System
C. Authority for Payment Suspension for Unfiled Cost Reports
D. Summary of Payment Suspension for Unfiled Cost Reports
II. Proposed Changes to the Ambulatory Payment Classification (APC) Groups and Relative Weights
A. Recommendations of the Advisory Panel on APC Groups
1. Establishment of the Advisory Panel
2. General Issues Considered by the Advisory Panel
3. Recommendations of the Advisory Panel and Our Responses
B. Other Changes Affecting the APCs
1. Limit on Variation of Costs of Services Classified Within a Group
2. Procedures Moved from New Technology APCs to Clinically Appropriate APCs
3. APC Assignment for New Codes Created During 2002
4. Recalibration of Weights for 2003
a. Data Issues
(1) Treatment of “Multiple Procedure” Claims
(2) Calendar Year 2002 Charge Data for Pass-Through Device Categories
b. Description of How Weights Were Calculated for 2003
5. Procedures That Will Be Paid Only As Inpatient Procedures
C. Partial Hospitalization
III. Transitional Pass-Through and Related Payment Issues
A. Background
B. Discussion of Pro Rata Reduction
C. Expiration of Transitional Pass-Through Payments in Calendar Year 2003
1. Devices
2. Drugs and Biologicals (Including Radiopharmaceuticals, Blood, and Blood Products)
3. Brachytherapy
D. Criteria for New Device Categories
E. Payment for Transitional Pass-Through Drugs and Biologicals for Calendar Year 2003
IV. Wage Index Changes for Calendar Year 2003
V. Copayment for Calendar Year 2003
VI. Conversion Factor Update for Calendar Year 2003
VII. Outlier Policy for Calendar Year 2003
VIII. Other Policy Decisions and Proposed Changes
A. Hospital Coding for Evaluation and Management (E/M) Services
B. Observation Services Start Printed Page 52093
C. Payment Policy When A Surgical Procedure on the Inpatient List Is Performed on an Emergency Basis
1. Current Policy
2. Hospital Concerns
3. Clarification of Payment Policy
4. Orders to Admit
D. Status Indicators
E. Other Policy Issues Relating to Pass-Through Device Categories
1. Reducing Transitional Pass-Through Payments To Offset Costs Packaged Into APC Groups
2. Devices Paid With Multiple Procedures
F. Outpatient Billing for Dialysis
IX. Summary of and Responses to MedPAC Recommendations
X. Summary of Proposed Changes for 2003
A. Changes Required by Statute
B. Additional Changes to OPPS and Payment Suspension Provisons
C. Changes to the Regulations Text
XI. Summary of Proposed Payment Suspension Provisions
XII. Collection of Information Requirements
XIII. Response to Public Comments
XIV. Regulatory Impact Analysis
A. OPPS
1. General
2. Changes in this Proposed Rule
3. Limitations of Our Analysis
4. Estimated Impacts of this Proposed Rule
5. Projected Distribution of Outlier Payments
B. Payment Suspension for Unfiled Cost Reports Regulations Text
Addenda
Addendum A—List of Ambulatory Payment Classifications (APCs) with Status Indicators, Relative Weights, Payment Rates, and Copayment Amounts
Addendum B—Payment Status by HCPCS Code, and Related Information
Addendum C—Hospital Outpatient Payment for Procedures by APC: Displayed on Website Only
Addendum D—Payment Status Indicators for the Hospital Outpatient Prospective Payment System
Addendum E—CPT Codes That Would Be Paid Only As Inpatient Procedures
Addendum H—Wage Index for Urban Areas
Addendum I—Wage Index for Rural Areas
Addendum J—Wage Index for Hospitals That Are Reclassified
Alphabetical List of Acronyms Appearing in the Proposed Rule
ACEP American College of Emergency Physicians
AMA American Medical Association
APC Ambulatory payment classification
AWP Average wholesale price
BBA Balanced Budget Act of 1997
BIPA Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000
BBRA Balanced Budget Refinement Act of 1999
CCR Cost center specific cost-to-charge ratio
CMHC Community mental health center
CMS Centers for Medicare & Medicaid Services (Formerly known as the Health Care Financing Administration)
CPT (Physician's) Current Procedural Terminology, Fourth Edition, 2002, copyrighted by the American Medical Association
CSW Clinical social worker
CY Calendar year
DRG Diagnosis-related group
DSH Disproportionate Share Hospital
EACH Essential Access Community Hospital
E/M Evaluation and management
ERCP Endoscopic retrograde cholangiopancreatography
ESRD End-stage renal disease
FACA Federal Advisory Committee Act
FY Federal fiscal year
HCPCS Healthcare Common Procedure Coding System
HIPAA Health Insurance Portability and Accountability Act of 1996
ICU Intensive care unit
ICD-9-CM International Classification of Diseases, Ninth Edition, Clinical Modification
IME Indirect Medical Education
IPPS (Hospital) inpatient prospective payment system
LTC Long Term Care
MedPAC Medicare Payment Advisory Commission
MDH Medicare Dependent Hospital
MSA Metropolitan statistical area
NECMA New England County Metropolitan Area
OCE Outpatient code editor
OMB Office of Management and Budget
OPD (Hospital) outpatient department
OPPS (Hospital) outpatient prospective payment system
OT Occupational therapist
PHP Partial hospitalization program
PPS Prospective payment system
PPV Pneumococcal pneumonia (virus)
PRA Paperwork Reduction Act
RFA Regulatory Flexibility Act
RRC Rural Referral Center
RVUs Relative value units
SCH Sole Community Hospital
TEFRA Tax Equity and Fiscal Responsibility Act
USPDI United States Pharmacopoeia Drug Information
Comparison of Proposed 2003 Payment Rates to 2002 Payment Rates
The outpatient pass-through provisions of the BBRA and BIPA have been exceptionally difficult to implement, arguably the most complex and difficult in the history of the Medicare program. In CY 2002, the pass-through payments, and the APC rates were calculated on the best information available. This was often manufacturer list prices, which may not reflect not actual prices paid by hospitals. For CY 2003, far more data is available on the actual charges for hospital OPDs, and these are reflected in the rates in this proposed rule. In many cases these new rates are significantly different from CY 2003 rates, but they are based on actual hospital charges, and on far more complete data than were the CY 2002 rates. Nevertheless, CMS is actively seeking comment on all aspects of these rates, given the significant changes in the proposed rule, and the agency is open to making changes, perhaps significant, in the final rule based on comments.
The 2003 payment rates proposed in this proposed rule are, for many items and services, significantly higher or lower than the payment rates for the same items and services for 2002, particularly for APCs which use medical devices, and for APCs for drugs that will no longer be eligible for pass-through status in 2003 and paid under separate APCs. Some proposed payments for 2003 are far lower than the 2002 payment amounts (and some are higher).
For example, as can be seen in Addenda A, the proposed rate for APC 0108 (Insertion/Replacement/Repair of Cardioverter-Defibrilator Leads) shows a dramatic decrease in payment compared to the 2002 rate. This reduction for a number of APCs is of concern to us because of the potential impact on access to care. We invite public comment and suggestions on how to address the potential for adverse impact of these proposed changes.
The proposed 2003 payment rates reflect the use of updated data, as required by the statute, in calculating payment rates in accordance with the methodologies set forth in the statute and regulations. The proposed payment rates reflect mathematical calculations based on the latest available program data.
Our goal in this proposed rule is to explain the methodology and to solicit comments on our rate-setting methods and the effect on beneficiary access, provider participation and the fiscal integrity of the Medicare Trust Fund.
Devices
We believe that there are several factors that may explain the differences between the proposed payment amounts for 2003 and the payment amounts for 2002 (some, but not all of which, are significant).
First, we believe that the payment rates for the device related procedures for 2002 may in some cases have been higher than they would have been had actual hospital acquisition cost data been available for us to use. Specifically, because we lacked hospitals' cost data for devices, we used the best data available to us at the time which was manufacturer data regarding the hospitals' acquisition costs in providing the devices. We assumed that a device would be provided with a related procedure and packaged 75 percent of these manufacturer estimated Start Printed Page 52094costs for the devices into the APCs for the procedures.
The costs that we packaged in for some devices may have been higher than actual hospital acquisition costs. The differences between the 2002 payment rate and the lower 2003 proposed payments are based on our data sources. While the 2003 rates are based on 2001 hospital claims and the latest available cost report data, the 2002 rates are based on manufacturer data for devices. We use charges on the hospital claims data to estimate hospital costs. We apply hospital-specific, department-specific cost-to-charge ratios (CCRs) from each provider's most recently submitted cost report to the charges to develop the estimate of costs. In most cases, the provider's most recently submitted cost report is from fiscal year 1999. An adjustment factor is applied in developing CCRs for cost reports that have not yet been settled, so that the CCRs will more closely reflect CCRs from a settled cost report.
Second, there may be problems in the data, particularly for coding of devices in 2001. As discussed later in this preamble, devices were to be coded using device specific C codes from the start of the OPPS on August 1, 2000 until the law changes required that we establish category codes by April 1, 2001. We then granted a grace period until July 1, 2001, during which we accepted both device specific codes and category codes. During a Town Hall meeting with the public on April 5, 2001, and in other contacts with hospitals (such as the open forum calls and visits to hospitals) we have been told that hospitals had difficulty in submitting proper HCPCS coding for services and for devices once OPPS began and that, in many cases, they did not bill for devices for which they should have claimed payment.
In some cases, hospitals were confused by the change from device specific codes to category codes; in other cases, the use of HCPCS codes was new and they had a long learning curve to learn how to use HCPCS codes. Our initial data analysis suggested that hospitals may not have billed for the devices using the device or category codes in all cases. If the charges were not on the claim, they would not have been picked up for calculation of the median cost for the service and the associated device, possibly resulting in a proposed payment rate for the APC that is inappropriately low and other rates that are inappropriately too high. However, based on our analysis which is described later, we believe that hospitals often showed the charges for the devices in the applicable revenue centers (such as, supplies) and that the charges for the devices often were on the claim, even if the HCPCS code was not.
We welcome public comments regarding these issues for these payment changes and proposals regarding how problems with claims data could be rectified for development of the final rule.
Drugs
As discussed later in this preamble, we propose to package the costs for lower cost drugs into the payment for the APC in which they are used and to pay specialty drugs and high cost drugs under separate APCs. Some of the APCs for separately paid drugs also show significant reductions in payments compared to the pass-through payments made in 2002. Several factors may help place these decreases in perspective.
These changes result largely because the payment method for items in transitional pass-through payment status differs significantly from other services paid under the OPPS, and as items lose transitional pass-through payment status they are subject to a different payment method. In particular, a drug in transitional pass-through payment status is paid based on 95 percent of the average wholesale price for the drug, possibly subject to a uniform reduction.[1]
In contrast, a drug not in transitional pass-through status is paid as are other services under the OPPS. The statute provides that services (other than transitional pass-through items) be paid on the basis of a service-specific relative weight multiplied by a conversion factor. The relative weight is determined based on the median hospital cost, where the cost on each claim is derived by multiplying the submitting hospital's charge by a cost-to-charge ratio (determined from the hospital's latest submitted cost report, usually from fiscal year 1999). We anticipate that a hospital's charges on particular services reflect, at least in relative terms, the hospital's resource use in providing that service.
Per the statute, the conversion factor was set at the initiation of the system to achieve budget neutrality relative to the prior system; it is updated each year by the rate of increase in the hospital market basket. This mechanism does reflect changes in input costs from the initial base, but the system is not rebased to reflect the absolute level of such costs.
This payment method was not intended to assure that hospitals, even on average, are reimbursed costs of particular services. In fact, because the conversion factor was calibrated to reflect prior reductions in hospital operating and capital costs that were built into the baseline for overall program expenditures, the OPPS is not set to pay full costs to hospitals.[2]
Further, nothing in the payment method prescribed by the statute requires or anticipates that hospitals would be reimbursed full costs of purchased inputs such as drugs, just as it does not anticipate that hospitals would be reimbursed for the full cost of any other services they deliver.
The payment methods are set out in section 1833(t) of the Act. This section does not permit continuation of a pass-through payment (at 95 percent of AWP or some other level) for drugs losing their transitional pass-through status. This section permits the Secretary to specify APC groupings, and we are proposing in 2003 to continue to pay separately for certain drugs that had transitional pass-through status in 2002 and that are no longer eligible for pass-through status in 2003. These drugs would be in separate APCs, rather than being packaged into other, procedure-related APCs; the payment method would be the same relative-weight payment method used for other APCs.
The resulting payment rates incorporate the best evidence we have regarding what hospitals charged in 2001. They may diverge, however, from payment rates based on the AWP, including those in use for 2002. As is discussed above, movement from pass-through payment rates to relative-weight based payment rates would be expected to lead to decreases in payments, even if AWP represented a reliable measure of hospital acquisition costs (As discussed above, we use hospital charges and hospital-specific, department-specific cost-to-charge ratios to estimate hospital costs. In most cases, cost-to-charge ratios are derived from 1999 cost reports).
However, we believe this outcome is also be due to deficiencies in AWP as a measure of hospital acquisition costs. AWP is not an accurate estimate of what Start Printed Page 52095providers actually pay for drugs. Studies undertaken over the past decade by the Office of the Inspector General, the Department of Justice, and the General Accounting Office that compare AWP with actual drug acquisition costs have consistently shown that published AWPs considerably exceed these costs (See “MEDICARE Payments for Covered Outpatient Drugs Exceed Providers’ Costs”, GAO-01-1118). Therefore, it is to be expected that the proposed 2003 APC payment rates based on median hospital costs for these drugs will be lower than the 2002 payment rates for the same drugs that are based on AWP. The Administration has repeatedly stated its view that AWP inaccurately represents actual market pricing. The pass-through system pays based on AWP, creating further incentives for artificially high AWP listings. We believe the steep reductions in some drug prices reflect these incentives, and that the new rates more accurately reflect the actual acquisition costs for hospitals pay. Still, we are interested in soliciting comments on these costs, and the mechanisms to identify them.
I. Background
A. Authority for the Outpatient Prospective Payment System
When the Medicare statute was originally enacted, Medicare payment for hospital outpatient services was based on hospital-specific costs. In an effort to ensure that Medicare and its beneficiaries pay appropriately for services and to encourage more efficient delivery of care, the Congress mandated replacement of the cost-based payment methodology with a prospective payment system (PPS). The Balanced Budget Act of 1997 (BBA) (Pub. L. 105-33), enacted on August 5, 1997, added section 1833(t) to the Social Security Act (the Act) authorizing implementation of a PPS for hospital outpatient services. The Balanced Budget Refinement Act of 1999 (BBRA) (Pub. L. 106-113), enacted on November 29, 1999, made major changes that affected the hospital outpatient PPS (OPPS). The Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000 (BIPA) (Pub. L. 106-554), enacted on December 21, 2000, made further changes in the OPPS. The OPPS was first implemented for services furnished on or after August 1, 2000.
B. Summary of Rulemaking for the Outpatient Prospective System
- On September 8, 1998, we published a proposed rule (63 FR 47552) to establish in regulations a PPS for hospital outpatient services, to eliminate the formula-driven overpayment for certain hospital outpatient services, and to extend reductions in payment for costs of hospital outpatient services. On June 30, 1999, we published a correction notice (64 FR 35258) to correct a number of technical and typographic errors in the September 1998 proposed rule including the proposed amounts and factors used to determine the payment rates.
- On April 7, 2000, we published a final rule with comment period (65 FR 18434) that addressed the provisions of the PPS for hospital outpatient services scheduled to be effective for services furnished on or after July 1, 2000. Under this system, Medicare payment for hospital outpatient services included in the PPS is made at a predetermined, specific rate. These outpatient services are classified according to a list of ambulatory payment classifications (APCs). The April 7, 2000 final rule with comment period also established requirements for provider departments and provider-based entities and prohibited Medicare payment for nonphysician services furnished to a hospital outpatient by a provider or supplier other than a hospital unless the services are furnished under arrangement. In addition, this rule extended reductions in payment for costs of hospital outpatient services as required by the BBA and amended by the BBRA. Medicare regulations governing the hospital OPPS are set forth at 42 CFR part 419.
- On June 30, 2000, we published a notice (65 FR 40535) announcing a delay in implementation of the OPPS from July 1, 2000 to August 1, 2000. We implemented the OPPS on August 1, 2000.
- On August 3, 2000, we published an interim final rule with comment period (65 FR 47670) that modified criteria that we use to determine which medical devices are eligible for transitional pass-through payments. The August 3, 2000 rule also corrected and clarified certain provider-based provisions included in the April 7, 2000 rule.
- On November 13, 2000, we published an interim final rule with comment period (65 FR 67798). This rule provided for the annual update to the amounts and factors for OPPS payment rates effective for services furnished on or after January 1, 2001. We implemented the 2001 OPPS on January 1, 2001. We also responded to public comments on those portions of the April 7, 2000 final rule that implemented related provisions of the BBRA and public comments on the August 3, 2000 rule.
- On November 2, 2001, we published a final rule (66 FR 55857) that announced the Medicare OPPS conversion factor for calendar year 2002. In addition, it described the Secretary's estimate of the total amount of the transitional pass-through payments for CY 2002 and the implementation of a uniform reduction in each of the pass-through payments for that year.
- On November 2, 2001, we also published an interim final rule with comment period (66 FR 55850) that set forth the criteria the Secretary will use to establish new categories of medical devices eligible for transitional pass-through payments under Medicare's OPPS.
- On November 30, 2001, we published a final rule (66 FR 59856) that revised the Medicare OPPS to implement applicable statutory requirements, including relevant provisions of BIPA, and changes resulting from continuing experience with this system. It addition, it described the CY 2002 payment rates for Medicare hospital outpatient services paid under the PPS. This final rule also announced a uniform reduction of 68.9 percent to be applied to each of the transitional pass-through payments for certain categories of medical devices and drugs and biologicals.
- On December 31, 2001, we published a final rule (66 FR 67494) that delayed, until no later than April 1, 2002, the effective date of CY 2002 payment rates and the uniform reduction of transitional pass-through payments that were announced in the November 30, 2001 final rule. In addition, this final rule indefinitely delayed certain related regulatory provisions.
- On March 1, 2002, we published a final rule (67 FR 9556) that corrected technical errors that affected the amounts and factors used to determine the payment rates for services paid under the Medicare OPPS and corrected the uniform reduction to be applied to transitional pass-through payments for CY 2002 as published in the November 30, 2001 final rule. These corrections and the regulatory provisions that had been delayed became effective on April 1, 2002.
C. Authority for Payment Suspensions for Unfiled Cost Reports
Authority for the provision regarding payment suspensions for unfiled cost reports is contained within the authority for subpart C of 42 CFR Part 405, that is, sections 1102, 1815, 1833, 1842, Start Printed Page 520961866, 1870, 1871, 1879, and 1892 of the Social Security Act (42 U.S.C. 1302, 1395g, 13951, 1395u, 1395cc, 1395gg, 1395hh, 1395pp, and 1395ccc) and 31 U.S.C. 3711.
D. Summary of Payment Suspensions for Unfiled Cost Reports
This provision is set forth in our existing regulations at 42 CFR 405.371 as follows:
Section 405.371 (a) provides that Medicare payments may be suspended, in whole or in part, following overpayments determined by the Medicare contractor when overpayment exists or when the payments to be made may not be correct.
Section 405.371(b) provides, in relevant part, that a payment suspension may proceed only after certain procedural requirements contained at § 405.372 are met.
Existing § 405.371(c) provides for suspension of payment if a provider has failed to timely file an acceptable cost report. Payment to the provider is immediately suspended until a cost report is filed and determined by the intermediary to be acceptable.
With the increased transition to the prospective payment systems, the cost report settlement process has become less determinative of an institutional provider's Medicare reimbursement. For instance, in the case of an inpatient acute care hospital, the base DRG payment (as opposed to any teaching or disproportionate share payments, or pass-through payments) is determined when a claim is initially adjudicated, and does not generally change at the time of cost report settlement. Similarly, the APC payment for an outpatient service is also based on the claim adjudication. For home health agencies, minimal changes to payment are made at the time of cost report settlement, and for skilled nursing facilities, the main cost report issues revolve around bad debt determinations. In all of these cases, a significant proportion of the institution's payments are determined based on the adjudication of claims, and do not change at the point of settling the cost report. However, the filing of cost reports remains important for settling some payments, such as medical education payments, even for providers that are fully transitioned to prospective payment systems. Also, cost reports for PPS providers are used for determining prospective payment rates for future years. For these reasons, tailored payment suspensions can still be an effective measure for ensuring that providers comply with their obligation to file timely and acceptable cost reports.
II. Proposed Changes to the Ambulatory Payment Classification (APC) Groups and Relative Weights
Under the OPPS, we pay for hospital outpatient services on a rate-per-service basis that varies according to the APC group to which the service is assigned. Each APC weight represents the median hospital cost of the services included in that APC relative to the median hospital cost of the services included in APC 601, Mid-Level Clinic Visits. The APC weights are scaled to APC 601 because a mid-level clinic visit is one of the most frequently performed services in the outpatient setting.
Section 1833(t)(9)(A) of the Act requires the Secretary to review the components of the OPPS not less often than annually and to revise the groups and related payment adjustment factors to take into account changes in medical practice, changes in technology, and the addition of new services, new cost data, and other relevant information. Section 1833(t)(9)(A) of the Act requires the Secretary, beginning in 2001, to consult with an outside panel of experts when annually reviewing and updating the APC groups and the relative payment weights.
Finally, section 1833(t)(2) of the Act provides that, subject to certain exceptions, the items and services within an APC group cannot be considered comparable with respect to the use of resources if the highest median or mean cost item or service in the group is more than 2 times greater than the lowest median or mean cost item or service within the same group (referred to as the “2 times rule”).
We use the median cost of the item or service in implementing this provision. The statute authorizes the Secretary to make exceptions to the 2 times rule “in unusual cases, such as low volume items and services.”
The APC groups that we are proposing in this rule as the basis for payment in 2003 under the OPPS have been analyzed within this statutory framework.
A. Recommendations of the Advisory Panel on APC Groups
1. Establishment of the Advisory Panel
Section 1833(t)(9)(A) of the Act, requires that we consult with an outside panel of experts when annually reviewing and updating the APC groups and the relative weights. The Act specifies that the panel will act in an advisory capacity. The expert panel, which is to be composed of representatives of providers, is to review and advise us about the clinical integrity of the APC groups and their weights. The panel is not restricted to using our data and may use data collected or developed by organizations outside the Department in conducting its review.
On November 21, 2000, the Secretary signed the charter establishing an “Advisory Panel on APC Groups” (the Panel). The Panel is technical in nature and is governed by the provisions of the Federal Advisory Committee Act (FACA) as amended (Pub. L. 92-463). To establish the Panel, we solicited members in a notice published in the Federal Register on December 5, 2000 (65 FR 75943). We received applications from more than 115 individuals nominating either themselves or a colleague. After carefully reviewing the applications, we chose 15 highly qualified individuals to serve on the Panel. The first APC Panel meeting was held on February 27, February 28, and March 1, 2001 to discuss the 2001 APCs in anticipation of the 2002 OPPS.
We published a notice in the Federal Register on December 14, 2001 to announce the location and time of the second Panel meeting, a list of agenda items, and that the meeting was open to the public. We also provided additional information through a press release and on our website. We convened the second meeting of the Panel on January 22 through January 24, 2002.
2. General Issues Considered by the Advisory Panel
In this section, we summarize the Panel's discussion of a recommendation by the Panel's Research Subcommittee concerning the format of written submissions and oral presentations to the Panel and of several general OPPS payment issues.
Content for Future Presentations to the Panel
During the 2001 meeting, the Panel heard many different types of oral presentations. The Panel members felt that requiring consistency for all presentations with regard to format, data submission, and general information would assist them in analyzing the submissions and presentations and making recommendations. Therefore, during the 2001 meeting, the Panel recommended the creation of a Research Subcommittee. The Research Subcommittee was established during the 2001 meeting and had regular conference calls to discuss the development and implementation of standards for written submissions and oral presentations to the Panel during its meetings. The Research Subcommittee also analyzed complex issues (such as the use of multiple procedure claims Start Printed Page 52097data to set APC relative weights) that could not be addressed in the time allotted for the annual meeting.
The Panel began its 2002 meeting by considering the Research Subcommittee's recommendation to the Panel on requirements for written submissions and oral presentations. The Research Subcommittee recommended that all future oral presentations and written submissions contain the following:
- Name, address, and telephone number of the proposed presenter.
- Financial relationship(s), if any, with any company whose products, services, or procedures are under consideration.
- CPT codes involved.
- APC(s) affected.
- Description of the issue.
- Clinical description of the service under discussion, with comparison to other services within the APC.
- Description of the resource inputs associated with the service under discussion, with a comparison to resource inputs for other services within the APC.
- Recommendations and rationale for change.
- Expected outcome of change and potential consequences of no change.
The Panel adopted the Subcommittee s recommendation. Presentations for the 2003 meeting must contain, at a minimum, this information.
Inpatient Only List
At its February 2001 meeting, the Panel discussed the existence of the inpatient list. The Panel favored its elimination. At the January 2002 meeting, Panel members noted that hospitals receive no payment for a service performed in an outpatient department that appears on the inpatient list, even though the physician performing that service will receive payment for his or her services. The Panel believes the physician should determine what procedure to perform and that both the hospital and the physician should receive payment for the procedure. We continue to disagree with the position taken by the Panel regarding the inpatient list for reasons that we discuss in detail in the April 7, 2000 final rule (65 FR 18456).
Prior to the 2002 Panel meeting, we received requests from hospital and surgical associations and societies to remove certain procedures from the inpatient list. We reviewed those requests and presented to the Panel the requests for which we were unable to make a determination based on the information submitted with the request.
The Panel considered removing the following procedures from the inpatient list:
CPT Description 21390 Treat eye socket fracture. 27216 Treat pelvic ring fracture. 27235 Treat thigh fracture. 32201 Drain, percut, lung lesion. 33967 Insert ia percut device. 47490 Incision of gallbladder. 62351 Implant spinal canal cath. 64820 Remove sympathetic nerves. 92986 Revision of aortic valve. 92987 Revision of mitral valve. 92990 Revision of pulmonary valve. 92997 Pul art balloon repr, precut. 92998 Pul art balloon repr, precut. The Panel recommended that we solicit comments and additional information from hospitals and medical specialty societies that have an interest in these procedures. The Panel also recommended that we present to them at their 2003 meeting any such comments that we receive to assist in their evaluation of whether to recommend removing the codes from the inpatient list.
The Panel did recommend that we remove from the inpatient list CPT code 47001, Biopsy of liver, needle; when done for indicated purpose at time of other major procedure. Panel members stated that this add-on code is being billed with surgical procedures that are payable under the OPPS. The Panel noted that coding edits prevent payment for the other payable OPPS services if CPT code 47001 is on the claim. We agree with the Panel's recommendation and we propose to remove 47001 from the inpatient list. We further propose to assign it status indicator “N” so that costs associated with CPT code 47001 would be packaged into the APC payment for the primary procedure performed during the same operative session.
One presenter at the Panel meeting suggested removing CPT codes 53448, 54411, and 54417 from the inpatient list because he believed they were being performed in the outpatient setting. After discussing this suggestion, the Panel recommended that these codes remain on the inpatient list because they involve removing a prosthesis through an infected operative field and cannot be safely and effectively performed in the outpatient setting. We agree with the Panel's recommendation, and we are not proposing to remove these codes from the inpatient list.
In section II.B.5 of this preamble, below, we discuss additional procedures, which were not considered by the Panel, that we propose to remove from the inpatient list. We discuss in detail our reasons for proposing these additional changes, and we propose two new criteria that we would adopt in the future when evaluating whether to make a procedure on the inpatient list payable under the OPPS. Table 6 in section II.B.5 lists all the procedures we propose to remove from the inpatient list, including those discussed by the Panel. We are considering the removal of CPT code 33967, Insertion of intra-aortic balloon assist device, percutaneous from the inpatient list, but did not include it in Table 6. The Panel considered this code for removal from the inpatient list and had concerns about whether performing this procedure in an outpatient setting is appropriate. Further, we have not been able to confirm that this procedure is being performed on Medicare beneficiaries in an outpatient setting. We solicit comments, including clinical data and specific case reports, that would support payment for CPT 33967 under the OPPS.
Multiple Bills
During its February 2001 meeting, the Panel received oral testimony identifying CMS exclusive use of single procedure claims to set relative weights for APCs as a potential problem in setting appropriate payment rates for APCs. Therefore, the panel asked its Research Subcommittee to work with CMS staff, using the Endoscopic Retrograde Cholangiopancreatography (ERCP) code family as a case study, to explore the use of multiple procedure claims data for setting relative weights. This code family was selected because presenters had suggested that when procedures in this family are performed, it is typical to perform more than one procedure during a session.
The Subcommittee reviewed pre-OPPS claims data for these codes, paying particular attention to common code combinations and costs per procedure and per code combination. After lengthy review, the Panel concluded that (1) it could not determine whether findings based on review of pre-OPPS data could be extrapolated to post-OPPS claims data; (2) the variability in allocation of costs across ERCP line items and the existence of claims where the same ERCP code was billed more than once indicate that problems exist with the accuracy of facility coding for these procedures; and (3) analysis of multiple claims data for ERCP may not be applicable to other sets of services.
The Subcommittee made the following recommendations to the Panel, which the Panel approved: Start Printed Page 52098
- We should continue to explore the use of multiple procedure claims data for setting payment rates but should continue to use only single procedure claims data to determine relative payment weights for CY 2003.
- We should work with the APC Panel to explore the use of multiple claims data drawn from OPPS claims for services such as radiation oncology in time for the next APC Panel meeting.
- We should educate hospitals on appropriate coding and billing practices to ensure that claims with multiple procedures are properly coded and that costs are properly allocated to each procedure.
One presenter to the panel suggested a method to increase the number of claims that could be considered as single claims. Currently, we consider any claim submitted with two or more primary codes (that is, a code assigned to an APC for separate payment) to be a multiple procedure claim. When these claims contain line items for revenue centers without an accompanying Healthcare Common Procedure Coding System (HCPCS) code there is no way to determine the appropriate primary code with which to package the revenue center. The presenter suggested that we consider all claims where every line contains a separately payable HCPCS code as a single procedure claim, reasoning that on such claims we do not have to determine how and where to “package” line items not identified by a separately payable HCPCS code. Where every line item contains a separately payable HCPCS code, every cost can easily be allocated to a separately payable HCPCS code on the line item and all costs for each HCPCS code can then be accurately and completely determined.
We agree. We describe in section II.B.4 how we determined the number of single claims used to set the APC relative weights proposed for 2003 using this methodology. We ask for comments on our methodology.
Packaging
We sought the Panel's guidance on whether we should package the costs of HCPCS codes for radiologic guidance and radiologic supervision and interpretation services whose descriptors require that they only be performed in conjunction with a surgical procedure.
There are a number of reasons why we package the costs of certain procedures. For example, “add-on” procedures and radiologic guidance procedures should never be billed on a claim without the code for an associated procedure. A facility should not submit a claim for ultrasound guidance for a biopsy unless the claim also includes the biopsy procedure, because the guidance is necessary only when a biopsy is performed. A claim for a packaged guidance procedure (or a supervision and interpretation procedure whose descriptor requires it be performed in association with a surgical procedure) would be returned to the provider for correction and resubmission.
Also, we use packaging because billing conventions allow hospitals to report costs for certain services using only revenue center codes (that is, hospitals are not required to specify HCPCS codes for certain services). Packaging allows these costs to be captured in the data used to calculate median costs for services with an APC.
Several presenters to the panel requested that we not package any radiologic guidance or supervision and interpretation codes. They believe that hospitals will not use codes for which they do not receive a separate payment. If that were the case, it would be difficult to track utilization for these procedures and make it difficult for radiology departments to receive an appropriate payment for their services. A few presenters also pointed out that various forms of guidance with widely varying costs can be used for a single surgical procedure. Therefore, we might unintentionally create an incentive for inappropriate care by packaging several guidance procedures with varying costs into a single surgical code. Additionally, a manufacturer of ultrasound guidance equipment used for placement of radiation fields commented that, because guidance is rarely used for this purpose, its costs could not be adequately captured by packaging it into a common procedure where the vast majority of claims did not use guidance.
The Panel concluded that, even though we could be setting relative weights based on error claims, we should not package additional radiologic guidance and supervision and interpretation procedures and should continue to explore methodologies that would allow these procedures to be recognized for separate payment. The Panel also recommended that radiology guidance codes that were in APC 268 for CY 2001 but that were designated with status indicator “N” as packaged services in 2002, be restored as separately payable services for CY 2003. The Panel requested that this topic be placed on the agenda for the next Panel meeting.
Add-On Codes
We presented for the Panel's consideration several options for payment of add-on codes, including assignment of status indicator “N” to package them into the payment for the base procedure. Add-on codes described additional procedures performed by the same physician that are associated with the primary procedure, and which cannot be billed without the primary procedure. Such a methodology would create a single, weight averaged payment for the parent procedure and the add-on procedure while addressing the problem that any “single” claim for an add-on procedure is, by definition, an error claim. After thorough review, the Panel concluded that we should continue to pay for add-on codes separately, setting relative weights with the use of single procedure claims in spite of the fact that these were error claims. The Panel asked us to continue exploring ways to most appropriately pay for these services. They requested that this item also be placed on the agenda for the next Panel meeting.
We propose to accept the recommendations of the APC Panel both for packaging radiology guidance and supervision and interpretation codes and for payment of add-on codes. We are proposing to pay separately in 2003 for radiology guidance codes that were paid in APC 268 in CY 2001 but that were packaged in 2002.
3. Recommendations of the Advisory Panel and Our Responses
In this section, we consider the Panel's recommendations affecting specific APCs. The most recent data available for the Panel to review in considering specific APC groupings were the 1999-2000 pre-OPPS claims data that were the basis of the CY 2002 relative payment weights. The APC titles are shown in this discussion of the APC Panel recommendations as they existed when the APC Panel met in January 2002. In a few cases the APC titles were changed for the proposed 2003 OPPS and therefore some APCs do not have the same title in Addenda A as they have in this section.
As discussed below, the Panel sometimes declined to recommend a change in an APC even though the APC violated the 2 times rule. In section II.B.1 of this preamble, we discuss our proposals regarding the 2 times rule based on the CY 2001 data we are using to recalibrate the 2003 APC relative weights. Section II.B.1 also details the criteria we use in deciding to make an exception to the 2 times rule. We asked the Panel to review many of the Start Printed Page 52099exceptions we implemented in 2001 and 2002. We refer to the exceptions as “violations of the 2 times” rule in the following discussion.
APC 215: Level I Nerve and Muscle Tests
APC 216: Level III Nerve and Muscle Tests
APC 218: Level II Nerve and Muscle Tests
We presented this agenda item because APC 215 appeared to violate the 2 times rule. In order to remedy this violation, we asked the Panel to consider the following changes:
- Move CPT codes 95858, 95921, and 95922 from APC 215 to APC 218.
- Move CPT code 95930 from APC 216 to APC 218.
- Move CPT code 92275 from APC 216 to APC 231.
- Move CPT code 95920 from APC 218 to APC 216.
A presenter to the Panel who represented a device manufacturer noted that the resources used to provide 95921, Autonomic nerve function test, are not similar to the resources required for performing the procedures in APC 218, where we had suggested moving the device. He requested that the code be reassigned to APC 216 where it resided in calendar year 2000. Because there were very few claims for the code in the 1999 and 2000 data, the Panel voiced concern about making the change without sufficient data to support such a move.
The Panel recommended that the changes we asked them to consider be made, that is, to move CPT codes 95921 and 95922 to APC 218. However, if the calendar year 2001 data support a move of 95921 to APC 216, the Panel recommended that we consider that move.
APC 600: Low Level Clinic Visits
APC 601: Mid Level Clinic Visits
APC 602: High Level Clinic Visits
APC 610: Low Level Emergency Visits
APC 611: Mid Level Emergency Visits
APC 612: High Level Emergency Visits
The Panel's recommendations related to facility coding for clinic and emergency department visits are discussed below, in section VIII.A.
APC 296: Level I Therapeutic Radiologic Procedures
APC 297: Level II Therapeutic Radiologic Procedures
APC 263: Level I Miscellaneous Radiology Procedures
APC 264: Level II Miscellaneous Radiology Procedures
APCs 296, 263, and 264 appear to violate the 2 times rule. We asked the Panel to consider three options for reconfiguring these APCs so that they would conform with the 2 times rule.
Option 1: Create a new APC, Level III Therapeutic Radiology Procedures, by moving CPT code 75984 from APC 296 and 74475 from APC 297. Also, move CPT codes 76101, 70390, and 71060 from APC 263 to APC 264 and move CPT code 75980 from APC 297 to APC 296.
Option 2: Move CPT codes 76101, 703690, and 71060 from APC 263 to APC 264 and move CPT code 75984 from APC 296 to APC 264. Move CPT code 75980 from APC 297 to APC 296.
Option 3: Create a new APC, Level III Miscellaneous Radiology Procedures, by moving CPT codes 76080, 7036736, 76101, 70390, 74190, and 71060 from APC 263. Move CPT code 74327 from APC 296 to APC 263 and move CPT code 75980 from APC 297 to APC 296. APC 264 remains unchanged.
One presenter to the panel objected to the use of miscellaneous APCs in the OPPS. The presenter argued that we are charged with creating clinically coherent APCs and that miscellaneous APCs contradict the principle of clinical coherence. We noted that in spite of considerable effort to do so, we have not been able to incorporate the procedures assigned to miscellaneous APCs into other, more clinically homogeneous APCs. We asked the presenter to propose a configuration for consideration.
The Panel noted that none of the options that we presented resolve all of the 2 times violations. However, the Panel agreed that Option 2 would create more clinically coherent APCs without creating a new APC based on anticipated device costs that would be billed in 2002. In addition, the Panel invited the American College of Radiology and other interested parties to propose further changes for the Panel's consideration next year.
We propose to accept the Panel's recommendations that option 2 be implemented.
APC 230: Level I Eye Tests and Treatments
APC 231: Level III Eye Tests and Treatments
APC 232: Level I Anterior Segment Eye Procedures
APC 233: Level II Anterior Segment Eye Procedures
APC 234: Level III Anterior Segment Eye Procedures
APC 235: Level I Posterior Segment Eye Procedures
APC 236: Level II Posterior Segment Eye Procedures
APC 237: Level III Posterior Segment Eye Procedures
APC 238: Level I Repair and Plastic Eye Procedures
APC 239: Level II Repair and Plastic Eye Procedures
APC 240: Level III Repair and Plastic Eye Procedures
APC 241: Level IV Repair and Plastic Eye Procedures
APC 242: Level V Repair and Plastic Eye Procedures
APC 247: Laser Eye Procedures Except Retinal
APC 248: Laser Retinal Procedures
APC 698: Level II Eye Tests and Treatments
APC 699: Level IV Eye Tests and Treatments
We asked the Panel to review these APCs to address clinical inconsistencies and violations of the 2 times rule. We suggested creating a new level for posterior segment eye procedures and other changes in order to make the groups more clinically coherent, as follows:
- Move CPT codes 65260 and 67218 from APC 237 to 236.
- Create a new APC (Level IV Posterior Segment Eye Procedures) by moving CPT codes 67107, 67112, 67040, and 67108 from APC 237.
- Move CPT codes 67145, 67105, and 67210 from APC 247 to APC 248.
- Move CPT code 66999 from APC 247 to APC 232.
- Move CPT code 67299 from APC 248 to APC 235.
- Move CPT codes 65855, 66761, and 66821 from APC 248 to APC 247.
- Move CPT code 67820 from APC 698 to APC 230.
- Move CPT code 67208 from APC 231 to APC 235.
- Move CPT codes 92226, 92284, 65205, 92140 from APC 231 to APC 698.
- Move CPT code 92235 from APC 231 to APC 699.
- Move CPT code 68100 from APC 233 to APC 232.
- Move CPT code 65180 from APC 233 to APC 234.
- Create a new APC (Level IV Anterior Segment Eye Procedures) by moving CPT codes 66172, 66185, 66180, 66225 from APC 234.
- Move CPT code 92275 from APC 216 to APC 231.
No presenters commented on these APCs, and, after brief discussion, the Panel recommended concurrence with our suggested changes. We propose to accept the Panel's recommendations. We note that when we were able to use 2001 claims data to re-evaluate the changes recommended by the Panel for these APCs, we found violations of the 2 times rule in the reconfigured APCs. Nonetheless, we propose to accept the Start Printed Page 52100Panel's recommendations because they result in more clinically coherent APCs. We solicit comments on further changes that would address the violations of the 2 times rule. We plan to place these APCs on the panel's agenda for 2003.
APC 110: Transfusion
APC 111: Blood Product Exchange
APC 112: Apheresis, Photopheresis, and Plasmapheresis
We presented these APCs to the Panel in 2001 because of their low payment rates and concern that our cost data was inaccurate. These APCs were on the agenda this year in order to obtain further comment on our cost data. We suggested no changes in the structure of these APCs.
Representatives of two associations made presentations regarding these APCs. One recommended that all the plasma derivatives and recombinant analogs that currently receive transitional pass-through payments be assigned to permanent APCs in 2003, similar to the designations of other blood products. The representative of the second association supported this recommendation.
The second presenter also pointed out that, consistent with our billing instructions, every claim that a hospital submits for a blood transfusion should include codes for both the blood product and the transfusion. Therefore, payment for blood and blood products is another area affected by the use of single bills in setting payment weights. The Panel agreed to look specifically at blood in its work on the multiple claims issues.
The Panel recommended that plasma derivatives be placed in their own APCs and classified in the same manner as whole blood products. In addition, the Panel observed that hospitals incur additional costs with each unit of blood product transfused and, therefore, recommended that APC 110 be revised to allow for the costs of additional units of blood product and clinical services.
In section III.C, we discuss our payment proposals for drugs and biologicals for which pass-through payments are scheduled to expire in 2003. Those proposals would affect payment for blood and blood products. We propose not to accept the Panel's recommendation to change current OPPS payment policy for transfusions. The current payment reflects weight averaging over the number of units transfused. Therefore, unless a hospital specializes in transfusing multiple units of blood, payments for this procedure should be, on average, appropriate.
Panel Recommendations to Defer Changes Pending Availability of 2001 Claims Data
Regarding the remaining APC groups that are addressed below, the Panel recommended that we make no changes until data from claims billed in 2001 under the OPPS become available for analysis. The Panel further requested that we place the APC groups in this section on the agenda for consideration at its meeting in 2003. The changes that we propose for the APCs in this section are based upon our review of the 2001 claims data, which did not become available until March 2002.
APC 203: Level V Nerve Injections
APC 204: Level VI Nerve Injections
APC 206: Level III Nerve Injections
APC 207: Level IV Nerve Injections
Several presenters to the Panel suggested changes in the configuration of these APCs because of concerns that the current classifications result in payment rates that are too low relative to the resource costs associated with certain procedures in the APCs. Several of these APCs include procedures associated with drugs or with device categories for which pass-through payments are scheduled to expire in 2003. The Panel recommended that we not change the structure of these APCs at this time. Because the structure of these APCs was substantially changed for 2002, and 2002 cost data was not yet available, the Panel felt it would be appropriate to review 2002 cost data prior to making further structural changes to these APCs. We propose to accept the Panel's recommendation. We will place these APCs on the Panel's agenda when 2002 cost data becomes available.
APC 43: Closed Treatment Fracture Finger/Toe/Trunk
APC 44: Closed Treatment Fracture/Dislocation, Except Finger/Toe/Trunk
On the basis of 1999-2000 claims data, these APCs violate the 2 times rule. The Panel reviewed these APCs and recommended no changes.
Our subsequent review of 2001 OPPS cost data shows continuing violations of the 2 times rule and that costs within these APCs are virtually identical. Therefore, we propose to combine APCs 43 and 44 into APC 43. The procedures in the consolidated APC are clinically homogeneous.
APC 58: Level I Strapping and Cast Application
APC 59: Level II Strapping and Cast Application
The Panel reviewed these APCs and recommended that no changes be made pending analysis of 2001 claims data. The panel did recommend that billing instructions be developed on the appropriate use of the codes in these APCs. We agree with the Panel's recommendation regarding the need for billing instructions, and we expect to develop such instructions for hospitals to use in 2003.
Our subsequent review of 2001 claims data reveals that, in some cases, costs for short casts and splints are greater than costs for long casts and splints. Moreover, the proposed payments for these two APCs, based on 2001 OPPS data, would not differ significantly from each other. Therefore, we propose to combine the codes in APC 58 and APC 59 into a single APC, APC 58. Combining these APCs does not compromise clinical homogeneity. The relative weight of the proposed single APC is virtually identical to the relative weight of each of the two current APCs. We propose to continue to work with hospitals to develop appropriate coding for these services and will review the appropriate APC structure for these services next year.
APC 279: Level I Angiography and Venography Except Extremity
APC 280: Level II Angiography and Venography Except Extremity
Without the benefit of 2001 OPPS claims data, it was difficult for the Panel to determine whether the apparent violation of the 2 times rule in APCs 279 and 280 was attributable to underreporting of procedures or inaccurate coding. Therefore, the Panel recommended no changes pending the availability of the more recent claims data. After subsequently reviewing the 2001 claims data, we propose to move CPT codes 75978, Transluminal balloon angioplasty, venous, radiological supervision and interpretation, and 75774, Angiography, selective, each additional vessel studied after basic examination, radiological supervision and interpretation, to new APC 0668. This would resolve violations of the 2 times rule and result in clinically coherent APCs.
APC 115: Cannula/Access Device Procedures
We propose to move CPT code 36860, External Cannula Declotting; without balloon catheter, to APC 103, Miscellaneous Vascular Procedures. We believe this makes both APC 115 and APC 103 more clinically homogeneous and it resolves a violation of the 2 times rule in APC 115 that was caused by the presence of CPT code 36860.
APC 93: Vascular Repair/Fistula Construction Start Printed Page 52101
APC 140: Esophageal Dilation without Endoscopy
APC 141: Upper GI Procedures
APC 142: Small Intestine Endoscopy
APC 143: Lower GI Endoscopy
APC 144: Diagnostic Anoscopy
APC 145: Therapeutic Anoscopy
APC 146: Level I Sigmoidoscopy
APC 147: Level II Sigmoidoscopy
APC 148: Level I Anal/Rectal Procedure
APC 149: Level II Anal/Rectal Procedure
Our subsequent review of 2001 claims data suggests that the cost data for APCs 144 and 145 are aberrant. The cost data for these APCs yield relative weights and payments that are significantly higher than the relative weights for APCs 146 and 147, which consist of similar procedures performed through a sigmoidoscope rather than an anoscope. As currently arranged, the APC configuration for these services could provide a financial incentive for hospitals to perform unnecessary anoscopic procedures, either alone or with a sigmoidoscopy. To rectify this problem, we propose to move the procedures in APCs 144 and 145 to APC 147 with the exception of CPT code 46600, Anoscopy; diagnostic, which we propose to assign to APC 340, Minor Ancillary procedures. We believe these changes would result in clinically coherent APCs with appropriate relative weights and payment rates.
APC 363: Otorhinolaryngologic Function Tests
Based on 2001 claims data, we propose to move CPT codes 92543, 92588, 92520, 92546, 92516, 92548, and 92584 to new APC 0660 (Level III Otorhinolaryngolgic Function Tests). This change would resolve a 2 times rule violation and create clinically coherent APCs.
APC 96: Non-Invasive Vascular Studies
APC 265: Level I Diagnostic Ultrasound Except Vascular
APC 266: Level II Diagnostic Ultrasound Except Vascular
APC 267: Vascular Ultrasound
APC 269: Level I Echocardiogram Except Transesophageal
APC 270: Transesophageal Echocardiogram
The APC Panel recommended making no changes in the configuration of these APCs. Several groups made a joint proposal to reconfigure these APCs arguing that their proposal resulted in more clinically coherent APCs. However, several other presenters commented that the joint proposal did not include several physician groups who commonly perform these procedures.
Based on 2001 claims data, we propose to make several changes in order to resolve 2 times rule violations and to make these APCs more clinically coherent. Specifically, we propose to move CPT code 43499 from APC 0140 to APC 141; CPT code 93721 from APC 0096 to APC 368; CPT code 93740 from APC 0096 to APC 367; CPT code 93888 from APC 0267 to APC 266; and CPT code 93931 from APC 0267 to APC 266. We also propose to move CPT codes 78627, 76825, and 93320 from APC 0269 to new APC 0671 to achieve more clinical coherence. We also propose to create new APC 0670 for intravascular ultrasound and intracardiac echocardiography consisting of CPT codes 37250, 37251, 92978, 92979, and 93662.
APC 291: Level I Diagnostic Nuclear Medicine Excluding Myocardial Scans
APC 292: Level II Diagnostic Nuclear Medicine Excluding Myocardial Scans
Subsequent to the APC Panel meeting, we received comments on these APCs from the Nuclear Medicine Task Force. After a thorough review of that proposal within the context of the 2001 claims data, we propose to accept the recommendations of the Nuclear Medicine Task Force, which would result in a complete reconfiguration of APCs 290, 291, and 292. Although the reconfiguration would create violations of the 2 times rule, we agree with the Task Force that the reconfigured APCs are more clinically coherent. We note that APCs 290, 291, and 292 as currently configured would also violate the 2 times rule. Therefore, we solicit comments on the proposed reconfiguration of APCs 290, 291, and 292 and on alternative groupings that would achieve clinical coherence without violating the 2 times rule.
APC 274: Myleography
APC 179: Urinary Incontinence Procedures
APC 182: Insertion of Penile Prosthesis
APC 19: Level I Excision/Biopsy
APC 20: Level II Excision/Biopsy
APC 21: Level IV Excision/Biopsy
APC 22: Level V Excision/Biopsy
APC 694: Level III Excision/Biopsy
Based on 2001 claims data, we propose to move several codes from APC 19 to APC 20 and several codes from ACP 20 to APC 21. Additionally, we propose to move CPT codes 11770, 54105, and 60512 to APC 22. We also propose to move CPT code 58999 to APC 191 and CPT code 37799 to APC 35. These changes would result in clinically coherent APCs that do not violate the 2 times rule.
APC 24: Level I Skin Repair
APC 25: Level II Skin Repair
APC 26: Level III Skin Repair
APC 27: Level IV Skin Repair
APC 686: Level V Skin Repair
Based on 2001 claims data, we propose to move CPT code 43870 from APC 0025 to APC 141; and CPT codes with high costs from APC 26 to APC 27. We also propose to move the codes remaining in APC 26 to APC 25. APC 26 would then be deleted. These changes would result in a more compact APC structure without compromising the clinical homogeneity of the reconfigured APCs and without violating the 2 times rule. See Table 1 for codes moving from APC 26 to APC 25 or APC 27.
Table 1.—HCPCS Codes Proposed To Be Moved From APC 26 into APC 25 or APC 27
2002 APC 26 2003 APC 25 2003 APC 27 11960 11960 11970 11970 12037 12037 12047 12047 12057 12057 13150 13150 13160 13160 14000 14000 14001 14001 14020 14020 14021 14021 14040 14040 14041 14041 14060 14060 14061 14061 14300 14300 14350 14350 15000 15000 15001 15001 15050 15050 15101 15101 15120 15120 15121 15121 15200 15200 15201 15201 15220 15220 15221 15221 15240 15240 15241 15241 15260 15260 15261 15261 15351 15351 15400 15400 15401 15401 15570 15570 15572 15572 15574 15574 15576 15576 15600 15600 15610 15610 15620 15620 15630 15630 15650 15650 15775 15775 15776 15776 15819 15819 15820 15820 15821 15821 15822 15822 15823 15823 Start Printed Page 52102 15825 15825 15826 15826 15829 15829 15835 15835 20101 20101 20102 20102 20910 20910 20912 20912 20920 20920 20922 20922 20926 20926 23921 23921 25929 25929 33222 33222 33223 33223 44312 44312 44340 44340 15580—Code Deleted 15625—Code Deleted APC 77: Level I Pulmonary Treatment
APC 78: Level II Pulmonary Treatment
APC 251: Level I ENT Procedures
APC 252: Level II ENT Procedures
APC 253: Level III ENT Procedures
APC 254: Level IV ENT Procedures
APC 256: Level V ENT Procedures
Based on 2001 claims data, we propose to address violations of the 2 times rule by moving CPT codes 40812, 42330, and 21015 from APC 0252 to APC 253 and by moving CPT codes 41120 and 30520 to APC 254.
B. Other Changes Affecting the APCs
1. Limit on Variation of Costs of Services Classified Within a Group
Section 1833(t)(2) of the Act provides that the items and services within an APC group cannot be considered comparable with respect to the use of resources if the highest cost item or service within a group is more than 2 times greater than the lowest cost item or service within the same group. However, the statute authorizes the Secretary to make exceptions to this limit on the variation of costs within each group in unusual cases such as low volume items and services. No exception may be made, however, in the case of a drug or biological that has been designated as an orphan drug under section 526 of the Federal Food, Drug, and Cosmetic Act.
Taking into account the proposed APC changes discussed in relation to the APC panel recommendations in this section of this preamble and the use of 2001 claims data to calculate the median cost of procedures classified to APCs, we reviewed all the APCs to determine which of them would not meet the 2 times limit. We use the following criteria when deciding whether to make exceptions to the 2 times rule for affected APCs:
- Resource homogeneity.
- Clinical homogeneity.
- Hospital concentration.
- Frequency of service (volume).
- Opportunity for upcoding and code fragmentation.
For a detailed discussion of these criteria, refer to the April 7, 2000 final rule (65 FR 18457).
The following table contains APCs that we propose to exempt from the 2 times rule based on the criteria cited above. In cases in which compliance with the 2 times rule appeared to conflict with a recommendation of the APC Advisory Panel, we generally accepted the Panel recommendation. This was because Panel recommendations were based on explicit consideration of resource use, clinical homogeneity, hospital specialization, and the quality of the data used to determine payment rates.
The median cost for hospital outpatient services for these and all other APCs can be found at website: http://www.cms.hhs.gov.
Table 2.—Table of Exempted Codes
NPRM APC Description 0012 Level I Debridement & Destruction 0019 Level I Excision/ Biopsy 0020 Level II Excision/ Biopsy 0025 Level II Skin Repair 0032 Insertion of Central Venous/Arterial Catheter 0043 Closed Treatment Fracture Finger/Toe/Trunk 0046 Open/Percutaneous Treatment Fracture or Dislocation 0058 Level I Strapping and Cast Application 0074 Level IV Endoscopy Upper Airway 0080 Diagnostic Cardiac Catheterization 0081 Non-Coronary Angioplasty or Atherectomy 0093 Vascular Repair/Fistula Construction 0097 Cardiac and Ambulatory Blood Pressure Monitoring 0099 Electrocardiograms 0103 Miscellaneous Vascular Procedures 0105 Revision/Removal of Pacemakers, AICD, or Vascular 0121 Level I Tube changes and Repositioning 0140 Esophageal Dilation without Endoscopy 0147 Level II Sigmoidoscopy 0148 Level I Anal/Rectal Procedure 0155 Level II Anal/Rectal Procedure 0165 Level III Urinary and Anal Procedures 0170 Dialysis 0179 Urinary Incontinence Procedures 0191 Level I Female Reproductive Proc 0192 Level IV Female Reproductive Proc 0203 Level VI Nerve Injections 0204 Level I Nerve Injections 0207 Level III Nerve Injection 0218 Level II Nerve and Muscle Tests 0225 Implantation of Neurostimulator Electrodes 0230 Level I Eye Tests & Treatments 0231 Level III Eye Tests & Treatments Start Printed Page 52103 0233 Level II Anterior Segment Eye Procedures 0235 Level I Posterior Segment Eye Procedures 0238 Level I Repair and Plastic Eye Procedures 0239 Level II Repair and Plastic Eye Procedures 0252 Level II ENT Procedures 0260 Level I Plain Film Except Teeth 0274 Myelography 0286 Myocardial Scans 0290 Level I Diagnostic Nuclear Medicine Excluding Myocardial Scans 0291 Level II Diagnostic Nuclear Medicine Excluding Myocardial Scans 0294 Level I Therapeutic Nuclear Medicine 0297 Level II Therapeutic Radiologic Procedures 0303 Treatment Device Construction 0304 Level I Therapeutic Radiation Treatment Preparation 0330 Dental Procedures 0345 Level I Transfusion Laboratory Procedures 0354 Administration of Influenza/Pneumonia Vaccine 0356 Level II Immunizations 0367 Level I Pulmonary Test 0368 Level II Pulmonary Tests 0370 Allergy Tests 0373 Neuropsychological Testing 0600 Low Level Clinic Visits 0602 High Level Clinic Visits 0660 Level III Otorhinolaryngologic Function Tests 0692 Electronic Analysis of Neurostimulator Pulse Generators 0694 Mohs Surgery 0698 Level II Eye Tests & Treatments 2. Procedures Moved From New Technology APCs to Clinically Appropriate APCs
In the November 30, 2001 final rule, we made final our proposal to change the period of time during which a service may be paid under a new technology APC (66 FR 59903), initially established in the April 7, 2000 final rule. That is, beginning in 2002, we will retain a service within a new technology APC group until we have acquired adequate data that allow us to assign the service to a clinically appropriate APC. This policy allows us to move a service from a new technology APC in less than 2 years if sufficient data are available, and it also allows us to retain a service in a new technology APC for more than 3 years if sufficient data upon which to base a decision for reassignment have not been collected.
Effective in 2003, we propose to move several procedures from new technology APCs to clinical APCs. Those procedures and the clinical APCs to which we propose to assign the procedures for payment in 2003 are identified in Table 3. Based upon our review of the 2001 OPPS claims data, we believe we have sufficient information upon which to base assignment of these procedures to clinical APCs. In making this determination, we reviewed both single and multiple procedure claims. We compared median cost data for the new technology procedures with median cost data for procedures that are clinically similar and for which we would expect costs to be similar. We also compared median cost data for the new technology procedures with median cost data for clinically related procedures, such as different methods of treating prostatic hypertrophy, where expected median costs were lower or higher than those of the new technology procedure. In some cases we propose classification of a new technology procedure in an APC with procedures that are similar both clinically and in terms of resource consumption. In other cases, we propose to create a new APC for a new technology procedure because we do not believe any of the existing APCs contain procedures that are clinically similar and similar in terms of resource consumption. We solicit comments on our proposed reassignment of the new technology procedures listed in Table 3.
Table 3.—Proposed Changes in HCPCS Assignments From New Technology APCs to Procedure APCs for 2003
HCPCS Description 2002 SI 2003 SI 2002 APC 2003 APC 19103 Bx breast percut w/device S T 0710 0658 33282 Implant pat-active ht record S S 0710 0680 36550 Declot vascular device T T 0972 0677 53850 Prostatic microwave thermotx T T 0982 0675 53852 Prostatic rf thermotx T T 0982 0675 55873 Cryoablate prostate T T 0982 0674 76075 Dual energy x-ray study S S 0707 0288 76076 Dual energy x-ray study S S 0707 0665 77520 Proton trmt, simple w/o comp S S 0710 0664 77522 Proton trmt, simple w/comp S S 0710 0664 77523 Proton trmt, intermediate S S 0712 0664 Start Printed Page 52104 77525 Proton treatment, complex S S 0712 0664 92586 Auditor evoke potent, limit S S 0707 0218 95965 Meg, spontaneous T S 0972 0717 95966 Meg, evoked, single T S 0972 0714 95967 Meg, evoked, each addl T S 0972 0712 C1300 Hyperbaric oxygen S S 0707 0659 C9708 Preview Tx Planning Software T T 0975 0973 G0125 PET img WhBD sgl pulm ring T S 0976 0667 G0166 Extrnl counterpulse, per tx T T 0972 0678 G0168 Wound closure by adhesive T X 0970 0340 G0173 Stereo radoisurgery, complete S S 0721 0663 G0204 Diagnostic mammography digital S S 0707 0669 G0206 Diagnostic mammography digital S S 0707 0669 G0210 PET img whbd ring dxlung ca S S 0714 0667 G0211 PET img whbd ring init lung S S 0714 0667 G0212 PET img whbd ring restag lun S S 0714 0667 G0213 PET img whbd ring dx colorec S S 0714 0667 G0214 PET img whbd ring init colre S S 0714 0667 G0215 PET img whbd restag col S S 0714 0667 G0216 PET img whbd ring dx melanom S S 0714 0667 G0217 PET img whbd ring init melan S S 0714 0667 G0218 PET img whbd ring restag mel S S 0714 0667 G0220 PET img whbd ring dx lymphom S S 0714 0667 G0221 PET img whbd ring init lymph S S 0714 0667 G0222 PET img whbd ring resta lymp S S 0714 0667 G0223 PET img whbd reg ring dx hea S S 0714 0667 G0224 PET img whbd reg ring ini hea S S 0714 0667 G0225 PET img whbd ring restag hea S S 0714 0667 G0226 PET img whbd dx esophag S S 0714 0667 G0227 PET img whbd ring ini esopha S S 0714 0667 G0228 PET img whbd ring restg esop S S 0714 0667 G0229 PET img metabolic brain ring S S 0714 0667 G0230 PET myocard viability ring S S 0714 0667 G0231 PET WhBD colorec; gamma cam S S 0714 0667 G0232 PET WhBD lymphoma; gamma cam S S 0714 0667 G0233 PET WhBD melanoma; gamma cam S S 0714 0667 G0234 PET WhBD pulm nod, gamma cam S S 0714 0667 3. APC Assignment for New Codes Created During 2002
During CY 2002 we created several HCPCS codes to describe services newly covered by Medicare and payable under the hospital OPPS. While we have assigned these services to APCs for CY 2002, the assignments are open to public comment in this proposed rule. In this proposed rule, we solicit comment on the APC assignment of these services. In addition, in this proposed rule, we are proposing the creation of several new HCPCS codes and APC assignments with an effective date of January 1, 2003. Table 4 below includes new procedural HCPCS codes either created for implementation in July 2002, which we intend to implement in October 2002, or which we propose to implement January 2003.
Table 4 does not include new codes for drugs and devices for which we established or intend to establish pass-through payment eligibility in July or October 2002. Furthermore, neither the new procedural HCPCS nor the new pass-through codes intended as of this publication for implementation beginning October 2002 or later are included in Addendum B of this proposed rule.
Table 4.—New G Codes for 2002 and Proposed G Codes for 2003
Code Long descriptor APC SI Proposed effective date G0245 Initial physician evaluation of a diabetic patient with diabetic sensory neuropathy resulting in a loss of protective sensation (LOPS) which must include the procedure used to diagnose LOPS; a patient history; and a physician examination that consists of at least the following elements—* * * 0600 V 7/01/02 G0246 Follow-up physician evaluation of a diabetic patient with diabetic sensory neuropathy resulting in a loss of protective sensation (LOPS) which must include the procedure used to diagnose LOPS; a patient history; and a physician examination that includes—* * * 0600 V 7/01/02 G0247 Routine foot care by a physician of a diabetic patient with diabetic sensory neuropathy resulting in a loss of protective sensation (LOPS) to include if present at least the following—* * * 0009 T 7/01/02 Start Printed Page 52105 G0248 Demonstration, at initial use, of home INR monitoring for a patient with mechanical heart valve(s) who meets Medicare coverage criteria, under the direction of a physician; includes: demonstration use and care of the INR monitor, obtaining at least one blood sample provision of instructions for reporting home INR test results and documentation of a patient's ability to perform testing 0708 S 7/01/02 G0249 Provision of test material and equipment for home INR monitoring to patient wih mechanical heart valve(s) who meets Medicare coverage criteria. Includes provision of materials for use in the home and reporting of test results to physician; per 4 tests 0708 S 7/01/02 G0250 Physician review/interpretation and patient management of home INR test for patient with mechanical heart valve(s) who meets other coverage criteria; per 4 tests (does not require face-to-face service) N/A E 7/01/02 G0AAA PET imaging for initial diagnosis of breast cancer and/or surgical planning for breast cancer (for example, initial staging of axillary lymph nodes), not covered by Medicare. N/A E 10/01/02 G0BBB PET imaging for breast cancer, full and partial-ring PET scanners only, staging/restaging after or prior to course of treatment 0285 S 10/01/02 G0CCC PET imaging for breast cancer, full and partial-ring PET scanners only, evaluation of response to treatment, performed during course of treatment 0285 S 10/01/02 G0DDD Current Perception Threshold/Sensory Nerve Conduction Test, (SNCT) per limb, any nerve. N/A E 10/01/02 G0EEE Intravenous infusion(s) during separately payable observation stay, Per observation stay (must be reported with G0244) 0340 X 10/01/02 G0FFF Bone marrow aspiration and biopsy performed through a single incision during a single session 0003 T 1/01/03 G0GGG Unscheduled or emergency treatment for dialysis for ESRD patient in the outpatient department of a hospital that does not have a certified ESRD facility 0170 S 1/01/03 G0HHH Injection procedure for sacroiliac joint; arthrography N/A N 1/01/03 G0JJJ Injection procedure for sacroiliac joint; provision of anesthetic, steroid, and/or other therapeutic agent 0204 T 1/01/03 G0KKK Prostate brachytherapy, including transperineal placement of needles or catheters into the prostate, cystoscopy, and interstitial radiation source application. 0684 T 1/01/03 G0LLL Initial nursing assessment of patient directly admitted to observation with diagnosis of congestive heart failure, chest pain or asthma. N N 1/01/03 G0MMM Initial nursing assessment of patient directly admitted to observation with diagnosis other than congestive heart failure, chest pain or asthma. 0706 S 1/01/03 G0NNN Transcatheter placement of a drug eluting intracoronary stent(s), percutaneous, with or without other therapeutic intervention, any method; single vessel. 0656 T 01/01/03 G0OOO Transcatheter placement of a drug eluting intracoronary stent(s), percutaneous, with or without other therapeutic intervention, any method; each additional vessel. 0656 T 01/01/03 HCPCS Codes Created During CY 2002
The G codes G0245 through G0250 were created to implement payment for newly covered Medicare services due to national coverage determinations. The G codes G0AAA-G0DDD will be established October 1, 2002 as a result of national coverage policies that will be effective October 1, 2002. These codes were created to accurately describe the services covered, to ensure they were reported correctly, to track their utilization, and to establish payment. We solicit comments on the APC assignment of these services. The codes describing evaluation and management services were assigned to clinic visit APCs containing similar services, and the codes describing procedural services were assigned to new technology APCs or to APCs containing procedures requiring similar resource consumption. Because G0250 is a professional service furnished by a physician, it is not payable under OPPS.
We expect to implement HCPCS code G0EEE (Intravenous Infusion(s) During Separately Payable Observation Stay) effective October 1, 2002 to describe infusion therapy given during a separately payable observation stay. This code is discussed in detail in section VIII.B of this proposed rule. We have assigned it to APC 0340. We believe APC 0340 appropriately accounts for the resources used for infusion during observation. This is because we believe that Q0081, which represents the same service as G0EEE, is typically billed with an APC that has a higher relative weight, therefore making APC 0120 payable at 50 percent of its payment rate.
HCPCS Codes Proposed in This Rule for January 1, 2003
We are proposing the creation of several new HCPCS codes for 2003 in order to address issues that have come to our attention, to describe new technology procedures, to implement policy proposals discussed in this rule, and to allow more appropriate reporting of procedures currently described by CPT (HCPCS Level I) codes.
(1) G0FFF—Bone Marrow Aspiration and Biopsy Services—we are proposing to create this code to describe bone marrow aspiration and biopsy performed through the same incision. We propose to place this code in APC 0003. This code also appears in the proposed rule for the physician fee schedule, published in the June 28, 2002 issue of the Federal Register (67 Start Printed Page 52106FR 43846). This code would facilitate proper reporting of this procedure.
(2) G0GGG—Unscheduled and Emergency Treatment for ESRD Patients—we are proposing this code in order to facilitate payment for dialysis provided to ESRD patients in the outpatient department of a hospital that does not have a certified ESRD facility. This code is described in detail in section VIII.G of this proposed rule.
(3) G0HHH and G0JJJ—Sacroiliac Joint Injections—we are proposing to create these two codes to replace CPT code 27096, Injection procedure for sacroiliac joint, arthrography and/or anesthetic steroid. CPT code 27096 describes two distinct procedures requiring different resource consumption. Moreover, our policy of packaging injection procedures required packaging of this procedure even when it was used to report injection of a steroid or anesthetic. In these cases, it was appropriately billed without another procedure and should have been payable. Therefore, in order to facilitate appropriate reporting and payment for the procedures described by CPT code 27096, we propose to create G0HHH, Injection procedure for sacroiliac joint, arthrography, and G0JJJ, Injection procedure for sacroiliac joint, provision of anesthetic and/or steroid. G0HHH would be given status indicator N, and G0JJJ would be assigned to APC 0204.
(4) G0KKK—Prostate Brachytherapy—we are proposing this code to implement our policy decision discussed in section III.C.3 of this proposed rule.
(5) G0LLL and G0MMM—Observation Care—we are proposing to create these codes to describe observation care provided to a patient who is directly admitted from a physician's office to a hospital for observation care. These codes are discussed in detail in section VIII.B of this rule.
(6) G0NNN, G0OOO; Drug Eluting Stents—
Drug-Eluting Stents
Drug-eluting coronary artery stents (referred to as “drug-eluting stents” in the discussion that follows) have been developed to combat the problem of restenosis of blood vessels previously treated for stenosis. The drug is coated on a stent with a special polymer, and after the stent is placed in the vessel, the drug is slowly released into the vessel wall tissue over a period of 30 to 45 days. The drug coating on the stent is intended to prevent the build-up of scar tissue that can narrow the reopened artery. The FDA has not yet approved this technology for general use. We understand the earliest date that a decision from the FDA is anticipated is late 2002.
We received an application to establish a new medical device category eligible for transitional pass-through payment under the OPPS for drug-eluting stents from a manufacturer of these stents. In the application for the new device category, the manufacturer asserts that drug-eluting stents meet the criteria for establishing a new device category that were set forth in the November 2, 2001 Federal Register. Specifically, the manufacturer believes a new device category is appropriate because drug-eluting stents meet the cost significance thresholds for a new device category, and they provide substantial therapeutic benefit to Medicare beneficiaries compared to other available therapies for coronary atherosclerosis.
Based on our review of the application as well as other information pertaining to drug-eluting stents, we determined that drug-eluting stents are described by an existing pass-through device category. As we discuss in section III.D of this preamble, section 1833(t)(6)(B)(ii)(IV) of the Act requires that a new category must include medical devices for which no existing category, or one previously in effect, is appropriate. In the program memorandum that we issued to our contractors on March 22, 2001 (Transmittal A-01-41) with instructions for the implementation of category codes for use in making transitional pass-through payments for devices, we established two categories that describe and could be used to bill for drug-eluting stents: HCPCS code C1874, Stent, coated/covered, with delivery system, and HCPCS code C1875, Stent, coated/covered, without delivery system. These two categories were based on devices that previously qualified for transitional pass-through payment on an item-specific basis. Although these two device categories are among those that will sunset after December 31, 2002, as we discuss in section III.C of this preamble, the fact that they exist precludes the establishment of a new device category for drug-eluting stents.
Payment for drug-eluting stents is not allowed under the OPPS until they receive FDA approval for general use. If the drug-eluting stents are approved for general use by the FDA, payment would be packaged into the APC payment for the procedures with which the stents are used. The cost of drug-eluting stents would be incorporated within the APC relative payment weights when we recalibrate the payment weights in CY 2005 using CY 2003 claims data.
In considering how we would pay for drug eluting stents under OPPS we thought carefully about how the payment should relate to payment for these stents under IPPS. Section 533 of BIPA added sections 1886(d)(5)(K) and (d)(5)(L) to the Act (as implemented by § 42 CFR 412.87 and 412.88 ) to reduce the time needed under the hospital inpatient PPS for the DRG system to recognize the higher costs of new technologies that meet certain criteria. Drug-eluting stents did not meet the inpatient PPS new technology cost threshold criterion in the May 9, 2002 proposed rule to update the hospital inpatient PPS for FY 2003. Therefore, in that proposed rule, we listed a new ICD-9 procedure code 36.07 (Insertion of drug-eluting coronary artery stent(s)) that would be effective for use October 1, 2002. We also proposed to add ICD-9 code 00.55 (Insertion of drug-eluting noncoronary artery stent) (67 FR 31630). To be consistent with our prior practice of assigning new technology to the same DRGs to which its predecessor technologies were assigned, we proposed in the May 9 inpatient PPS proposed rule to assign inpatient cases involving ICD-9 code 36.07 to DRG 517 (Percutaneous Cardiovascular Procedure with Coronary Artery Stent without AMI).
However, comments to the May 9, 2002 proposed IPPS rule and our own further consideration of this issue persuaded us that a different approach was needed for the IPPS given the preliminary evidence that drug-eluting stents could prove potentially to be transformational technology in the treatment of coronary artery disease. While this technology is not yet approved for general use by FDA, commenters to the May 9 hospital inpatient PPS proposed rule reported that drug-eluting stents have shown promise to significantly advance the treatment of coronary artery disease, and they encouraged CMS to consider the available data to determine the most appropriate DRG payment. Commenters supported reassignment of the new procedure codes for drug-eluting stent insertions to higher paying DRGs or, if necessary, the modification of all affected DRGs, once verifiable data on the costs associated with drug-eluting stents become available.
Many of the commenters who supported higher payment under the inpatient PPS for this technology were clinical practitioners and hospitals, who expressed great anticipation for the potential benefits of this technology. In addition, commenters referred to the likelihood that, once approved, patients would demand to have these new drug-Start Printed Page 52107eluting stents, putting tremendous financial strain on hospitals.
Commenters to the proposed rule for the inpatient PPS for FY 2003 also argued there should be long-term cost savings to the Medicare program and the health system generally from this technology after approval by the FDA. Specifically, if dramatically fewer patients require restenting, savings will result from fewer repeat angioplasty procedures. And, to the extent bypass surgeries are reduced, savings would result from that outcome as well.
In responding to these commenters in the inpatient final rule published in the Federal Register on August 1, 2002 (67 FR 50003), we noted that, although the FDA has not yet approved this technology for general use, public presentation of the results from recent clinical trials have found virtually no in-stent restenosis in patients treated with the drug-eluting stent. Therefore, we recognize the potentially significant impact this technology may conceivably have on the treatment of coronary artery blockages.
We are concerned that, if the FDA does approve this technology and the predictions of its rapid, widespread use are accurate, significant strain on hospital financial resources would result. In particular, we are concerned that the higher costs of this technology would create undue financial hardships for hospitals due to the high volume of stent cases and the fact that a large proportion of these cases could involve the new technology soon after FDA approval. Therefore, in the final rule for the FY 2003 inpatient PPS, we implemented an unprecedented approach in response to the unique circumstances surrounding the potential breakthrough nature of this technology and we created two new DRGs to reflect cases involving the insertion of a drug-eluting coronary artery stent. We discuss in detail in the final inpatient PPS rule our rationale for establishing these DRGs (67 FR 50003-50005).
Although the clinical trials for drug-eluting stents are being conducted on hospital inpatients, our 2001 hospital outpatient claims data included nearly 18,000 claims for procedures utilizing other types of coronary stents in the hospital outpatient setting. Every indication points to a steady increase in the future volume of coronary stent procedures performed on an outpatient basis. The same concerns that we express above about the impact of the advent of drug-eluting stents on hospital resources apply to procedures performed in the outpatient setting as well as the inpatient setting. We created these new DRGs for drug-eluting stents to ensure and promote beneficiary access to the best care possible by ensuring that our payment system keeps pace with what we believe will be a growing volume of coronary stent procedures if FDA approves drug-eluting coronary artery stents. We want to ensure that the costs of drug-eluting stents will be recognized sufficiently quickly to ensure beneficiary access in the outpatient setting over the 2 years that it will take for the costs of these devices to appear in the Medicare data on which we will base Medicare payments for them.
Drug-eluting stents may have been commercially marketed for 2 years by the time cost data for stent insertion procedures performed in CY 2003 are incorporated into the APC relative weights under the OPPS for CY 2005. Therefore, as we have done under the inpatient PPS for FY 2003 under these exceptional circumstances, we propose to deviate from our standard OPPS payment methodology to ensure consistent payment for drug-eluting stents in both the inpatient and outpatient settings; to ensure that hospital resources are not negatively affected by a sudden surge in demand for this new technology if FDA approval is received; and, to ensure that Medicare payment does not impede beneficiary access to what appears to be a potentially landmark advance in the treatment of coronary disease. Consistent with the special approach we implemented in the inpatient PPS final rule, we propose to create two new HCPCS codes and a new APC that may be used to pay for the insertion of coronary artery drug-eluting stents under the OPPS, to be effective if these stents receive FDA approval for general use. Of course, as with other new procedures, FDA approval does not mean that Medicare will always cover the approved item. Medicare coverage depends upon whether an item or service is medically necessary to treat illness or injury as determined by Medicare contractors based on the specifics of individual cases.
The new HCPCS codes that we propose are as follows: G0NNN—Transcatheter placement of a drug eluting intracoronary stent(s), percutaneous, with or without other therapeutic intervention, any method; single vessel G0OOO—Transcatheter placement of a drug eluting intracoronary stent(s), percutaneous, with or without other therapeutic intervention, any method; each additional vessel.
We propose to assign G0NNN and G0OOO to new APC 0656, Transcatheter Placement of Drug-Eluting Coronary Stents, with a status indicator of T.
To establish a payment amount for the proposed new APC, we propose to apply the same assumptions that we used in establishing the weights for DRG 526 (Percutaneous Cardiovascular Procedure with Drug-Eluting Stent with AMI) and DRG 527 (Percutaneous Cardiovascular Procedure With Drug-Eluting Stent Without AMI) as described in the final rule implementing the FY 2003 inpatient PPS. That is, based on prices in countries where drug-eluting stents are currently being used, manufacturer information and information furnished in response to the May 9, 2002 IPPS proposed rule, and the average price of currently available stents, we assume a price differential of approximately $1,200. Using an average of 1.5 stents per procedure, we propose to add $1,200 to the median costs established for APC 0104 based on 2001 claims data. We would then calculate a relative payment weight and payment rate for APC 0656 in accordance with the methodology that we discuss in section II.B. of this preamble. By taking this approach, we believe that payment for drug-eluting stents would be balanced between the OPPS and the inpatient PPS, minimizing the incentive to use payment as the basis for determining where to furnish this new technology.
We are taking the extraordinary temporary measure of establishing this APC and pricing it as we propose only because we have been advised by experts that these stents can be expected to revolutionize the provision of coronary care and can be expected to supplant use of existing stents. While the statute contemplates the difficulties of setting OPPS payments for new devices by providing the transitional pass-through mechanism, that mechanism does not work in this circumstance since these devices fall into a previously existing device category and do not meet the test for inclusion in new technology APCs. However, the law permits us to take into account changes in technology and the addition of new factors (See section 1833(t)(9)(A)) of the Act. In this case, we think the impact of this new technology will be so great compared to other new technologies that, to ensure beneficiary access to state-of-the-art medical care, we believe that we need to create new codes and a separate APC, paid based on the best information currently available, to ensure adequate payment to providers and access to care during the first 2 years of the device's existence. To undertake this methodology in other cases, we would Start Printed Page 52108have to be similarly convinced that the technology would not qualify for pass-through payment nor new technology APC payment, that it will revolutionize the provision of care and that it will replace an existing technology. As indicated previously, this payment mechanism would be a temporary one that would exist only until 2005, at which point we would have sufficient data to determine how to pay for these devices under the standard OPPS methodology for setting payment amounts.
We propose to implement payment under APC 0656 effective April 1, 2003, consistent with the effective date for implementation of the drug-eluting DRGs under the OPPS and contingent upon FDA approval by that date. If the FDA grants approval prior to April 1, 2003, hospitals would be paid for insertion of coronary artery drug-eluting stents under APC 104.
We are proposing to establish the new HCPCS codes and APC group for coronary artery drug-eluting stents to allow close tracking of the utilization and costs associated with these services. Once we obtain adequate cost data for coronary artery drug-eluting stents, we propose to incorporate these data into the current CPT codes for coronary stent placement. We invite comments on this proposed methodology for recognizing the additional costs of drug-eluting stents under the OPPS.
It is important to emphasize that we anticipate that the vast majority of new technologies in the future will continue to be routinely incorporated into the existing DRGs or through the new technology add-on payments under the inpatient PPS. Similarly, we expect in the future to continue to make payment under the OPPS for the vast majority of new technologies through the existing provisions for transitional pass-through payments for new devices, drugs, and biologicals and through new technology APCs.
4. Recalibration of APC Weights for 2003
Section 1833(t)(9)(A) of the Act requires that the Secretary review and revise the relative payment weights for APCs at least annually, beginning in 2001 for application in 2002. In the April 7, 2000 final rule (65 FR 18482), we explained in detail how we calculated the relative payment weights that were implemented on August 1, 2000 for each APC group. Except for some reweighting due to APC changes, these relative weights continued to be in effect for 2001. (See the November 13, 2000 interim final rule (65 FR 67824 to 67827).)
To recalibrate the relative APC weights for services furnished on or after January 1, 2003 and before January 1, 2004, we are proposing to use the same basic methodology that we described in the April 7, 2000 final rule. That is, we would recalibrate the weights based on claims and cost report data for outpatient services. We propose to use the most recent available data to construct the database for calculating APC group weights. For the purpose of recalibrating APC relative weights for 2003, the most recent available claims data are the approximately 110 million final action claims for hospital outpatient department services furnished on or after January 1, 2001 and before January 1, 2002 and processed through March 2002. Many of these 110 million claims were for services that are not paid under OPPS (such as, clinical laboratory tests). We matched the claims that are paid under OPPS to the most recent cost report filed by the individual hospitals represented in our claims data. The APC relative weights would continue to be based on the median hospital costs for services in the APC groups.
a. Data Issues
(1) Treatment of “Multiple Procedure” Claims
We have received many requests (through an April Town Hall meeting and other sources of contact with the public) asking that we ensure that the data from claims that contain charges for multiple procedures are included in the data from which we calculate the 2003 relative payment weights. They believe that relying solely on single procedure claims to recalibrate APC weights fails to take into account data for many frequently performed procedures, particularly those commonly performed in combination with other procedures.
We agree that optimally, it is desirable to use the data from as many claims as possible to recalibrate the relative payment weights, including those with multiple procedures. We identified certain multiple procedure claims that could be treated as single procedure claims, enabling us to greatly increase the number of services used to develop the APC payment weights for 2003. However, several inherent features of multiple bill claims prevented us from using all of them to recalibrate the payment weights. We discuss these obstacles below.
There are four scenarios that occur when multiple procedures are billed on a claim that result in our being unable to use all of those claims to recalibrate the APC weights. In each case, the underlying problem is that there are charges on the claim that we are unable to correctly associate with the HCPCS codes for the procedures on the claim (that is, payable HCPCS codes). In general, we are unable to determine with confidence what portion of those charges should be packaged into the charges for each of the procedures on the claim. The different scenarios that we describe below may occur singly or in combination on the same claim.
In the first scenario, costs associated with outpatient hospital services are reported in revenue centers that cannot be associated with individual HCPCS codes because they are ancillary and supportive of some or all services furnished to the beneficiary. We do not require that hospitals assign a HCPCS code to each revenue center and charge or that they split the charges within revenue centers by HCPCS code because they advise us that they are unable to account for costs in this manner. In addition, to collect and report this information would be burdensome and costly.
Where there is only one HCPCS code for a procedure on the claim, we can assign supporting charges in revenue centers to the single HCPCS code. However, when there are two or more HCPCS codes for procedures on the claim, we have no basis for allocating appropriately the ancillary charges reported under revenue centers to the HCPCS codes for separately payable procedures. For example, a claim containing HCPCS codes for a visit and a surgical procedure may show charges under the revenue center for family clinic (517) for the visit and under operating room (360) for the surgery. But in addition, the claim could show charges under the following revenue centers without assigning a HCPCS code to the revenue center: recovery room (710), charge A for sterile supplies (272), charge B for sterile supplies (272), anesthesia (370), and pharmacy (250). If only a single HCPCS code was billed, we could sum the charges shown under the ancillary revenue centers and attribute those charges to the HCPCS code for the single HCPCS code that was billed. However, because there is more than one separately payable code on the claim (clinic visit and surgery), we do not know which charge for sterile supplies should be mapped to the visit and which should be assigned to the surgery. Similarly, there is nothing on the claim to indicate whether the total pharmacy charge is associated with the surgery or with the clinic visit, or split between them. For this type of multiple procedure claim, we have chosen to Start Printed Page 52109exclude the claim from the pool of charges used to calculate median APC costs rather than risk assigning the ancillary revenue center charges incorrectly. This type of multiple procedure claim, often much more complex than this example, accounts for a significant portion of the multiple procedure claims that we are unable to use to recalibrate payment weights.
In the second scenario, we are unable to correctly assign to procedures the charges for HCPCS codes that we package into other procedures. HCPCS codes with status indicator “N” are not paid separately. Rather, the payment for these packaged items or services is recognized in the payment for a service or services billed on the same claim for which there is an APC payment rate. In calculating the median costs, we have to know where to incorporate the charges shown for the HCPCS code with status indicator “N.” When a packaged HCPCS codes is on a claim that also bills for more than one primary procedure (that is, procedures for which we make separate payment), we do not know with which of the procedures the charges for the packaged HCPCS code should be associated, or whether the charges for the packaged HCPCS code should be apportioned on some basis among the multiple primary procedures.
In the third scenario, in the case of multiple surgical procedures, our billing instructions permit hospitals to show charges for only one surgical procedure code although they report more than one surgical HCPCS code. Specifically, this billing convention has long been permitted in Medicare Intermediary Manual section 3626.4B3 and was reconfirmed by Medicare Transmittal A-01-50, which was issued on April 12, 2001 (http://www.hcfa.gov/pubforms/transmit/A0150.pdf) in response to hospital requests that we clarify whether they were required to create and report charges for each HCPCS code for each surgical service billed on a claim. We believe that to report charges for each HCPCS code for surgical services would have imposed an additional accounting and billing burden on hospitals that had not previously existed. This would have been in addition to the changes to the claims format and instructions that hospitals had recently made to accommodate OPPS and our other initiatives. As in the case of the ancillary services billed under revenue centers, the charges for each HCPCS code for the surgery were not needed to ensure that correct payment was made on the claim (since payment was made based on the code's APC assignment and not on reported charges).
However, because hospitals are permitted to report operating room charges for only one of the multiple surgical procedures on a claim, we are unable to identify a valid means of apportioning the operating room charges to the other procedures that were performed. We are not aware of any research on comparative hospital outpatient department (OPD) resource consumption by HCPCS codes that would indicate how to apportion a total charge among the individual codes on the claim. Moreover, these multiple surgical procedure claims frequently have problems similar to those discussed above in scenario one. Therefore, we are unable to use data from multiple surgery claims that are submitted in this form to calculate APC median costs.
In the fourth scenario are claims with multiple units of the same HCPCS code billed with charges in revenue centers or packaged HCPCS codes. In this case, we cannot determine the appropriate distribution of charges on the claim between the first and subsequent units of the HCPCS code. To approximate the charges that would occur if single rather than multiple units of the HCPCS code were billed, we would have to inflate the charges for the second and subsequent units of the service, which would eliminate the impact of the efficiencies that we believe occur when second and subsequent units of a procedure are performed. There are no data to suggest an appropriate factor to apportion charges for the second and subsequent units.
We considered several methods of apportioning charges from revenue centers and packaged HCPCS codes to enable us to use charge data from multiple procedure claims in the calculation of APC weights, but none of these methods was sufficient to yield cost data that we could be assured were valid. Specifically, we considered dividing the total charges in a revenue center or for a packaged HCPCS code by the number of payable HCPCS codes for multiple procedures on the claim. In the example of a claim for a visit code and a surgical code with the revenue center for sterile supplies billed twice on the same claim, we would sum the charges for sterile supplies, divide the sum by 2, and add the resulting divided charges for sterile supplies to the charges for each HCPCS code. The single pharmacy charge would be divided by 2, and half of the pharmacy charge would be added to each HCPCS code. We rejected this approach because of concern about whether it is likely to be sufficiently accurate to serve as a reasonable means of apportioning charges.
We also considered apportioning the charges among the codes based on physician work relative value units (RVUs) because time is a major factor in the establishment of physician work RVUs under the Medicare fee schedule for physician services. Time may be reflective of the comparative amount of resources used by the hospital for different surgical procedures, particularly charges for operating rooms, recovery rooms, and observation rooms. However, physician work RVUs also depend in part on the intensity and difficulty of the work of a physician in providing a service and would therefore not necessarily reflect accurately the relative resources a hospital would expend for the same procedure. Moreover, we do not believe that time appropriately reflects the use of resources such as pharmacy and supplies.
We then considered apportioning the charges among the codes based on physician nonfacility practice expense RVUs because practice expense RVUs reflect relative resource utilization for these services. However, we have no evidence that the relative practice expenses of physicians correlate with the resources that a hospital would use for the same service. Moreover, physician practice expenses are minimal for the many services typically furnished in a facility rather than the physician's office. For these services, the practice expense RVU reflects only minimal expenses for services, such as the physician's billing costs. They are, therefore, an inadequate proxy for the facility costs, such as supplies, drugs, equipment, nursing services, and overhead costs incurred by hospitals.
In summary, we concluded that the inherent drawbacks of these methodologies would outweigh any potential advantages accrued from the resulting increase in data used to calculate APC median costs. Without evidence to the contrary, we believe that applying these arbitrary methods of apportioning costs to multiple procedure claims would yield results that are less reliable and valid than continuing to rely on single procedure claims in calculating APC median costs.
We solicit public comment on the methods we considered for apportioning the total charges to individual HCPCS codes as described above. We also invite suggestions of other alternative means of apportioning the total costs on multiple procedure claims to the HCPCS codes for the procedures so that we can use more data from multiple procedure claims in the 2004 update of the OPPS.
We also solicit information on existing studies that would provide Start Printed Page 52110comparative hospital outpatient resource inputs by HCPCS code. In addition, we welcome suggestions for studies that we might undertake either to determine the relative value of OPD resources by HCPCS code or to provide a valid means of apportioning the charges among HCPCS codes when multiple surgical procedures are billed on the same claim with a single total charge for all services.
Further, we ask for comments on the feasibility of requiring hospitals to apportion all charges currently shown in revenue centers to the HCPCS codes billed so that we could use all multiple services claims in the calculation of the relative weights. For example, where the patient received multiple surgeries on the same day or received a visit and a procedure on the same day, the hospital would have to create a charge for each billable HCPCS code and that charge would have to encompass all charges for OR, recovery room, pharmacy, supplies, etc. that were relevant to that code. No charges would be billed under revenue centers alone or with packaged HCPCS codes (that is, HCPCS codes having a status indicator of N) since all charges would be reported under associated payable HCPCS codes. There would have to be corollary changes in completion of the cost report. Also, because hospitals must have a uniform charge structure, providers would need to charge all other payers and private pay patients in the same manner as they would be required to charge Medicare.
We are particularly interested in the views of hospitals and billing experts weighing the burden that could be created by these changes in billing rules relative to the potential benefit of calculating more precise OPPS payment rates that incorporate data from multiple procedure claims.
Finally, we solicit information regarding the extent to which efficiencies are realized when multiple services are furnished during the same visit or operative session. We currently discount the APC payment for the second and subsequent procedures performed during a single encounter by 50 percent in the expectation that the same efficiencies of service that are demonstrated to exist in the provision of physician services also exist in the provision of outpatient hospital services. In general, when a second or subsequent service is performed at the same time as an initial service, we believe that the combined resource costs associated with operating room time, recovery room time, anesthesia, supplies, and other services are less than if the procedures were performed separately. However, we are interested in empirical data regarding the extent to which these efficiencies of resource consumption actually occur.
(2) Calendar Year 2002 Charge Data for Pass-Through Device Categories
HCPCS coding for medical devices that qualified for transitional pass-through payment for services furnished in 2001 occurred in two different ways. (A detailed discussion of the provisions authorizing transitional pass-through payments for certain medical devices and drugs and biologicals can be found in section III of this preamble.) From August 1, 2000 until April 1, 2001, claims for medical devices that were paid on a pass-through basis were coded using device specific codes that were often manufacturer specific. BBRA required that, effective April 1, 2001, claims for medical devices eligible for transitional pass-through payment were to be billed using codes that applied to categories of devices. We issued the applicable category codes in Program Memoranda, Transmittals A-01-40 and A-01-41. We posted them on our web site at http://www.hcfa.gov/pubforms/transmit/A0140.pdf and http://www.hcfa.gov/pubforms/transmit/A0141.pdf,, respectively. The change to the use of category codes, rather than device specific codes, simplified coding and also expanded the number of devices that were eligible for transitional pass-through payment. The expansion occurred because devices that fit the categories but that had previously not met the criteria for transitional pass-through payments could now be billed for a transitional pass-through payment.
Moreover, in recognition of the impact of the change on hospital billing and in recognition of the short time between the passage of legislation (December 14, 2000) and the effective date for the new codes (April 1, 2001), we gave hospitals a 90-day grace period during which they could bill using either the device specific codes they had previously been using or the new category codes. For this reason, only services furnished on or after July 1, 2001 were required to be billed using the new device category codes.
We have been advised that during the period in which the 2001 OPPS was in effect, hospitals may not have billed properly for devices eligible for transitional pass-through payments. We understand that the changes in billing format and systems for implementation of the OPPS compounded the problems of billing using the device specific codes during the first 9 months of the OPPS. We have been informed that these problems were further compounded by the creation and requirement to use category codes on and after April 1, 2001. In general, we have been advised that hospitals may have been underpaid for transitional pass-through devices (because they did not bill separately for them and therefore did not get the pass-through payment) and that our data will not correctly show the charges associated with the devices (because the devices were not coded with device category codes on the claim).
We agree that where hospitals failed to show the code for the transitional pass-through device (whether the device specific code or the category code as applicable), they will not have received payment for the device as a transitional pass-through device. For many years, there have been processes in place for hospitals to submit adjustment bills so they can receive payment for all applicable services they furnished if they subsequently determine that their original bills were deficient. Notwithstanding, there is no method by which we can infer a charge on a claim for a service that is not billed by the hospital.
Regarding the impact of the absence of coding for devices on the data from claims submitted for July 2001 and later, we looked at the claims data for a sample of services for which we thought there should have been a device category billed because of the nature of the procedure (for example, insertion of a pacemaker). We found that there were many instances when a device category code was not billed when we would have expected it. However, we found that when we summed the charges for revenue centers with the charges for the procedure on claims where no category code was reported and compared those totals with the sum of charges from claims where both a device category code and the associated procedure code were billed, the results were very similar. From this analysis, we conclude that in many cases, particularly during the first half of the calendar year, hospitals included charges for transitional pass-through devices in the revenue center for supplies. Therefore, we believe cost data for transitional pass-through devices are contained in the charges of most claims, even where they are not separately identified by the code for the device category, which should have been reported.
We believe that this absence of category codes in the claims data and our data analysis, and the issues surrounding multiple procedure claims argue strongly for packaging the cost of these devices into the payment for the procedures with which they were used and to then create weights for Start Printed Page 52111procedures for the 2003 OPPS. Incorrect device coding could lead to skewed weights for the retired transitional pass-through devices, if we were to establish individual APCs for the expired device categories.
We believe that packaging the charges billed under the revenue centers into the charges for the procedures before setting the weights for the APCs will allow us to capture all of the cost data for services in which devices were used which will result in the most valid payment for the APC. This approach assures that the payment rate for the procedure includes accurate payment for the devices used in the procedure. Further discussion of our proposal to package payment for sunsetting transitional pass-through devices is contained in section III.C of this preamble.
b. Description of How Weights Were Calculated for 2003
The methodology we followed to calculate the APC relative payment weights proposed for CY 2003 is as follows:
- We excluded from the data approximately 15 million claims for those bill and claim types that would not be paid under the OPPS (for example, bill type 72X for dialysis services for patients with end-stage renal disease (ESRD)).
- Using the most recent available cost report from each hospital, we converted billed charges to costs and aggregated them to the procedure or visit level first by identifying the cost-to-charge ratio specific to each hospital's cost centers (“cost center specific cost-to-charge ratios” or CCRs) and then by matching the CCRs to revenue centers used on the hospital's 2001 outpatient bills. The CCRs include operating and capital costs but exclude items paid on a reasonable cost basis.
- We eliminated from the hospital CCR data 301 hospitals that we identified as having reported charges on their cost reports that were not actual charges (for example, a uniform charge applied to all services).
- We calculated the geometric mean of the total operating CCRs of hospitals remaining in the CCR data. We removed from the CCR data 67 hospitals whose total operating CCR exceeded the geometric mean by more than 3 standard deviations.
- We excluded from our data approximately 3 million claims submitted by the hospitals that we removed or trimmed from the hospital CCR data.
- We eliminated 1.2 million claims from hospitals located in Maryland, Guam, and the U.S. Virgin Islands.
- We matched revenue centers from the remaining universe of approximately 92.2 million claims to CCRs hospitals.
- We separated the 92.2 million claims that we had matched with a cost report into the following three distinct groups: (1) single-procedure claims, (2) multiple-procedure claims, and (3) claims on which we could not identify at least one OPPS covered service. Single-procedure claims are those that include only one HCPCS code (other than laboratory and incidentals such as packaged drugs and venipuncture) that could be grouped to an APC. Multiple-procedure claims include more than one HCPCS code that could be mapped to an APC. Dividing the claims in this manner yielded approximately 30.4 million single-procedure claims and 20.1 million multiple-procedure claims. Approximately 41.5 million claims without at least one covered OPPS service were set aside.
We converted 10.7 million multiple-procedure claims to single-procedure claims using the following criteria: (1) If a multiple-procedure claim contained lines with a HCPCS code in the pathology series (that is, CPT 80000 series of codes), we treated each of those lines as a single claim. (2) For multiple procedure claims with a packaged HCPCS code (status indicator “N”) on the claim, we ignored line items for chest X-rays (HCPCS codes 71010 and/or 71020) and/or EKGs (HCPCS code 93005) on these claims. If only one procedure (other than HCPCS codes 71010, 71020, and 93005) existed on the claim, we treated it as a single-procedure claim. (3) If the claim had no packaged HCPCS codes and if there were no packaged revenue centers on the claim, we treated each line with a procedure as a single claim if the line item was billed as a single unit. (4) If the claim had no packaged HCPCS codes on the claim but had packaged revenue centers for the procedure, we ignored the line item for chest X-rays and/or EKG codes (as identified above) and if only one HCPCS code remained, we treated the claim as a single procedure claim. We created an additional 31.3 million single-procedure bills through this process, which enabled us to use these data from multiple-procedure claims in calculation of the APC relative payment weights.
- To calculate median costs for services within an APC, we used only single-procedure bills and those multiple procedure bills that we converted into single claims. If a claim had a single code with a zero charge (that would have been considered a single-procedure claim), we did not use it. As we discussed in section II.B.4.a.(1) of this preamble, we did not use multiple-procedure claims that billed more than one separately payable HCPCS code with charges for packaged items and services such as anesthesia, recovery room, or supplies that could not be reliably allocated or apportioned among the primary HCPCS codes on the claim. We have not yet developed what we regard as an acceptable method of using multiple-procedure bills to recalibrate APC weights that minimizes the risk of improperly assigning charges to the wrong procedure or visit.
- For each single-procedure claim, we calculated a cost for every billed line item charge by multiplying each revenue center charge by the appropriate hospital-specific CCR. If an appropriate cost center did not exist for a given hospital, we crosswalked the revenue center to a secondary cost center when possible, or used the hospital's overall cost-to-charge ratio for outpatient department services. We excluded from this calculation all charges associated with HCPCS codes previously defined as not paid under the OPPS (for example, laboratory, ambulance, and therapy services). We included all charges associated with HCPCS codes that are designated as packaged services (that is, HCPCS codes with the status indicator of “N”).
- To calculate per-service costs, we used the charges shown in revenue centers that contained items integral to performing the service. We observed the packaging provisions set forth in the April 7, 2000 final rule with comment period that were in effect during 2001 (65 FR 18484). For instance, in calculating the cost of a surgical procedure, we included charges for the operating room, treatment rooms, recovery, observation, medical and surgical supplies, pharmacy, anesthesia, casts and splints, and donor tissue, bone, and organs. To determine medical visit costs, we included charges for items such as medical and surgical supplies, drugs, and observation in those instances where they are still packaged. Table 5 lists packaged services by revenue center that we are proposing to use to calculate per-service costs for outpatient services furnished in 2003.Start Printed Page 52112
Table 5.—Packaged Services by Revenue Code
Revenue code Description Surgery 250 PHARMACY 251 GENERIC 252 NONGENERIC 257 NONPRESCRIPTION DRUGS 258 IV SOLUTIONS 259 OTHER PHARMACY 260 IV THERAPY, GENERAL CLASS 262 IV THERAPY/PHARMACY SERVICES 263 IV THERAPY/DRUG SUPPLY/DELIVERY 264 IV THERAPY/SUPPLIES 269 OTHER IV THERAPY 270 M&S SUPPLIES 271 NONSTERILE SUPPLIES 272 STERILE SUPPLIES 274 PROSTHETIC/ORTHOTIC DEVICES 275 PACEMAKER DRUG 276 INTRAOCULAR LENS SOURCE DRUG 278 OTHER IMPLANTS 279 OTHER M&S SUPPLIES 280 ONCOLOGY 289 OTHER ONCOLOGY 290 DURABLE MEDICAL EQUIPMENT 370 ANESTHESIA 379 OTHER ANESTHESIA 390 BLOOD STORAGE AND PROCESSING 399 OTHER BLOOD STORAGE AND PROCESSING 560 MEDICAL SOCIAL SERVICES 569 OTHER MEDICAL SOCIAL SERVICES 624 INVESTIGATIONAL DEVICE (IDE) 630 DRUGS REQUIRING SPECIFIC IDENTIFICATION, GENERAL CLASS 631 SINGLE SOURCE 632 MULTIPLE 633 RESTRICTIVE PRESCRIPTION 700 CAST ROOM 709 OTHER CAST ROOM 710 RECOVERY ROOM 719 OTHER RECOVERY ROOM 720 LABOR ROOM 721 LABOR 762 OBSERVATION ROOM 810 ORGAN ACQUISITION 819 OTHER ORGAN ACQUISITION Medical Visit 250 PHARMACY 251 GENERIC 252 NONGENERIC 257 NONPRESCRIPTION DRUGS 258 IV SOLUTIONS 259 OTHER PHARMACY 270 M&S SUPPLIES 271 NONSTERILE SUPPLIES 272 STERILE SUPPLIES 279 OTHER M&S SUPPLIES 560 MEDICAL SOCIAL SERVICES 569 OTHER MEDICAL SOCIAL SERVICES 630 DRUGS REQUIRING SPECIFIC IDENTIFICATION, GENERAL CLASS 631 SINGLE SOURCE DRUG 632 MULTIPLE SOURCE DRUG 633 RESTRICTIVE PRESCRIPTION 637 SELF-ADMINISTERED DRUG (INSULIN ADMIN. IN EMERGENCY DIABETIC COMA 700 CAST ROOM 709 OTHER CAST ROOM 762 OBSERVATION ROOM 942 Other Diagnostic 254 PHARMACY INCIDENT TO OTHER DIAGNOSTIC 280 ONCOLOGY 289 OTHER ONCOLOGY Start Printed Page 52113 372 ANESTHESIA INCIDENT TO OTHER DIAGNOSTIC 560 MEDICAL SOCIAL SERVICES 569 OTHER MEDICAL SOCIAL SERVICES 622 SUPPLIES INCIDENT TO OTHER DIAGNOSTIC 624 INVESTIGATIONAL DEVICE (IDE) 710 RECOVERY ROOM 719 OTHER RECOVERY ROOM 762 OBSERVATION ROOM Radiology 255 PHARMACY INCIDENT TO RADIOLOGY 280 ONCOLOGY 289 OTHER ONCOLOGY 371 ANESTHESIA INCIDENT TO RADIOLOGY 560 MEDICAL SOCIAL SERVICES 569 OTHER MEDICAL SOCIAL SERVICES 621 SUPPLIES INCIDENT TO RADIOLOGY 624 INVESTIGATIONAL DEVICE (IDE) 710 RECOVERY ROOM 719 OTHER RECOVERY ROOM 762 OBSERVATION ROOM All Other APC Groups 250 PHARMACY 251 GENERIC 252 NONGENERIC 257 NONPRESCRIPTION DRUGS 258 IV SOLUTIONS 259 OTHER PHARMACY 260 IV THERAPY, GENERAL CLASS 262 IV THERAPY PHARMACY SERVICES 263 IV THERAPY DRUG/SUPPLY/DELIVERY 264 IV THERAPY SUPPLIES 269 OTHER IV THERAPY 270 M&S SUPPLIES 271 NONSTERILE SUPPLIES 272 STERILE SUPPLIES 279 OTHER M&S SUPPLIES 560 MEDICAL SOCIAL SERVICES 569 OTHER MEDICAL SOCIAL SERVICES 630 DRUGS REQUIRING SPECIFIC IDENTIFICATION, GENERAL CLASS 631 SINGLE SOURCE DRUG 632 MULTIPLE SOURCE DRUG 633 RESTRICTIVE PRESCRIPTION 762 OBSERVATION ROOM 942 EDUCATION/TRAINING - We standardized costs for geographic wage variation by dividing the labor-related portion of the operating and capital costs for each billed item by the proposed FY 2003 hospital inpatient prospective payment system (IPPS) wage index published in the Federal Register on May 9, 2002 (67 FR 31602). We used 60 percent to represent our estimate of that portion of costs attributable, on average, to labor. We have used this estimate since the inception of the OPPS and continue to believe that it is appropriate. See 65 FR 18496, the April 7, 2000 final rule for a complete description of how we derived this percentage.
- We summed the standardized labor-related cost and the nonlabor-related cost component for each billed item to derive the total standardized cost for each procedure or medical visit.
- We removed extremely unusual costs that appeared to be errors in the data using a trimming methodology analogous to what we use in calculating the diagnosis-related group (DRG) weights for the hospital IPPS. That is, we eliminated any bills with costs outside of 3 standard deviations from the geometric mean.
- After trimming the procedure and visit level costs, we mapped each procedure or visit cost to its assigned APC, including, to the extent possible, the proposed APC changes described in section II.A of this preamble.
- We calculated the median cost for each APC.
- Using the median APC costs, we calculated the relative payment weights for each APC. As in prior years, we scaled all the relative payment weights to APC 0601, Mid-level clinic visit, because it is one of the most frequently performed services in the hospital outpatient setting. This approach is consistent with that used in developing relative value units for the Medicare physician fee schedule. We assigned APC 0601 a relative payment weight of 1.00 and divided the median cost for each APC by the median cost for APC 0601 to derive the relative payment weight for each APC. Using 2001 data, the median cost for APC 0601 is $56.77.
Section 1833(t)(9)(B) of the Act requires that APC reclassification and recalibration changes and wage index changes be made in a manner that assures that aggregate payments under the OPPS for 2003 are neither greater Start Printed Page 52114than nor less than the aggregate payments that would have been made without the changes. To comply with this requirement concerning the APC changes, we compared aggregate payments using the CY 2002 relative weights to aggregate payments using the CY 2003 proposed weights. Based on this comparison, we are proposing to make an adjustment of 1.04227 to the weights. The weights that we are proposing for 2003, which incorporate the recalibration adjustments explained in this section, are listed in Addendum A and Addendum B.
5. Procedures That Will Be Paid Only As Inpatient Procedures
Before implementation of the OPPS, Medicare paid reasonable costs for services provided in the outpatient department. The claims submitted were subject to medical review by the fiscal intermediaries to determine the appropriateness of providing certain services in the outpatient setting. We did not specify in regulations those services that were appropriate to provide only in the inpatient setting and that, therefore, should be payable only when provided in that setting.
Section 1833(t)(1)(B)(i) of the Act gives the Secretary broad authority to determine the services to be covered and paid for under the OPPS. In the April 7, 2000 final rule, we identified procedures that are typically provided only in an inpatient setting and, therefore, would not be paid by Medicare under the OPPS (65 FR 18455). These procedures comprise what is referred to as the “inpatient list.” The inpatient list specifies those services that are only paid when provided in an inpatient setting. These are services that require inpatient care because of the nature of the procedure, the need for at least 24 hours of postoperative recovery time or monitoring before the patient can be safely discharged, or the underlying physical condition of the patient. As we discussed in the April 7, 2000 and the November 30, 2001 final rules, we use the following criteria when reviewing procedures to determine whether or not they should be moved from the inpatient list and assigned to an APC group for payment under the OPPS:
- Most outpatient departments are equipped to provide the services to the Medicare population.
- The simplest procedure described by the code may be performed in most outpatient departments.
- The procedure is related to codes we have already moved off the inpatient list.
We update the inpatient list as often as quarterly through program memoranda to reflect current advances in medical practice. We last updated the inpatient list in the November 30, 2001 final rule. As we discuss in section II.A.2, above, the APC Panel at its January 2002 meeting reviewed certain procedures on the inpatient list for which we had received requests that they be made payable under the OPPS. The Panel recommended that we solicit comments and further information about all these procedures except for CPT code 47001, which they recommended be removed from the inpatient list (see section II.A.2 above for a discussion of this and the other codes that the Panel considered for removal from the inpatient list). These procedures are included in Table 6, with the exception of CPT code 33967, which we are not proposing to pay for under the OPPS for reasons that we explain in section II.A.2.
In preparing this proposed rule to update the OPPS for CY 2003, we compared procedures with status indicator “C” (status indicator “C” is assigned to inpatient procedures that are not payable under the OPPS) to the list of procedures that are currently on the ambulatory surgical center (ASC) list of approved procedures, to procedures that we proposed to add to the ASC list in a proposed rule published in the Federal Register on June 12, 1998 (63 FR 32291), and to procedures recommended for addition to the ASC list by commenters in response to the June 12, 1998 proposed rule. We found that there are procedures on the current ASC list, or procedures proposed for addition to the ASC list, or procedures recommended by commenters for addition to the ASC list that are assigned status indicator “C” under the OPPS. A review of 2001 physician claims data also revealed that physicians are performing some of these “C” status indicator procedures on Medicare beneficiaries on an outpatient basis. We concluded that it was appropriate to propose removal of procedures from the OPPS inpatient list that are being performed on an outpatient basis and/or that we had determined could be safely and appropriately performed on a Medicare beneficiary in an ASC under the applicable ASC rules that are set forth in 42 CFR 416.22. We believe that our payment policies for surgical procedures provided in an outpatient hospital setting and in the ASC setting should be consistent to the extent possible within the limitations imposed by statutory or regulatory requirements. So, we propose to add the following criteria for use in reviewing procedures to determine whether they should be removed from the inpatient list and assigned to an APC group for payment under the OPPS:
- We have determined that the procedure is being performed in numerous hospitals on an outpatient basis; or
- We have determined that the procedure can be appropriately and safely performed in an ASC and is on the list of approved ASC procedures or proposed by us for addition to the ASC list.
In addition to the procedures considered by the APC Panel for removal from the inpatient list, Table 6 includes the procedures that we are proposing to be removed from the inpatient list for payment under the OPPS. We applied the criteria discussed above in order to be consistent with the ASC list of approved procedures, and with utilization data that indicate the procedures are being performed on an outpatient basis. We solicit comments on whether the procedures in Table 6 should be paid under the OPPS. We also solicit comments on the APC assignment that we propose for these procedures in the event we determine in the final rule, based on comments, that these procedures would be payable under the OPPS in 2003. We ask that commenters recommending reclassification of a procedure to an APC include evidence (preferably from peer-reviewed medical literature) that the procedure is being performed on an outpatient basis in a safe and effective manner.
Following our review of the comments that we receive about the procedures in Table 6, we propose either to assign a CPT code to an APC for payment under the OPPS or, if the comments do not provide sufficient information and data to enable us to make a decision, to present the comments to the APC Panel at its 2003 meeting.Start Printed Page 52115
Start Printed Page 52116Table 6.—Procedures on the Inpatient List Proposed for Payment Under the OPPS in CY 2003.
CPT code Proposed status indicator Proposed APC Description 21390 T 0256 OPEN TREATMENT OF ORBITAL FLOOR BLOWOUT FRACTURE; PERIORBITAL APPROACH, WITH ALLOPLASTIC OR OTHER IMPLANT. 22100 T 0208 PARTIAL EXCISION OF POSTERIOR VERTEBRAL COMPONENT (EG, SPINOUS PROCESS, LAMINA OR FACET) FOR INTRINSIC BONY LESION, SINGLE VERTEBRAL SEGMENT; CERVICAL. 22101 T 0208 PARTIAL EXCISION OF POSTERIOR VERTEBRAL COMPONENT (EG, SPINOUS PROCESS, LAMINA OR FACET) FOR INTRINSIC BONY LESION, SINGLE VERTEBRAL SEGMENT; THORACIC. 22102 T 0208 PARTIAL EXCISION OF POSTERIOR VERTEBRAL COMPONENT (EG, SPINOUS PROCESS, LAMINA OR FACET) FOR INTRINSIC BONY LESION, SINGLE VERTEBRAL SEGMENT; LUMBAR. 22103 T 0208 PARTIAL EXCISION OF POSTERIOR VERTEBRAL COMPONENT (EG, SPINOUS PROCESS, LAMINA OR FACET) FOR INTRINSIC BONY LESION, SINGLE VERTEBRAL SEGMENT; EACH ADDITIONAL SEGMENT (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE). 23035 T 0049 INCISION, BONE CORTEX (EG, OSTEOMYELITIS OR BONE ABSCESS), SHOULDER AREA. 23125 T 0051 CLAVICULECTOMY; TOTAL. 23195 T 0050 RESECTION, HUMERAL HEAD. 23395 T 0051 MUSCLE TRANSFER, ANY TYPE, SHOULDER OR UPPER ARM; SINGLE. 23397 T 0052 MUSCLE TRANSFER, ANY TYPE, SHOULDER OR UPPER ARM; MULTIPLE. 23400 T 0050 SCAPULOPEXY (EG, SPRENGELS DEFORMITY OR FOR PARALYSIS). 24150 T 0052 RADICAL RESECTION FOR TUMOR, SHAFT OR DISTAL HUMERUS;. 24151 T 0052 RADICAL RESECTION FOR TUMOR, SHAFT OR DISTAL HUMERUS; WITH AUTOGRAFT (INCLUDES OBTAINING GRAFT). 24152 T 0052 RADICAL RESECTION FOR TUMOR, RADIAL HEAD OR NECK;. 24153 T 0052 RADICAL RESECTION FOR TUMOR, RADIAL HEAD OR NECK; WITH AUTOGRAFT (INCLUDES OBTAINING GRAFT). 25170 T 0052 RADICAL RESECTION FOR TUMOR, RADIUS OR ULNA. 25390 T 0050 OSTEOPLASTY, RADIUS OR ULNA; SHORTENING. 25391 T 0051 OSTEOPLASTY, RADIUS OR ULNA; LENGTHENING WITH AUTOGRAFT. 25392 T 0050 OSTEOPLASTY, RADIUS AND ULNA; SHORTENING (EXCLUDING 64876). 25393 T 0051 OSTEOPLASTY, RADIUS AND ULNA; LENGTHENING WITH AUTOGRAFT. 25420 T 0051 REPAIR OF NONUNION OR MALUNION, RADIUS AND ULNA; WITH AUTOGRAFT (INCLUDES OBTAINING GRAFT). 27035 T 0052 DENERVATION, HIP JOINT, INTRAPELVIC OR EXTRAPELVIC INTRA-ARTICULAR BRANCHES OF SCIATIC, FEMORAL, OR OBTURATOR NERVES. 27216 T 0050 PERCUTANEOUS SKELETAL FIXATION OF POSTERIOR PELVIC RING FRACTURE AND/OR DISLOCATION (INCLUDES ILIUM, SACROILIAC JOINT AND/OR SACRUM). 27235 T 0050 PERCUTANEOUS SKELETAL FIXATION OF FEMORAL FRACTURE, PROXIMAL END, NECK, UNDISPLACED, MILDLY DISPLACED, OR IMPACTED FRACTURE. 31582 T 0256 LARYNGOPLASTY; FOR LARYNGEAL STENOSIS, WITH GRAFT OR CORE MOLD, INCLUDING TRACHEOTOMY. 31785 T 0254 EXCISION OF TRACHEAL TUMOR OR CARCINOMA; CERVICAL. 32201 T 0070 PNEUMONOSTOMY; WITH PERCUTANEOUS DRAINAGE OF ABSCESS OR CYST. 38700 T 0113 SUPRAHYOID LYMPHADENECTOMY. 42842 T 0254 RADICAL RESECTION OF TONSIL, TONSILLAR PILLARS, AND/OR RETROMOLAR TRIGONE; WITHOUT CLOSURE. 43030 T 0253 CRICOPHARYNGEAL MYOTOMY. 47490 T 0152 PERCUTANEOUS CHOLECYSTOSTOMY. 47001 N BIOPSY OF LIVER, NEEDLE; WHEN DONE FOR INDICATED PURPOSE AT TIME OF OTHER MAJOR PROCEDURE. 62351 T 0208 IMPLANTATION, REVISION OR REPOSITIONING OF TUNNELED INTRATHECAL OR EPIDURAL CATHETER, FOR LONG-TERM MEDICATION ADMINISTRATION VIA AN EXTERNAL PUMP OR IMPLANTABLE RESERVOIR/INFUSION PUMP; WITH LAMINECTOMY. 64820 T 0220 SYMPATHECTOMY; DIGITAL ARTERIES, EACH DIGIT. 69150 T 0252 RADICAL EXCISIONS EXTERNAL AUDITORY CANAL LESION; WITHOUT NECK DISSECTION. 69502 T 0254 MASTOIDECTOMY; COMPLETE. 92986 T 0083 PERCUTANEOUS BALLOON VALVULOPLASTY; AORTIC VALVE. 92987 T 0083 PERCUTANEOUS BALLOON VALVULOPLASTY; MITRAL VALVE. 92990 T 0083 PERCUTANEOUS BALLOON VALVULOPLASTY; PULMONARY VALVE. 92997 T 0081 PERCUTANEOUS TRANSLUMINAL PULMONARY ARTERY BALLOON ANGIOPLASTY; SINGLE VESSEL. 92998 T 0081 PERCUTANEOUS TRANSLUMINAL PULMONARY ARTERY BALLOON ANGIOPLASTY; EACH ADDITIONAL VESSEL (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) C. Partial Hospitalization
Payment Methodology
As we discussed in the April 7, 2000 OPPS final rule (65 FR 18452), partial hospitalization is an intensive outpatient program of psychiatric services provided to patients in the place of inpatient care. A partial hospitalization program (PHP) may be provided by a hospital to its outpatients or by a Medicare-certified community mental health center (CMHC). Payment to providers under the OPPS for PHPs represents the provider's overhead costs associated with the program. Because a day of care is the unit that defines the structure and scheduling of partial hospitalization services, effective for services furnished on or after August 1, 2000, we established a per diem payment methodology for the PHP APC. We analyzed the service components billed by hospitals over the course of a billing period and determined the median hospital cost of furnishing a day of partial hospitalization. We were unable to use CMHC data in computing the per diem because up until April 1, 2000, CMHCs were not required to report HCPCS codes. In addition, section 1833(t)(2)(C) of the Act requires that we establish relative payment weights based on median (or mean, at the election of the Secretary) hospital costs determined by 1996 claims and the most recent available cost report data. This analysis resulted in a per diem payment of $202.19 effective August 1, 2000. This amount was updated effective January 1, 2001 and April 1, 2002 to $206.82 and $212.27.
Although we did not use CMHC data in establishing the initial APC for partial hospitalization (or in the updates made since then), in the April 7, 2000 final rule we made a commitment to analyze future data from hospitals and CMHCs to determine if refinements to the per diem are warranted. Based on our review of 2001 claims data submitted under the OPPS, we have developed a payment rate for partial hospitalization following the same methodology used to establish all the APC payment amounts. However, because a day of care is the unit for PHP services, we computed the median cost of furnishing a day of partial hospitalization. Other than the unit of service being a day of care, the method we used to determine median costs for PHP is no different than that used for all other APCs as described in other sections of this proposed rule. The CY 2003 proposed payment rate for the partial hospitalization APC is $256.96 per day, of which $51.39 is the beneficiary's coinsurance.
We used calendar year 2001 bills from both hospitals and CMHCs. We used data from all the hospital bills reporting condition code 41, which identifies the claim as partial hospitalization. Since section 1866(e)(2) of the Act specifies that a CMHC is a provider of service “* * * only with respect to the furnishing of partial hospitalization services * * *,” we used all bills from CMHCs. We used cost-to-charge ratios from the most recently available hospital and CMHC cost reports to develop costs from line item charges reported on bills. Since hospitals and CMHCs are now required to report line item dates of service on claims, we used that data to refine our estimates of line item costs.
We then computed per diem costs by summing the line item costs on each bill and dividing by the number of days on each bill. Using this method of determining costs, preliminary per diem cost estimates for CMHCs were much higher than expected, in many cases more than twice the average per diem for inpatient psychiatric care and more than three times the hospital median PHP per diem cost. The data strongly suggests that the costs were reported incorrectly. We believe that the data are unusable without adjustment.
Closer examination of the CMHC cost report data showed that costs from CMHC finalized cost reports were considerably lower than costs from “as submitted” CMHC cost reports. To account for the difference between settled and as-filed cost report data, we computed the ratio of total final costs to total as-filed costs over a 3-year period (FYs 1998-2000) and calculated an average adjustment factor which we applied to the costs on each claim. The adjusted costs were summed, then divided by the number of days on that bill.
Treatment of Professional Services Under PHP
Section 410.43 describes the conditions and exclusions of partial hospitalization services. That section lists the services that are separately covered and not paid as partial hospitalization services. The list includes—
- Physician services that meet the requirements of 42 CFR 415.102(a) for payment on a fee schedule basis;
- Physician assistant services, as defined in section 1861(s)(2)(K)(i) of the Act;
- Nurse practitioner and clinical nurse specialist services, as defined in section 1861(s)(2)(K)(ii) of the Act;
- Qualified psychologist services, as defined in section 1861(ii) of the Act; and
- Services furnished to SNF residents as defined in 42 CFR 411.15(p).
Based on this section, in the April 7, 2000 OPPS rule, we stated that the APC for partial hospitalization represents the provider's overhead costs, support staff, and the services of clinical social workers (CSWs) and occupational therapists (OTs), whose professional services are considered to be partial hospitalization services for which Medicare payment is made to the provider. Before implementation of the OPPS, the services of CSWs and OTs in a PHP were billed by the hospitals to the fiscal intermediaries and paid on a reasonable cost basis.
We have looked carefully at the differences between the cost experiences of CMHCs and of hospitals with respect to PHP services, as well as how payment is made for other hospital outpatient psychiatric services, to identify areas where improvements can be made in OPPS. One of the areas in which we identified discrepancies was in the coverage of CSW services. The way in which CSW services are currently billed and paid depends upon the circumstances under which CSW services are provided. In some settings, payment for CSW services is part of a bundled payment. In other settings, separate payment for CSW services is made.
Generally, CSW services furnished to hospital outpatients are bundled, which means that only the hospital may bill for such services. However, payment for CSW professional services furnished to hospital outpatients is made under the physician fee schedule. Therefore, the hospital outpatient department bills separately the Part B carrier for CSW services furnished to outpatients who are not in a PHP. CSW professional services are paid at 75 percent of the clinical psychologist fee schedule.
However, when CSWs furnish services to hospital outpatients or a CMHC under a partial hospitalization program, hospitals may not bill separately for the services of a CSW. Instead, for coverage and payment purposes, the services are recognized as partial hospitalization services. Partial hospitalization services are billed by hospitals and CMHCs to the fiscal intermediaries and paid the OPPS PHP APC per diem amount.
The different methodologies for payment of CSW services has proven both confusing and burdensome for hospitals because they must implement separate billing schemes for CSW services depending upon whether an Start Printed Page 52117individual outpatient is admitted to a PHP program or to any other hospital outpatient psychiatric program. We believe that these challenges have resulted in incorrect reporting by hospitals which has led to an under-representation of CSW services in the OPPS PHP APC per diem amount.
To facilitate proper billing and to ensure comparable reporting of costs by hospitals and CMHCs, we are proposing to allow separate payment for CSW services furnished in CMHCs. This means that both hospitals and CMHCs will bill the carrier for CSW services furnished to PHP patients. Therefore, we are proposing to amend § 410.43(b) to add clinical social worker services that meet the requirements of section 1861(hh)(2) of the Act to the list of professional services not considered to be PHP services. We believe this change will allow CSW services to be more appropriately reflected in both settings as part of PHPs.
III. Transitional Pass-Through and Related Payment Issues
A. Background
Section 1833(t)(6) of the Act provides for temporary additional payments or “transitional pass-through payments” for certain medical devices, drugs, and biologicals. As originally enacted by the BBRA, this provision required the Secretary to make additional payments to hospitals for current orphan drugs, as designated under section 526 of the Federal Food, Drug, and Cosmetic Act, Pub. L. 107-186; current drugs, biologic agents, and brachytherapy devices used for the treatment of cancer; and current radiopharmaceutical drugs and biological products.
For those drugs, biologicals, and devices referred to as “current,” the transitional pass-through payment began on the first date the hospital OPPS was implemented (before enactment of the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act (BIPA), Pub. L. 106-554, enacted December 21, 2000).
Transitional pass-through payments are also required for certain “new” medical devices, drugs, and biological agents that were not being paid for as a hospital outpatient service as of December 31, 1996 and whose cost is “not insignificant” in relation to the OPPS payment for the procedures or services associated with the new device, drug, or biological. Under the statute, transitional pass-through payments are to be made for at least 2 years but not more than 3 years.
Section 1833(t)(6)(B)(i) of the Act required that we establish by April 1, 2001, initial categories to be used for purposes of determining which medical devices are eligible for transitional pass-through payments. Section 1833(t)(6)(B)(i)(II) of the Act explicitly authorized us to establish initial categories by program memorandum. On March 22, 2001, we issued two Program Memoranda, Transmittals A-01-40 and A-01-41 that established the initial categories. We posted them on our web site at http://www.hcfa.gov/pubforms/transmit/A0140.pdf and http://www.hcfa.gov/pubforms/transmit/A0141.pdf, respectively.
Transmittal A-01-41 includes a list of the initial device categories and a crosswalk of all the item-specific codes for individual devices that were approved for transitional pass-through payments as of January 21, 2001 to the initial category code by which the device is to be billed beginning April 1, 2001. Items eligible for transitional pass-through payments are generally coded using a Level II HCPCS code with an alpha prefix of “C.” Pass-through device categories are identified by status indicator “H” and pass-through drugs and biologicals are identified by status indicator “G.” Subsequently, we added two additional categories and made clarifications to some of the categories' long descriptors found in transmittal A-01-73. A current list of device category codes in effect as of July 1, 2002 can be found in Transmittal A-02-050, which was issued on June 17, 2002. This Program Memorandum can be accessed on our web site at http://www.hcfa.gov. The list is also included in this preamble in Table 7.
Section 1833(t)(6)(B)(ii) of the Act also requires us to establish, through rulemaking, criteria that will be used to create additional device categories. The criteria for new categories are the subject of a separate interim final rule with comment period that we published in the Federal Register on November 2, 2001 (66 FR 55850). We will respond to public comments on that interim final rule in the final rule that implements the 2003 OPPS update.
Transitional pass-through categories are for devices only; they do not apply to drugs or biologicals. The regulations at § 419.64 governing transitional pass-through payments for eligible drugs and biologicals are unaffected by the creation of categories.
The process to apply for transitional pass-through payment for eligible drugs and biological agents or for additional device categories can be found on respective pages on our web site at http://www.hcfa.gov. If we revise the application instructions in any way, we will post the revisions on our web site and submit the changes for approval by the Office of Management and Budget (OMB) under the Paperwork Reduction Act (PRA). Notification of new drug, biological, or device category application processes are generally posted on the OPPS web site at http://www.hcfa.gov/Medicare/hopsmain.html.
B. Discussion of Pro Rata Reduction
Section 1833(t)(6)(E) of the Act limits the total projected amount of transitional pass-through payments for a given year to an “applicable percentage” of projected total payments under the hospital OPPS. For a year before 2004, the applicable percentage is 2.5 percent; for 2004 and subsequent years, we specify the applicable percentage up to 2.0 percent. If we estimate before the beginning of the calendar year that the total amount of pass-through payments in that year would exceed the applicable percentage, section 1833(t)(6)(E)(iii) of the Act requires a (prospective) uniform reduction in the amount of each of the transitional pass-through payments made in that year to ensure that the limit is not exceeded. We make an estimate of pass-through spending to determine not only whether payment exceeds the applicable percentage but also to determine the appropriate reduction to the conversion factor.
We will make an estimate of pass-through spending in 2003 using the methodology described below. Making an estimate of pass-though spending in 2003 entails estimating spending for two groups of items. The first group consists of those items for which we have claims data (that is, items that were eligible in 2001 and that will continue to be eligible in 2003). The second group consists of those items for which we have no direct claims data (that is, items that became or will become eligible in 2002 and will retain pass-through status and items that will be newly eligible beginning in 2003).
To estimate 2003 pass-through spending for device categories in the first group, we will use volume and hospital cost (derived from charges on claims using cost-to-charge ratios) information from 2001 claims data. This information will be projected forward to 2003 levels using appropriate inflation and utilization factors. For existing categories with no claims data in 2001 that are or will be active in 2002, we will follow the method described in the November 2, 2001 final rule (66 FR 55857). We will use price information from manufacturers and volume estimates from claims related to procedures that use the devices in question. This information will be Start Printed Page 52118projected forward to 2003 using appropriate inflation and utilization factors to estimate 2003 pass-through spending for this group of categories. For categories that become eligible in 2003, we will use the same method as described for categories that are newly active in 2002. Any new categories for 2003 will be announced after the publication of this proposed rule but prior to the publication of the final rule. Therefore the estimate of pass-through spending will incorporate pass-through spending for categories made effective January 1, 2003.
To estimate 2003 pass-through spending for drugs, biologicals, and radiopharmaceuticals, in the first group, we will use volume data from 2001 claims and the average wholesale price (AWP) as published in the July 2002 Red Book. This information will be projected forward to 2003 using the appropriate utilization factor. (Because 2003 payment rates for pass-through drugs will be based on the July 2002 AWPs, we do not apply an inflation factor.) The pass-through amount for drugs, biologicals, and radiopharmaceuticals is the difference between the payment rate (that is, 95 percent of the AWP) and the amount that would have been included in the payment rate of its associated APC had the drug, biological, or radiopharmaceutical been packaged. Section V.E. describes this methodology. To estimate pass-through spending for drugs in this group, for each drug we will multiply the drug's estimated utilization times the pass-through amount (for example, the difference between 95 percent of AWP for the drug and the amount included in the payment rate for its associated APC). For most drugs, the pass-through amount will be based on the weighted average ratios described in Section IV.E. However some drugs may fall into two other classes. The first class includes a drug that is new and for which there are no previously existing costs in an associated APC. For such a drug, we propose that the pass-through amount would be 95 percent of the AWP (because there are no previously existing costs in an associated APC) and there will be no copayment (because there are no previously existing costs in an APC on which to base a copayment). The second class includes a drug that is new and is a substitute for only one drug whose cost is recognized in the OPPS through an unpackaged APC. For drugs in this second class, we propose that the pass-through amount would be the difference between 95 percent of the AWP for the pass-through drug and the payment rate for the comparable dose of the associated drug's APC. The copayment would be based on the payment rate of its associated APC.
For existing drugs, biologicals, and radiopharmaceuticals for which we have no claims data in 2001 and which are active or will be active in 2002 as well as for drugs, biologicals, and radiopharmaceuticals, we will derive volume estimates from information submitted by manufacturers as well as other sources (such as, peer-reviewed clinical studies) and the AWP as published in the July 2002 Red Book. This information will be projected forward to 2003 using the appropriate utilization factor. Again, because 2003 payment rates for pass-through drugs will be based on the July 2002 AWP, we do not apply an inflation factor. To estimate pass-through spending for drugs in this group, for each drug we will multiply the drug's estimated utilization times the pass-through amount. For most drugs, these amounts will be based on the weighted average ratios described in Section IV.E. However some drugs may fall into two other classes. The first class includes a drug that is new and has no previously existing costs included in an associated APC. For such a drug, we propose that the pass-through amount would be 95 percent of the AWP (because there are no previously existing costs included in an APC) and there would be no copayment (because there are no previously existing costs in an APC on which to base a copayment). The table below shows two such drugs, Y-90 Zevalin and IN-111 Zevalin. The second class includes a drug that is new and is a substitute for only one drug that is recognized in the OPPS, through an unpackaged APC. The table below shows one such drug, Darbepoetin alfa, which is a new substitute of epoetin. For drugs in this second class, the pass-through amount will be the difference between 95 percent of the AWP for the pass-through drug and the payment rate for the comparable dose of the associated drug's APC. The copayment will be based on the payment rate of its associated APC. For drugs, biologicals, and radiopharmaceuticals that may receive pass-through status effective January 1, 2003, we will use the same methodology as described for drugs, biologicals, and radiopharmaceuticals that received pass-through status in 2002. Any new pass-through drugs, biologicals, and radiopharmaceuticals effective beginning in 2003 will be announced after the publication of this proposed rule but prior to the publication of the final rule. Therefore the estimate of pass-through spending will incorporate pass-through spending for these drugs, biologicals, and radiopharmaceuticals made effective January 1, 2003.
Finally, we will incorporate an estimate of pass-through spending for items that become eligible later in 2003 (that is, April 1, 2003; July 1, 2003; and October 1, 2003) based on estimates for items that will become eligible for pass-through status January 1, 2003. Specifically, we will assume a proportionate amount of spending for items that become eligible later in the year while making an adjustment to account for the fact that items made eligible later in the year will not have received pass-through payments for the entire year.
After using the methodologies described above to determine projected 2003 pass-through spending for the groups of devices, drugs, biologicals, and radiopharmaceuticals described above, we would calculate total projected 2003 pass-through spending as a percentage of the total (that is, Medicare and beneficiary payments) projected payments under OPPS to determine if the pro rata reduction would be required.
Below is a table showing our current estimate of 2003 pass-through spending based on information available at the time this table was developed. We are uncertain whether pass-through spending in 2003 will exceed $457 million or 2.5 percent of total OPPS spending. We have not yet completed the estimate of pass-through spending for a number of drugs. In particular, we are in the process of obtaining additional information about the utilization volume for several pass-through drugs. We invite comments on the methodology described above as well as the assumptions shown in the table below including anticipated utilization and utilization not yet determined. More information regarding the assumptions used to create these estimates is available at http://cms.hhs.gov/regulations/regnotices.asp. Start Printed Page 52119
Start Printed Page 52120Table X.
HCPC APC DRUG, biological 2002 payment rate 2001 utilization 2003 Pass-through payment portion 2003 estimated utilization 2003 anticipated pass-through payment Existing Pass-through Drugs/Biologicals A9700 9016 Echocardiography Contrast* $118.75 300,000 $34.44 368,686 $12,696,607.35 C1774 734 Darbepoetin alfa, 1 mcg 4.74 6136252 1.37 7,541,157 10,366,074.10 C1058 1058 TC 99M oxidronate, per vial 36.74 4,000 10.65 4,916 52,375.96 C1064 1064 I-131 cap, each add mCi 5.86 4,575 1.88 5,622 485,208.00 C1065 1065 I-131 sol, each add mCi 15.81 4,575 5.06 5,622 1,309,068.00 C1775 1775 FDG, per dose (4-40 mCi/ml) 475.00 30,000 137.75 36,869 5,078,642.94 J9219 7051 Leuprolide acetate implant 5,399.80 66 1,565.94 81 127,014.83 J9017 9012 Arsenic Trioxide 23.75 6.89 TBD To be determined J7517 9015 Mycophenolate mofetil 2.40 0.70 TBD To be determined J0587 9018 Botulinum toxin type B 8.79 2.55 TBD To be determined C9019 9019 Caspofugen acetate, 5 mg 34.20 9.92 TBD To be determined C9110 9110 Alemtuzumab, per 10mg/ml 486.88 141.20 517 72,997.92 C9111 9111 Inj. Bivalrudin, 250 mg vial 397.81 115.36 TBD To be determined C9112 9112 Perflutren lipid micro, 2ml 148.20 300,000 42.98 368,686 15,845,365.98 C9113 9113 Inj Pantoprazole sodium, vial 22.80 6.61 TBD To be determined C9114 9114 Nesiritide, per 1.5 mg vial 433.20 125.63 TBD To be determined C9115 9115 Zoledronic acid, 2 mg 406.78 117.97 TBD To be determined C9200 9200 Orcel, per 36 cm2 1,135.25 329.22 TBD To be determined C9201 9201 Dermagraft, per 37.5 sq cm 577.60 167.50 TBD To be determined Pass-through Drugs/Biologicals Effective October 2002 C9116 9116 Ertapenem sodium 36.24 10.51 TBD To be determined C9117 9117 Y-90 Zevalin 19,181.44 19,181.44 9,000 172,632,960.00 C9118 9118 IN-111 Zevalin 2,769.65 2,769.65 9,000 24,926,850.00 C9119 9119 Pegfilgrastim 2,802.50 2,367.13 85,258 201,815,396.40 Pass-through Devices C1765 1754 Adhesion barrier 256 261 20,011.00 C1783 1783 Ocular implant, aqueous drainage 2000 2042 1,327,300.00 C1888 1888 Endovascular, non-cardiac 184 188 136,300.00 C1900 1900 Lead, left ventricular 1000 1021 2,042,000.00 C2618 2618 Probe, cryoablation 1120 1144 531,106.00 C. Expiration of Transitional Pass-Through Payments in Calendar Year 2003
1. Devices
Section 1833(t)(6)(B)(iii) of the Act requires that a category of devices be eligible for transitional pass-through payments for at least 2, but not more than 3, years. This period begins with the first date on which a transitional pass-through payment is made for any medical device that is described by the category. We propose that 95 device categories currently in effect will expire effective January 1, 2003. Our proposed payment methodology for devices that have been paid by means of pass-through categories, but for which pass-through status will expire effective January 1, 2003, is discussed in the section below.
Although the device category codes became effective on April 1, 2001, many of the item-specific C-codes for pass-through devices that were crosswalked to the new category codes were approved for pass-through payment in CY 2000, or as of January 1, 2001. (The crosswalk for item-specific C-codes to category codes was issued in Transmittals A-01-41 and A-01-97, cited in section III.A.) To establish the expiration date for the category codes listed in Table 7, we determined when item-specific devices that are described by the categories were first made effective for pass-through payment before the implementation of device categories. These dates are listed in Table 7 in the column entitled “Date First Populated.” We propose to base the expiration date for a device category on the earliest effective date of pass-through status for any device that populates that category. Thus, the 95 categories for devices that will have been eligible for pass-through payments for at least 2 years as of December 31, 2002 would not be eligible for pass-through payments effective January 1, 2003.
Below is Table 7, which includes a comprehensive list of all pass-through device categories effective on or before July 1, 2002 with the date that devices described by the category first became effective for payment under the pass-through provisions and their respective proposed expiration dates.
Table 7.—List of Pass-through Device Categories With Proposed Expiration Dates
HCPCS codes Category long descriptor Date first populated Expiration date 1 C1883 Adaptor/extension, pacing lead or neurostimulator lead (implantable) 8/1/00 12/31/02 2 C1765 Adhesion barrier 10/01/00-3/31/01; 7/1/01 12/31/03 3 C1713 Anchor/screw for opposing bone-to-bone or soft tissue-to-bone (implantable) 8/1/00 12/31/02 4 C1715 Brachytherapy needle 8/1/00 12/31/02 5 C1716 Brachytherapy seed, Gold 198 10/1/00 12/31/02 6 C1717 Brachytherapy seed, High Dose Rate Iridium 192 1/1/01 12/31/02 7 C1718 Brachytherapy seed, Iodine 125 8/1/00 12/31/02 8 C1719 Brachytherapy seed, Non-High Dose Rate Iridium 192 10/1/00 12/31/02 9 C1720 Brachytherapy seed, Palladium 103 8/1/00 12/31/02 10 C2616 Brachytherapy seed, Yttrium-90 1/1/01 12/31/02 11 C1721 Cardioverter-defibrillator, dual chamber (implantable) 8/1/00 12/31/02 12 C1882 Cardioverter-defibrillator, other than single or dual chamber (implantable) 8/1/00 12/31/02 13 C1722 Cardioverter-defibrillator, single chamber (implantable) 8/1/00 12/31/02 14 C1888 Catheter, ablation, non-cardiac, endovascular (implantable) 7/1/02 12/31/04 15 C1726 Catheter, balloon dilatation, non-vascular 8/1/00 12/31/02 16 C1727 Catheter, balloon tissue dissector, non-vascular (insertable) 8/1/00 12/31/02 17 C1728 Catheter, brachytherapy seed administration 1/1/01 12/31/02 18 C1729 Catheter, drainage 10/1/00 12/31/02 19 C1730 Catheter, electrophysiology, diagnostic, other than 3D mapping (19 or fewer electrodes) 8/1/00 12/31/02 20 C1731 Catheter, electrophysiology, diagnostic, other than 3D mapping (20 or more electrodes) 8/1/00 12/31/02 21 C1732 Catheter, electrophysiology, diagnostic/ablation, 3D or vector mapping 8/1/00 12/31/02 22 C1733 Catheter, electrophysiology, diagnostic/ablation, other than 3D or vector mapping, other than cool-tip 8/1/00 12/31/02 23 C2630 Catheter, electrophysiology, diagnostic/ablation, other than 3D or vector mapping, cool-tip 10/1/00 12/31/02 24 C1887 Catheter, guiding (may include infusion/perfusion capability) 8/1/00 12/31/02 25 C1750 Catheter, hemodialysis/peritoneal, long-term 8/1/00 12/31/02 26 C1752 Catheter, hemodialysis/peritoneal, short-term 8/1/00 12/31/02 27 C1751 Catheter, infusion, inserted peripherally, centrally or midline (other than hemodialysis) 8/1/00 12/31/02 28 C1759 Catheter, intracardiac echocardiography 8/1/00 12/31/02 29 C1754 Catheter, intradiscal 10/1/00 12/31/02 30 C1755 Catheter, intraspinal 8/1/00 12/31/02 31 C1753 Catheter, intravascular ultrasound 8/1/00 12/31/02 32 C2628 Catheter, occlusion 10/1/00 12/31/02 33 C1756 Catheter, pacing, transesophageal 10/1/00 12/31/02 34 C2627 Catheter, suprapubic/cystoscopic 10/1/00 12/31/02 35 C1757 Catheter, thrombectomy/embolectomy 8/1/00 12/31/02 36 C1885 Catheter, transluminal angioplasty, laser 10/1/00 12/31/02 37 C1725 Catheter, transluminal angioplasty, non-laser (may include guidance, infusion/perfusion capability) 8/1/00 12/31/02 38 C1714 Catheter, transluminal atherectomy, directional 8/1/00 12/31/02 39 C1724 Catheter, transluminal atherectomy, rotational 8/1/00 12/31/02 40 C1758 Catheter, ureteral 10/1/00 12/31/02 41 C1760 Closure device, vascular (implantable/insertable) 8/1/00 12/31/02 42 L8614 Cochlear implant system 8/1/00 12/31/02 43 C1762 Connective tissue, human (includes fascia lata) 8/1/00 12/31/02 Start Printed Page 52121 44 C1763 Connective tissue, non-human (includes synthetic) 10/1/00 12/31/02 45 C1881 Dialysis access system (implantable) 8/1/00 12/31/02 46 C1764 Event recorder, cardiac (implantable) 8/1/00 12/31/02 47 C1767 Generator, neurostimulator (implantable) 8/1/00 12/31/02 48 C1768 Graft, vascular 1/1/01 12/31/02 49 C1769 Guide wire 8/1/00 12/31/02 50 C1770 Imaging coil, magnetic resonance (insertable) 1/1/01 12/31/02 51 C1891 Infusion pump, non-programmable, permanent (implantable) 8/1/00 12/31/02 52 C2626 Infusion pump, non-programmable, temporary (implantable) 1/1/01 12/31/02 53 C1772 Infusion pump, programmable (implantable) 10/1/00 12/31/02 54 C1893 Introducer/sheath, guiding, intracardiac electrophysiological, fixed-curve, other than peel-away 10/1/00 12/31/02 55 C1766 Introducer/sheath, guiding, intracardiac electrophysiological, steerable, other than peel-away 1/1/01 12/31/02 56 C1892 Introducer/sheath, guiding, intracardiac electrophysiological, fixed-curve, peel-away 1/1/01 12/31/02 57 C1894 Introducer/sheath, other than guiding, other than intracardiac electrophysiological, non-laser 8/1/00 12/31/02 58 C2629 Introducer/sheath, other than guiding, other than intracardiac electrophysiological, laser 1/1/01 12/31/02 59 C1776 Joint device (implantable) 10/1/00 12/31/02 60 C1895 Lead, cardioverter-defibrillator, endocardial dual coil (implantable) 8/1/00 12/31/02 61 C1777 Lead, cardioverter-defibrillator, endocardial single coil (implantable) 8/1/00 12/31/02 62 C1896 Lead, cardioverter-defibrillator, other than endocardial single or dual coil (implantable) 8/1/00 12/31/02 63 C1900 Lead, left ventricular coronary venous system 7/1/02 12/31/04 64 C1778 Lead, neurostimulator (implantable) 8/1/00 12/31/02 65 C1897 Lead, neurostimulator test kit (implantable) 8/1/00 12/31/02 66 C1898 Lead, pacemaker, other than transvenous VDD single pass 8/1/00 12/31/02 67 C1779 Lead, pacemaker, transvenous VDD single pass 8/1/00 12/31/02 68 C1899 Lead, pacemaker/cardioverter-defibrillator combination (implantable) 1/1/01 12/31/02 69 C1780 Lens, intraocular (new technology) 8/1/00 12/31/02 70 C1878 Material for vocal cord medialization, synthetic (implantable) 10/1/00 12/31/02 71 C1781 Mesh (implantable) 8/1/00 12/31/02 72 C1782 Morcellator 8/1/00 12/31/02 73 C1784 Ocular device, intraoperative, detached retina 1/1/01 12/31/02 74 C1783 Ocular implant, aqueous drainage assist device 7/1/02 12/31/04 75 C2619 Pacemaker, dual chamber, non rate-responsive (implantable) 8/1/00 12/31/02 76 C1785 Pacemaker, dual chamber, rate-responsive (implantable) 8/1/00 12/31/02 77 C2621 Pacemaker, other than single or dual chamber (implantable) 1/1/01 12/31/02 78 C2620 Pacemaker, single chamber, non rate-responsive (implantable) 8/1/00 12/31/02 79 C1786 Pacemaker, single chamber, rate-responsive (implantable) 8/1/00 12/31/02 80 C1787 Patient programmer, neurostimulator 8/1/00 12/31/02 81 C1788 Port, indwelling (implantable) 8/1/00 12/31/02 82 C2618 Probe, cryoablation 4/1/01 12/31/03 83 C1789 Prosthesis, breast (implantable) 10/1/00 12/31/02 84 C1813 Prosthesis, penile, inflatable 8/1/00 12/31/02 85 C2622 Prosthesis, penile, non-inflatable 10/1/01 12/31/02 86 C1815 Prosthesis, urinary sphincter (implantable) 10/1/00 12/31/02 87 C1816 Receiver and/or transmitter, neurostimulator (implantable) 8/1/00 12/31/02 88 C1771 Repair device, urinary, incontinence, with sling graft 10/1/00 12/31/02 89 C2631 Repair device, urinary, incontinence, without sling graft 8/1/00 12/31/02 90 C1773 Retrieval device, insertable 1/1/01 12/31/02 91 C2615 Sealant, pulmonary, liquid (Implantable) 1/1/01 12/31/02 92 C1817 Septal defect implant system, intracardiac 8/1/00 12/31/02 93 C1874 Stent, coated/covered, with delivery system 8/1/00 12/31/02 94 C1875 Stent, coated/covered, without delivery system 8/1/00 12/31/02 95 C2625 Stent, non-coronary, temporary, with delivery system 10/1/00 12/31/02 96 C2617 Stent, non-coronary, temporary, without delivery system 10/1/00 12/31/02 97 C1876 Stent, non-coated/non-covered, with delivery system 8/1/00 12/31/02 98 C1877 Stent, non-coated/non-covered, without delivery system 8/1/00 12/31/02 99 C1879 Tissue marker (implantable) 8/1/00 12/31/02 100 C1880 Vena cava filter 1/1/01 12/31/02 We considered a number of options on how to pay for devices after their pass-through payment status expires effective January 1, 2003. We held a Town Hall Meeting on April 5, 2002, to solicit recommendations on how to pay for drugs, biologicals, and devices once their eligibility for transitional pass-through payments expires in accordance with the time limits set by the statute. Interested parties representing hospitals, physician specialty groups, device and drug manufacturers and trade associations, and other organizations presented their views on these issues.
We have carefully considered all the comments, concerns, and recommendations submitted to us regarding payment for devices and drugs and biologicals that would no Start Printed Page 52122longer be eligible for pass-through payments in 2003. One consideration under the OPPS is the need to enable beneficiary access to new, and often costly, medical technology. We have also had to assess the extent to which the most recently available data that are the basis for prospectively setting payment rates for services within the APC system adequately reflect the costs incurred by hospitals to furnish this new technology. Having considered these factors, we propose to package the costs of medical devices no longer eligible for pass-through payment in 2003 into the costs of the procedures with which the devices were billed in 2001. (Our proposal to pay for pass-through drugs and biologicals whose pass-through status expires in 2003 is discussed below, in section III.C.2.)
The methodology that we propose to use to package pass-through device costs is consistent with the methodology for packaging that we describe in section II.B.4.b. That is, to calculate the total cost for a service on a per-service basis, we included all charges billed with the service in a revenue center in addition to packaged HCPCS codes with status indicator “N.” We also packaged the 2001 charges for devices that will cease to be eligible for pass-through payment in 2003 into the changes for the HCPCS codes with which the devices were billed. We relied on the hospitals to correctly code their bills for all costs, including pass-through devices, using HCPCS codes and revenue centers as appropriate to describe the services that they furnished.
We discuss in section II.B.4.a.(2), issues related to coding and billing for pass-through devices in 2001 and how our analysis of the claims data suggests that in some instances charges for devices were billed in revenue centers and in other instances with a device-specific or device category “C” code. We did not want to lose the device costs billed by hospitals through revenue centers in developing our relative weights for APCs, yet we were unable to separate the device costs from other costs included in the revenue centers. This problem is resolved by our proposal to package the costs of both the device “C” codes and the billed revenue centers, whichever appears on the claim. We are confident that this method will allow us to capture all device related costs billed by hospitals.
We customarily allow a grace period for HCPCS codes that are scheduled for deletion. When we allow a grace period for deleted codes, we permit deleted codes to continue to be billed and paid for 90 days after the effective date of the changes that require their deletion. However, we propose to not allow a grace period for expiring pass-through codes because permitting a grace period would result in pass-through payment for the items for which we propose to cease pass-through payment effective with services furnished on or after January 1, 2003. Effective for services furnished on or after January 1, 2003, hospitals would submit charges for all surgically inserted devices in the supply, implant, or device revenue center that most appropriately describes the implant. Device costs will thus be packaged into and reflected in the costs for the procedure with which they are associated. Therefore, effective for services furnished on or after January 1, 2003, we propose to reject line items containing a “C” code for a device category scheduled to expire effective January 1, 2003.
2. Drugs and Biologicals (Including Radiopharmaceuticals, Blood, and Blood Products)
Under the OPPS, we currently pay for drugs and biologicals, including radiopharmaceuticals, blood, and blood products, in one of three ways: packaged payment, separate APCs and transitional pass-through payment.
Packaged Payment
As we explained in the April 7, 2000 final rule, we generally package the cost of drugs and biologicals into the APC payment rate for the primary procedure or treatment with which the drugs are usually furnished (65 FR 18450). Hospitals do not receive separate payment from Medicare for packaged items and supplies, and hospitals may not bill beneficiaries separately for any such packaged items and supplies whose costs are recognized and paid for within the national OPPS payment rate for the associated procedure or service. (Transmittal A-01-133, a Program Memorandum issued to Intermediaries on November 20, 2001, explains in greater detail the rules regarding separate payment for packaged services). Hospitals bill for costs directly related and integral to performing a procedure or furnishing a service using a revenue center or packaged HCPCS code (status indicator “N”). As discussed earlier in section II.B.4.a(2), we list the packaged services, by revenue center, that we use to calculate per-service costs.
As specified in the regulations at § 419.2(b), costs directly related and integral to performing a procedure or furnishing a service on an outpatient basis are included in the determination of OPPS payment rates for the procedure or service. For example, sedatives administered to patients while they are in the preoperative area being prepared for a procedure are supplies that are integral to being able to perform the procedure. Similarly, mydriatic drops instilled into the eye to dilate the pupils, anti-inflammatory drops, antibiotic ointments, and ocular hypotensives that are administered to the patient immediately before, during, or following an ophthalmic procedure are considered an integral part of the procedure without which the procedure could not be performed. The costs of these items are packaged into and reflected within the OPPS payment rate for the procedure. Likewise, barium or low osmolar contrast media are supplies that are integral to a diagnostic imaging procedure as is the topical solution used with photodynamic therapy furnished at the hospital to treat non-hyperkeratotic actinic keratosis lesions of the face or scalp. Local anesthetics such as marcaine, lidocaine (with or without epinephrine) and antibiotic ointments such as bacitracin, placed on a wound or surgical incision at the completion of a procedure, are other examples. The hospital furnishes these items while the patient is in the hospital and registered as an outpatient for the purpose of receiving a therapy, treatment, procedure, or service. These and other such supplies may be furnished pre-operatively, while the patient is being prepared for a procedure; intra-operatively, while the procedure is being performed; or post-operatively, while the patient is in the recovery area prior to discharge. Or, these items may be part of an E/M service furnished during a clinic visit or in the emergency department. All of these supplies are directly related and integral to the performance of a separately payable therapy, treatment, procedure, or service with which they are furnished. Therefore, we do not generally recognize them as separately payable services. We package their cost into the cost of the primary procedure, and we pay for them as part of the APC payment.
Separate APCs for Drugs Not Eligible for Transitional Pass-Through Payment
There are certain new technology drugs and biologicals that are not eligible for transitional pass-through payments but for which we have made separate payment. Beginning with the April 7, 2000 rule (65 FR 18476), we created separate new technology APCs for these drugs and biologicals as well as devices. For example, we did not package into the emergency room visit APCs the various drugs classified as tissue plasminogen activators (TPAs) Start Printed Page 52123and other thrombolytic agents that are used to treat patients with myocardial infarctions. We also did not package the costs of certain vaccines into the payment for visits or procedures. Rather, we created temporary individual APC groups for these drugs to allow separate payment so as not to discourage their use where appropriate. In the case of blood and blood products, wide variations in patient requirements convinced us that we should pay for these items separately rather than packaging their costs into the procedural APCs. Moreover, the Secretary's Advisory Council on Blood Safety and Access recommended that blood and blood products be paid separately to ensure that there were no incentives that would be inconsistent with the promotion of blood safety and access.
In the case of the other drugs and vaccines that we did not package into payment for visits or procedures, we paid separately for them because we wanted to avoid creating an incentive to cease providing these drugs when they were medically indicated.
We based the payment rate for the APCs for these drugs and biologicals on median hospital acquisition costs. To determine the hospital acquisition cost for the drugs, we imputed a cost using the same ratios of drug acquisition cost to AWP that we discuss below in connection with calculating acquisition costs for transitional pass-through drug payments. That is, we multiplied the AWP for the drug by the applicable ratio (sole or multisource drug) based on data collected in an external survey of hospital drug acquisition costs.
We set beneficiary copayment amounts for these drug and biological APCs at 20 percent of the imputed acquisition cost. In 2003 we will use status indicator “K” to denote the APCs for drugs and biologicals (including blood and blood products) and certain brachytherapy seeds that are paid separately from and in addition to the procedure or treatment with which they are associated but that are not eligible for transitional pass-through payment.
Transitional Pass-Through Payments for Eligible Drugs and Biologicals
BBRA provided for special transitional pass-through payments for a period of 2 to 3 years for the following drugs and biologicals (pass-through payments for devices are addressed in section III.C.1 of this proposed rule):
- Current orphan drugs, as designated under section 526 of the Federal Food, Drug, and Cosmetic Act.
- Current drugs and biologic agents used for treatment of cancer.
- Current radiopharmaceutical drugs and biological products.
- New drugs and biological agents.
In this context, “current” refers to those items for which hospital outpatient payment was being made on August 1, 2000, the date on which the OPPS was implemented. A “new” drug or biological is a product that is not paid under the OPPS as a “current” drug or biological, was not paid as a hospital outpatient service before January 1, 1997, and for which the cost is not insignificant in relation to the payment for the APC with which it is associated.
Section 1833(t)(6)(D)(i) of the Act sets the payment rate for pass-through eligible drugs as the amount by which the amount determined under section 1842(o) of the Act, that is, 95 percent of the applicable average wholesale price (AWP), exceeds the difference between 95 percent of the applicable AWP and the portion of the otherwise applicable fee schedule amount (that is, the APC payment rate) that the Secretary determines is associated with the drug or biological. Therefore, in order to determine the pass-through payment amount, we first had to determine the cost that was packaged for the drug or biological within its related APC. In order to determine this amount, we used data on hospital acquisition costs for drugs from a survey that is described more fully in the April 7, 2000 and the November 30, 2001 final rules. The ratio of hospital acquisition cost, on average, to AWP that we used is as follows:
- For sole-source drugs, the ratio of acquisition cost to AWP equals 0.68.
- For multisource drugs, the ratio of acquisition cost to AWP equals 0.61.
- For multisource drugs with generic competitors, the ratio of acquisition cost to AWP equals 0.43.
Section 1833(t)(6)(C)(i) of the Act specifies that the duration of transitional pass-through payments for current drugs and biologicals must be no less than 2 years nor any longer than 3 years beginning on the date that the OPPS is implemented. Therefore, the latest date for which current drugs that have been in transitional pass-through status since August 1, 2000 will be eligible for transitional pass-through payments is July 31, 2003. We propose to remove these drugs from transitional pass-through status effective January 1, 2003 because the law gives us the discretion to do so and because we generally implement annual OPPS updates on January 1 of each year. We would be in violation of the law if we were to not remove these drugs and biologicals from transitional pass through status before August 2, 2003. The next new OPPS that will go into place will not be effective until January 1, 2004, at which time, the statute's 3-year limit on pass-through payments for these drugs would have been exceeded. We further propose to remove from transitional pass-through status, beginning January 1, 2003, those drugs for which transitional pass-through payments were made effective on or prior to January 1, 2001 because the law gives us the discretion to do so and we believe that, to the extent possible, payments should be made under the OPPS, without pass-through payment, when the law permits, as it does in this case.
As explained above, our policy has been to package payment for drugs and biologicals into the payment for the procedure or service to which the drug is integral and directly related. In general, packaging the costs of items and services into the payment for the primary procedure or service with which it is associated encourages hospital efficiencies and also enables hospitals to manage their resources with maximum flexibility. Packaging costs into a single aggregate payment for a service procedure or episode of care is a fundamental principle that distinguishes a prospective payment system from a fee schedule. Our proposal to package the costs of devices that we discuss in section III.C.1 of this preamble is based on this principle. As we refine the OPPS in the future, we intend to continue to package, to the maximum possible extent, the costs of any items and services that are furnished with an outpatient procedure or service into the APC payment for services with which it is billed.
Notwithstanding our commitment to package as many costs as possible, we are aware of concerns that were presented at the April 5, 2002 Town Hall meeting and that have been brought to our attention by various interested parties, that packaging payments for certain drugs, especially those that are particularly expensive or rarely used, might result in insufficient payments to hospitals, which could adversely affect beneficiary access to medically necessary services.
The options that we considered included packaging the costs of all drugs and biologicals, both those with status indicator “K” in 2002 and those that would no longer receive pass-through payments in 2003, or continuing to make separate payment for both categories of drugs and biologicals through separate APCs. After careful consideration of the various options for 2003, we propose to package the cost of many drugs for which separate payment is made currently. But Start Printed Page 52124we also propose to continue making separate payment for orphan drugs (as defined below), blood and blood products, vaccines that are paid under a benefit separate from the outpatient hospital benefit (that is, influenza, pneumococcal pneumonia, and hepatitis B), and certain higher cost drugs as explained below. The payment rates for those drugs for which we would make separate payment in 2003 would be an APC payment rate based on a relative weight calculated in the same way that relative weights for procedural APCs are calculated.
Orphan Drugs
We recognize that orphan drugs that are used solely for an orphan condition or conditions are generally expensive and, by definition, are rarely used. We believe that if the cost of these drugs were packaged into the payment for an associated procedure or visit, the payment for the procedure might be insufficient to compensate a hospital for the typically high cost of this special type of drug. Therefore, we propose to establish separate APCs to pay for those orphan drugs that are used solely for orphan conditions.
To identify the orphan drugs for which we would continue to make separate payment, we applied the following criteria:
- The drug must be designated as an orphan drug by FDA and approved by FDA for the orphan condition.
- The current United States Pharmacopoeia Drug Information (USPDI) shows that the drug had neither an approved use for other than an orphan condition nor an off label use for conditions other than the orphan condition. There are three orphan drugs that are used solely for orphan conditions for which we propose to make separate payment: J0205 Alglucerase injection (APC 0900); J0256 Alpha 1 proteinase inhibitor (APC 0901); and J09300 Gemtuzumab ozogamicin (APC 9004).
Blood and Blood Products
From the onset of the OPPS, we have made separate payment for blood and blood products either in APCs with status indicator “K” or as pass-through drugs and biologicals with status indicator “G” rather than packaging them into payment for the procedures with which they were administered. As we explained in the April 7, 2000 final rule (65 FR 18449), the high degree of variability in blood use among patients could result in payment inequities if the costs of blood and blood products were packaged with their administration. We also want to ensure that costs associated with blood safety testing are fully recognized. The safety of the nation's blood supply continues to be among the highest priorities of the Secretary's council on Blood Safety and Access. Therefore, we propose to continue to pay separately for blood and blood products.
Vaccines Covered Under a Benefit Other Than OPPS
Outpatient hospital departments administer large numbers of the vaccines for influenza (flu), pneumococcal pneumonia (PPV), and hepatitis B, typically by participating in immunization programs encouraged by the Secretary because these vaccinations greatly reduce death and illness in vulnerable populations. In recent years, the availability and cost of the vaccines (particularly the flu vaccine) have varied considerably. We want to avoid creating any disincentives to provide these important preventative services that might result from packaging their costs into those of primary procedures, visits, or administration codes. Therefore, we propose to pay for these vaccines under OPPS through the establishment of separate APCs.
Higher Cost Drugs
While our preferred policy is to package the cost of drugs and other items into the cost of the procedures with which they are associated, we are concerned that beneficiary access to care may be affected by packaging certain higher cost drugs. For this reason, we propose to allow payment under separate APCs for high cost drugs for an additional year while we further study various payment options. Specifically, we propose to pay separately for drugs for which the median cost per line (cost per unit multiplied by the number of units billed on the claim) exceeded $150, as determined below.
To establish a reasonable threshold for determining which drugs we would pay under separate APCs rather than through packaging, we calculated the median cost per unit using 2001 claims data for each of the drugs for which transitional pass-through payment ceases January 1, 2003 and for those additional drugs that we have paid separately (status indicator “K”) since the outset of OPPS. We excluded from these calculations the orphan drugs, vaccines, and blood and blood products discussed above. The unit median represents the cost per single unit dose of the drug as described by its HCPCS code. Because many drugs are used and billed in multiple unit doses, we then multiplied the median cost per unit for the drug by the average number of units that were billed per line. The average number of units per drug equals the total units divided by the total number of times the drug was billed. This calculation gave us an approximate median cost per line for the drug. We viewed this as being the approximate cost per administration because we believed that a single administration of a drug was billed as a single line item on a claim and that the correct number of units was placed in the “units” field of the claim form. We then arrayed the median cost per line in ascending order and examined the distribution. A natural break occurs at $150 per line, the midpoint of a $10 span between the drug immediately above and below the $150 point. Within the array, approximately 61 percent of the drugs fall below the $150 point and 39 percent of the array are above the point. Among the drugs that we propose to package are some radiopharmaceuticals, vaccines, anesthetics, and anticancer agents. After including the costs of packaged drugs in the services with which they were provided, we noted that the median costs of those services increased. For example, based on 2001 data, APC 117, Chemotherapy Administration by Infusion Only, showed a median cost before packaging of $129.53 and showed a median cost after packaging of $210.36. Similarly, APC 118, Chemotherapy administration by both infusion and another technique, showed a median cost before packaging of $136.00 and a median cost after packaging of $309.65. We believe that this appropriately represents the cost of packaged drugs on a per administration basis. However, in particular, we solicit comments that address specific alternative protocols we might use when several packaged drugs whose total cost significantly exceeds the applicable APC payment amount may be administered to a patient on the same day (for example, multiple agent cancer chemotherapy).
We request comments on the factors we considered in determining which drugs to package in 2003. We are particularly interested in comments with respect to the exclusion of high cost drugs from packaging. We are continuing to analyze the effect of our drug packaging proposal to assess whether the $150 threshold should be adjusted to avoid significant overpayments or underpayments for the base APCs relative to the median costs of the individual drugs packaged into the APCs. Depending on this analysis, we may revise our threshold or criteria for packaging in the final rule for 2003. Start Printed Page 52125We expect to further consider each of these exclusions for packaging when we develop our proposals for the 2004 OPPS.
Although we expect to expand packaging of drugs to package payment for more drugs into the APC for the services with which they are billed, we are, nonetheless, requesting comments on alternatives to packaging. One example of an alternative approach is to use different criteria from those we propose in this proposed rule to identify the drugs to package into procedure APCs and the drugs to pay separately. We could package all drugs for which the median cost was less than $500 or alternatively package drugs for which the median cost was less than $100. Another alternative approach would be to create APCs for groups of drugs based on their costs. Under such an approach we could group drugs with costs between $0 and $100 and pay at the mid-point—$50. The next group could consist of drugs with a median cost between $100 and $250 and pay at the mid-point—$175. This approach would be similar to that employed for new technology services. Another approach would be to create separate APCs for each drug. Under this approach we would create a separate APC for each drug (regardless of its median cost) and use its relative weight to calculate a payment rate for the drug. We welcome a full discussion of the alternatives as we determine the best way to ensure that hospitals are paid appropriately for the drugs they administer to the Medicare beneficiaries whom they treat in their outpatient departments.
Table 8 lists drugs and biologicals for which separate payment is currently being made in 2002 with either status indicator “K” or “G” and whose costs we propose to package in 2003. Drugs that we propose to pay for separately in 2003 are designated in Addendum B by status indicator “K” or “G.”.
Table 8.—Drugs and Biologicals Separately Payable in CY 2002
HCPCS Short description 90296 Diphtheria antitoxin 90375 Rabies ig, im/sc 90376 Rabies ig, heat treated 90378 Rsv ig, im, 50mg 90379 Rsv ig, iv 90385 Rh ig, minidose, im 90389 Tetanus ig, im 90393 Vaccina ig, im 90396 Varicella-zoster ig, im 90471 Immunization admin 90476 Adenovirus vaccine, type 4 90477 Adenovirus vaccine, type 7 90585 Bcg vaccine, percut 90586 Bcg vaccine, intravesical 90632 Hep a vaccine, adult im 90633 Hep a vacc, ped/adol, 2 dose 90634 Hep a vacc, ped/adol, 3 dose 90645 Hib vaccine, hboc, im 90646 Hib vaccine, prp-d, im 90647 Hib vaccine, prp-omp, im 90648 Hib vaccine, prp-t, im 90665 Lyme disease vaccine, im 90675 Rabies vaccine, im 90676 Rabies vaccine, id 90680 Rotovirus vaccine, oral 90690 Typhoid vaccine, oral 90691 Typhoid vaccine, im 90692 Typhoid vaccine, h-p, sc/id 90700 Dtap vaccine, im 90701 Dtp vaccine, im 90702 Dt vaccine < 7, im 90703 Tetanus vaccine, im 90704 Mumps vaccine, sc 90705 Measles vaccine, sc 90706 Rubella vaccine, sc 90707 Mmr vaccine, sc 90708 Measles-rubella vaccine, sc 90710 Mmrv vaccine, sc 90712 Oral poliovirus vaccine 90713 Poliovirus, ipv, sc 90716 Chicken pox vaccine, sc 90717 Yellow fever vaccine, sc 90718 Td vaccine > 7, im 90719 Diphtheria vaccine, im 90720 Dtp/hib vaccine, im 90721 Dtap/hib vaccine, im 90725 Cholera vaccine, injectable 90727 Plague vaccine, im 90733 Meningococcal vaccine, sc 90735 Encephalitis vaccine, sc 90749 Vaccine toxoid A4642 Satumomab pendetide per dose Start Printed Page 52126 A9500 Technetium TC 99m sestamibi A9502 Technetium TC99M tetrofosmin A9503 Technetium TC 99m medronate A9504 Technetium tc 99m apcitide A9505 Thallous chloride TL 201/mci A9508 Iobenguane sulfate I-131 A9510 Technetium TC99m Disofenin A9700 Echocardiography Contrast C1066 IN 111 satumomab pendetide C1079 CO 57/58 per 0.5 uCi C1087 I-123 per 100 uCi C1094 TC99Malbumin aggr, per 1.0 mCi C1097 TC 99M MEBROFENIN, PER Vial C1098 TC 99M PENTETATE, PER Vial C1099 TC 99M PYROPHOSPHATE, PER Via C1166 CYTARABINE LIPOSOMAL, 10 mg C1188 I-131 cap, per 1-5 mCi C1200 TC 99M Sodium Glucoheptonat C1201 TC 99M SUCCIMER, PER Vial C1202 TC 99M SULFUR COLLOID, Vial J2020 Linezolid inj, 200mg J7525 Tacrolimus inj, per 5 mg C9007 Baclofen Intrathecal kit-1am C9008 Baclofen Refill Kit-500mcg J0706 Caffeine Citrate, inj, 1ml C9100 Iodinated I-131 Albumin C9102 51 Na Chromate, 50 mCi C9103 Na Iothalamate I-125, 10 uCi J0150 Injection adenosine 6 MG J0350 Injection anistreplase 30 u J0640 Leucovorin calcium injection J0706 Caffeine Citrate, inj, per 5 mg J1245 Dipyridamole injection J1260 Dolasetron mesylate J1325 Epoprostenol injection J1327 Eptifibatide injection J1436 Etidronate disodium inj J1438 Etanercept injection J1565 RSV-ivig J1570 Ganciclovir sodium injection J1620 Gonadorelin hydroch/ 100 mcg J1626 Granisetron HCl injection J1670 Tetanus immune globulin inj J1830 Interferon beta-1b / .25 MG J2260 Inj milrinone lactate / 5 ML J2275 Morphine sulfate injection J2405 Ondansetron hcl injection J2765 Metoclopramide hcl injection J2770 Quinupristin/dalfopristin J2820 Sargramostim injection J2995 Inj streptokinase /250000 IU J2997 Alteplase recombinant J3010 Fentanyl citrate injeciton J3280 Thiethylperazine maleate inj J3365 Urokinase 250,000 IU inj J7310 Ganciclovir long act implant J7316 Sodium hyaluronate injection, per 5 mg J7500 Azathioprine oral 50 mg J7501 Azathioprine parenteral J7506 Prednisone oral J7516 Cyclosporin parenteral 250 mg J8510 Oral busulfan J8530 Cyclophosphamide oral 25 MG J8600 Melphalan oral 2 MG J8610 Methotrexate oral 2.5 MG J9000 Doxorubic hcl 10 MG vl chemo J9020 Asparaginase injection J9031 Bcg live intravesical vac J9050 Carmus bischl nitro inj J9070 Cyclophosphamide 100 MG inj J9093 Cyclophosphamide lyophilized J9100 Cytarabine hcl 100 MG inj Start Printed Page 52127 J9120 Dactinomycin actinomycin d J9130 Dacarbazine 10 MG inj J9181 Etoposide 10 MG inj J9190 Fluorouracil injection J9212 Interferon alfacon-1 J9213 Interferon alfa-2a inj J9214 Interferon alfa-2b inj J9215 Interferon alfa-n3 inj J9230 Mechlorethamine hcl inj J9250 Methotrexate sodium inj J9270 Plicamycin (mithramycin) inj J9320 Streptozocin injection J9340 Thiotepa injection J9360 Vinblastine sulfate inj J9370 Vincristine sulfate 1 MG inj Q0163 Diphenhydramine HCl 50 mg Q0164 Prochlorperazine maleate 5 mg Q0166 Granisetron HCl 1 mg oral Q0167 Dronabinol 2.5 mg oral Q0169 Promethazine HCl 12.5 mg oral Q0171 Chlorpromazine HCl 10 mg oral Q0173 Trimethobenzamide HCl 250 mg Q0174 Thiethylperazine maleate 10 mg Q0175 Perphenazine 4 mg oral Q0177 Hydroxyzine pamoate 25 mg Q0179 Ondansetron HCl 8 mg oral Q0180 Dolasetron mesylate oral Q2002 Elliotts b solution per ml Q2003 Aprotinin, 10,000 kiu Q2004 Bladder calculi irrig sol Q2007 Ethanolamine oleate 100 mg Q2008 Fomepizole, 15 mg Q2009 Fosphenytoin, 50 mg Q2010 Glatiramer acetate, per dose Q2013 Pentastarch 10% solution Q2014 Sermorelin acetate, 0.5 mg J2940 Somatrem injection Q2018 Urofollitropin, 75 iu Q2021 Lepirudin Q3002 Gallium ga 67 Q3004 Xenon xe 133 Q3005 Technetium tc99m mertiatide Q3006 Technetium tc99m glucepatate Q3007 Sodium phosphate p32 Q3009 Technetium tc99m oxidronate Q3010 Technetium tc99m labeledrbcs 3. Brachytherapy
Section 1833(t)(6) of the Act requires us to establish transitional pass-through payments for devices of brachytherapy. As of August 1, 2000, we established item-specific device codes including codes for brachytherapy seeds, needles, and catheters. Effective April 1, 2001, we established category codes for brachytherapy seeds on a per seed basis (one for each isotope), brachytherapy needles on a per needle basis, and brachytherapy catheters on a per catheter basis. Because initial payment was made for a device in each of these categories in August 2000, we propose that these categories (and the transitional pass-through payments) will be discontinued as of January 1, 2003. Furthermore, as discussed above, we propose that there will be no grace period for billing these category codes.
We received comments, both in writing and at the April 2002 Town Hall meeting, recommending that we continue to make separate payment for brachytherapy seeds. The basis for this recommendation is that the number of brachytherapy seeds implanted per procedure is variable. These commenters stated that the number and type of seeds implanted in a given patient depends on the type of tumor, its size, extent, and biology, and the amount of radioactivity contained in each seed. For example, a given type of cancer may be treated by implanting seeds of different isotopes (for example, iodine or palladium) depending on its biological characteristics. Further, depending on the size of the tumor, the number of implanted seeds that may be required to effectively treat the cancer is quite variable (for example, from 25 to 100 seeds). In addition, implantable seeds may be manufactured with different amounts of radioactivity, and it may be preferable to implant fewer seeds with higher activity in some cases while in other cases it may be preferable to implant a larger number of seeds with lower activity. To further complicate the matter, the HCPCS codes used to report implantation of brachytherapy seeds are not tumor-specific. Instead, they are defined based on the number of sources, that is, the number of seeds or ribbons used in the procedure. This means that the treatment of many different tumors requiring implantation of widely Start Printed Page 52128varying numbers of seeds is described by a single HCPCS code. Therefore, it has been argued that given the costs of seeds and the variety of treatments described by a single HCPCS code, the cost of brachytherapy billed under a single HCPCS code could vary by as much as $3,000.
In determining whether to package seeds into their associated procedures, we considered all these factors as well as our claims data. Consistent with our proposed policy for other device costs and the cost of many drugs, as well as with the principles of a prospective payment system, our preferred policy is to package the cost of brachytherapy devices into their associated procedures. For 2003, in the case of remote afterloading high intensity brachytherapy and prostate brachytherapy, which we discuss below, we propose to package the costs into payment for the procedures with which they are billed.
For other uses of brachytherapy, we propose to defer packaging of brachytherapy seeds for at least 1 year. In those cases, when paying separately in 2003 for brachytherapy seeds, we propose to continue payment on a per seed basis. The payment amount would be based on the median cost of brachytherapy seeds, per seed, as determined from our claims data.
We solicit comments on methodologies we might use to package all brachytherapy seeds beginning in CY 2004. For example, creation of tumor-specific brachytherapy HCPCS codes would reduce the variability in seed implantation costs associated with the current HCPCS codes used for seed implantation.
As stated above, beginning January 1, 2003, we propose to package payment for brachytherapy seeds into the payment for the following two types of brachytherapy services:
Remote Afterloading High Intensity Brachytherapy.
Participants in the April 5, 2002 Town Hall meeting expressed concern about packaging single use brachytherapy seeds into payment for procedures.
Remote afterloading high intensity brachytherapy treatment does not involve implantation of seeds. Instead, it utilizes a single radioactive “source” of high dose iridium with a 90-day life span. This single source is purchased and used multiple times in multiple patients over its life. One or more temporary catheters are inserted into the area requiring treatment, and the radioactive source is briefly inserted into each catheter and then removed. Because the source never comes in direct contact with the patient, it may be used for multiple patients. We note that the cost of the radioactive source, per procedure, is the same irrespective of how many catheters are inserted into the patient. Further, because the number of treatments administered with a single source over a 90-day period may vary and because the cost of the source is fixed, it is difficult if not impossible to determine a per “treatment” cost for the source. Moreover, we believe that the costs of this type of source should be amortized over the life of the source. Therefore, each hospital administering this type of therapy should include a charge (which is hospital-specific) for the radiation source in the charge for the procedure. Therefore, we propose to package the costs associated with high dose iridium into the HCPCS codes used to describe this procedure. Those codes are: 77781, 77782, 77783, and 77784.
Prostate Brachytherapy
The preponderance of brachytherapy claims under OPPS to date is for prostate brachytherapy. Brachytherapy is administered in several other organ systems, but the claims volume for non-prostate brachytherapy is very small, and hence our base of information on which to make payment decisions is slim. Furthermore, prostate brachytherapy uses only two isotopes, which are similar in cost, while brachytherapy on other organs involves a variety of isotopes with greater variation in cost. Consequently, we believe it would be prudent to wait for further experience to develop before proceeding to package non-prostate brachytherapy seeds.
A number of commenters at the April 5, 2002, Town Hall Meeting and elsewhere have stressed to us their views that brachytherapy seeds should remain unpackaged. The principle argument put forth in favor of this approach is that the number of seeds used is highly variable across patients. We do not find this argument compelling. Payments in the OPPS, as in other prospective payment systems, are based on averages. We expect hospitals, in general, to be able to accommodate variation across patients in resource costs of services paid in a particular payment cell. The degree of variation should be immaterial as long as the payment is appropriate for a typical case, the hospital treats a caseload the resource use of which approximates a typical distribution, and the number of cases treated by a hospital is sufficiently large to overcome peculiarities in resource use that might be observed with a very small number of cases. We believe the service volume at hospitals providing prostate brachytherapy is likely to be large enough for a payment reflecting average use of seeds to be appropriate.
Additionally, appropriate payment for prostate brachytherapy has been of concern to many commenters since implementation of the OPPS because facilities must use multiple HCPCS codes on a single claim to accurately describe the entire procedure. Because we determine APC relative weights using single procedure claims, commenters have argued that payments for prostate brachytherapy are, in part, based on error claims, resulting in underpayment for this important service. We agree that basing the relative weights for APCs reported for prostate brachytherapy services on only the small number of claims related to this service that are single procedure claims may be problematic. To increase the number of claims we could use to develop the proposed 2003 relative payment weights for prostate brachytherapy, we began by identifying all claims billed in 2001 for prostate brachytherapy. That is, we identified all claims that contained a line item for HCPCS code 77778, Interstitial radiation source application; complex, and HCPCS code 55859, Transperineal placement of needles or catheters into prostate for interstitial radioelement application, with or without cystoscopy. We discovered more than 12,000 claims that met these specifications, suggesting that most of the procedures coded under HCPCS code 77778 were for prostate brachytherapy. Unfortunately, closer analysis of these claims revealed that hospitals do not report prostate brachytherapy using a uniform combination of codes. Of the more than 12,000 claims for prostate brachytherapy that we identified in the 2001 claims data, no single combination of HCPCS codes occurred more than 25 times.
Therefore, in order to facilitate tracking of this service, we propose to establish a G code for hospital use only that will specifically identify prostate brachytherapy. We propose as the descriptor for this G code the following: “Prostate brachytherapy, including transperineal placement of needles or catheters into the prostate, cystoscopy, and interstitial radiation source application.” This G code would be used by hospitals instead of HCPCS codes 55859 and 77778 to bill for prostate brachytherapy. Hospitals would continue to use HCPCS codes 55859 and 77778 when reporting services other than prostate brachytherapy. We would also instruct hospitals to continue to Start Printed Page 52129report separately other services provided in conjunction with prostate brachytherapy, such as dosimetry and ultrasound guidance. These additional services would be paid according to the APC payment rate established by our usual methodology.
This G code will allow us to package brachytherapy seeds into the procedures for administering prostate brachytherapy while permitting us to pay separately for brachytherapy seeds which are administered for other procedures. Therefore, we propose to package the costs of the brachytherapy seeds, catheters, and needles into the payment for the prostate brachytherapy G code. In order to develop a payment amount for this G code, we used all claims where both HCPCS codes 55859 and 77778 appeared. We packaged all revenue centers and appropriate HCPCS codes, that is, HCPCS with status indicator “N.” We then determined median costs of the line items for HCPCS codes 55859 and 77778 and added the two. Next, we packaged the costs of all C codes, whether an item-specific or a device category code, into the payment amount. We propose to assign APC 0684 with status indicator “T.” We believe the payment rate proposed for this G code appropriately reflects the costs of the procedures, the brachytherapy seeds, and any other devices associated with these procedures. We solicit comments on this proposal.
Packaging of Other Device Costs Associated with Brachytherapy
We propose to package the costs of brachytherapy needles and catheters with whichever procedures they are reported, similar to our proposal for packaging the costs of other devices that will no longer be eligible for a transitional pass-through payment in 2003. Because the HCPCS code descriptors for brachytherapy are based on the number of catheters or needles used, we believe the costs of these devices would be appropriately reflected within the costs of the associated procedure.
D. Criteria for New Device Categories
Section 1833(t)(6)(B)(ii) of the Act, as amended by BIPA, required us to establish criteria by July 1, 2001 that will be used to create additional device categories to be used in determining eligibility of a device for pass-through payments. This provision requires that no medical device be described by more than one category. In addition, the criteria must include a test of whether the average cost of devices that would be included in a category is “not insignificant” in relation to the APC payment amount for the associated service.
On November 2, 2001, we published in the Federal Register an interim final rule (66 FR 55850) that set forth the criteria for establishing new (that is, additional) categories of medical devices eligible for transitional pass-through payments under the hospital outpatient PPS as required by section 1833(t)(6)(B)(ii) of the Act. The provisions relating to transitional pass-through payments for eligible drugs and biologicals remained unchanged and were not addressed in the November 2001 interim final rule (except for a change relating to contrast agents as provided in section 430 of BIPA). We received several public comments regarding our criteria published in the November 2001 interim final rule. We will respond to these public comments in the final rule for the OPPS for 2003.
In the November 2, 2001 interim final rule, we implemented new § 419.66(c), which establishes the criteria for establishing a new device category. We propose to make a technical correction to § 419.66(c)(1), which establishes one of those criteria. Specifically, we discuss in the November 2, 2001 interim final rule the criterion that a new category must describe devices that demonstrate substantial improvement in medical benefits for Medicare beneficiaries compared to the benefits obtained by devices in previously established (that is, previously existing) categories or other available treatments, as described in regulations at new § 419.66(c)(1) (66 FR 55852). Section 1833(t)(6)(B)(ii)(IV) of the Act requires that a new category must include medical devices for which no existing category, or one previously in effect, is appropriate. In the November 2, 2001 IFC, we addressed in the preamble the requirement that no category previously in effect could describe a new category (66 FR 55852), but we did not conform the regulations text to this requirement. Therefore, we propose to correct § 419.66(c)(1) to read as follows:
(1) CMS determines that a device to be included in the category is not described by any of the existing categories or by any category previously in effect, and was not being paid for as an outpatient service as of December 31, 1996.
E. Payment for Transitional Pass-Through Drugs and Biologicals for Calendar Year 2003
As discussed in the November 13, 2000 interim final rule (65 FR 67809) and the November 30, 2001 final rule (66 FR 59895), we update the payment rates for pass-through drugs on an annual basis. Therefore, as we have done for prior updates, we propose to update the APC rates for drugs that are eligible for pass-through payments in 2003 using the most recent version of the Red Book, the July 2002 version in this case. The updated rates effective January 1, 2003 would remain in effect until we implement the next annual update in 2004, when we would again update the AWPs for any pass-through drugs based on the latest quarterly version of the Red Book. This retains the update of pass-through drug prices on the same calendar year schedule as the other annual OPPS updates.
As described in our final rule of November 30, 2001 (66 FR 59894), in order to establish the applicable beneficiary copayment amount and the pass-through payment amount, we must determine the cost of the pass-through eligible drug or biological that would have been included in the payment rate for its associated APC had the drug or biological been packaged. We used hospital acquisition costs as a proxy for the amount that would have been packaged, based on data from an external survey of hospital drug costs (see the April 7, 2000 final rule (65 FR 18481)). That survey concluded that—
- For drugs available through only one source drugs, the ratio of acquisition cost to AWP equals 0.68;
- For multisource drugs, the ratio of acquisition cost to AWP equals 0.6l;
- For drugs with generic competitors, the ratio is 0.43.
As we stated in our final rule of November 30, 2001 (66 FR 59896), we considered the use of the study-derived ratios of drug costs to AWP to be an interim measure until we could obtain data on hospital costs from claims. We stated that we anticipated having this data to use in setting payment rates for 2003.
As described elsewhere in this preamble, we used 2001 claims data to calculate a median cost per unit of drug for each drug for which we are currently paying separately. We compared the median per unit cost of each drug to the AWP to determine a ratio of acquisition cost to AWP. Using the total units billed for each drug, we then calculated a weighted average for each of the above three categories of drugs. These calculations resulted in the following weighted average ratios:
- For sole-source drugs, the ratio of cost to AWP equals 71.0 percent.
- For multisource drugs, the ratio of cost to AWP equals 68.0 percent.
- For drugs with generic competitors, the ratio of cost to AWP equals 46.0 percent. Start Printed Page 52130
We propose to use these percentages for determining the applicable beneficiary copayment amount and the pass-through payment amount for drugs eligible for pass-through payment in 2003.
We propose to use these percentages for determining the applicable beneficiary copayment amount and the pass-through payment amount for most drugs eligible for pass-through payment in 2003. However some drugs may fall into two other classes. The first class includes a drug that is new and for which no cost is yet included in an associated APC. For such a drug, because there is no cost for the drug yet included in an associated APC, the pass-through amount will be 95 percent of the AWP and there would be no copayment. The second class includes a drug that is new and is a substitute for only one drug that is recognized in the OPPS through an unpackaged APC. For drugs in this second class, the pass-through amount would be the difference between 95 percent of the AWP for the pass-through drug and the payment rate for the comparable dose of the associated drug's APC. The copayment would be based on the payment rate of its associated APC. We believe that using this methodology will yield a more accurate payment rate.
We have received questions with respect to our definition of multisource drugs. In determining whether a drug is available from multiple sources, we consider repackagers to be among the sources. This is consistent with the findings of the survey cited above which indicated a lower ratio of acquisition cost to AWP from multiple sources including repackagers.
We note that determining that a drug is eligible for a pass-through payment or assigning a status indicator “K” to a drug or biological (indicating that the drugs or biologicals is paid based on a separate APC rate) indicates only the method by which the drug or biological is paid if it is covered by the Medicare program. It does not represent a determination that the drug is covered by the Medicare program. For example, Medicare contractors must determine whether the drug or biological is: (1) reasonable and necessary to treat the beneficiary's conditions; and (2) excluded from payment because it is usually self-administered by the patient.
IV. Wage Index Changes for Calendar Year 2003
Section 1833(t)(2)(D) of the Act requires that we determine a wage adjustment factor to adjust for geographic wage differences, in a budget neutral manner, that portion of the OPPS payment rate and copayment amount that is attributable to labor and labor-related costs.
We used the proposed Federal fiscal year (FY) 2003 hospital inpatient PPS wage index to make wage adjustments in determining the proposed payment rates set forth in this proposed rule. The proposed FY 2003 hospital inpatient wage index published in the May 9, 2002 Federal Register (67 FR 31431) is reprinted in this proposed rule as Addendum H—Wage Index for Urban Areas; Addendum I—Wage Index for Rural Areas; and Addendum J—Wage Index for Hospitals That Are Reclassified. We propose to use the final FY 2003 hospital inpatient wage index to calculate the payment rates and coinsurance amounts that we will publish in the final rule implementing the OPPS for CY 2003.
V. Copayment for Calendar Year 2003
Section 1833(t)(8)(C)(ii) of the Act accelerates the reduction of beneficiary copayment amounts, providing that, for services furnished on or after April 1, 2001 and before January 1, 2002, the national unadjusted coinsurance for an APC cannot exceed 57 percent of the APC payment rate. The statute provides that the national unadjusted coinsurance for an APC cannot exceed 55 percent in 2002 and 2003. The statute provides for further reductions in future years so that the national unadjusted coinsurance for an APC cannot exceed 55 percent of the APC payment rate in 2002 and 2003, 50 percent in 2004, 45 percent in 2005, and 40 percent in 2006 and thereafter.
For 2003, we determined copayment amounts for new and revised APCs using the same methodology that we implemented for 2002 (see the November 30, 2001 final at 66 FR 59888). See Addendum B for proposed national unadjusted copayments for 2003. Our regulations at § 419.41 conform to this provision of the Act.
VI. Conversion Factor Update for Calendar Year 2003
Section 1833(t)(3)(C)(ii) of the Act requires us to update the conversion factor used to determine payment rates under the OPPS on an annual basis. Section 1833(t)(3)(C)(iv) of the Act provides that for 2003, the update is equal to the hospital inpatient market basket percentage increase applicable to hospital discharges under section 1886(b)(3)(B)(iii) of the Act.
The most recent forecast of the hospital market basket increase for FY 2003 is 3.5 percent. To set the proposed OPPS conversion factor for 2003, we increased the 2002 conversion factor of $50.904 (the figure from the March 1, 2002 final rule (67 FR 9556)) by 3.5 percent.
In accordance with section 1833(t)(9)(B) of the Act, we further adjusted the proposed conversion factor for 2003 to ensure that the revisions we are proposing to update by means of the wage index are made on a budget-neutral basis. We calculated a budget neutrality factor of .98715 for wage index changes by comparing total payments from our simulation model using the proposed FY 2003 hospital inpatient PPS wage index values to those payments using the current (FY 2002) wage index values.
The increase factor of 3.5 percent for 2003 and the required wage index budget neutrality adjustment of .98715 result in a proposed conversion factor for 2003 of 52.009.
VII. Outlier Policy for Calendar Year 2003
For OPPS services furnished between August 1, 2000 and April 1, 2002, we calculated outlier payments in the aggregate for all OPPS services that appear on a bill in accordance with section 1833(t)(5)(D) of the Act. In the November 30, 2001 final rule (66 FR 59856, 59888), we specified that beginning with 2002, we will calculate outlier payments based on each individual OPPS service. We revised the aggregate method that we had used to calculate outlier payments and began to determine outliers on a service-by-service basis.
As explained in the April 7, 2000 final rule (65 FR 18498), we set a target for outlier payments at 2.0 percent of total payments. For purposes of simulating payments to calculate outlier thresholds, we propose to continue to set the target for outlier payments at 2.0 percent, as we did for CYs 2001 and 2002. For 2002, the outlier threshold is met when costs of furnishing a service or procedure exceed 3.5 times the APC payment amount, and the current outlier payment percentage is 50 percent of the amount of costs in excess of the threshold. Based on our simulations for 2003, we propose to set the threshold for 2003 at 2.75 times the APC payment amounts, and the proposed 2003 payment percentage applicable to costs over the threshold at 50 percent. Start Printed Page 52131
VIII. Other Policy Decisions and Proposed Changes
A. Hospital Coding for Evaluation and Management (E/M) Services
Background
Currently, facilities code clinic and emergency department visits using the same current procedural terminology (CPT) codes as physicians. For both clinic and emergency department visits, there are five levels of care. While there is only one set of codes for emergency visits, clinic visits are differentiated by new patient, established patient, and consultation visits. CPT codes 99201 through 99205 are used for new patients, CPT codes 99211 through 99215 are used for established patients, and CPT codes 99281 through 99285 for emergency patients.
Physicians determine the proper code for reporting their services by referring to CPT descriptors and our documentation guidelines. The descriptors and guidelines are helpful to physicians because they reference taking a history, performing an examination, and making medical decisions. The lower levels of service (for example, CPT codes 99201, 99211, and 99281) are used for shorter visits and for patients with uncomplicated problems, and the higher levels of service (for example, CPT codes 99205, 99215, and 99285) are used for longer visits and patients with complex problems.
These codes were defined to reflect the activities of physicians. It is generally agreed, however, that they do not describe well the range and mix of services provided by facilities to clinic and emergency patients (for example, ongoing nursing care, preparation for diagnostic tests, and patient education).
Before the implementation of the OPPS, facilities were paid on the basis of charges reduced to costs. In that system, because use of a correct HCPCS code did not influence payment, there was little incentive to correctly report the level of service. In fact, many facilities reported all clinic and emergency visits with the lowest level of service (for example, CPT codes 99211, 99201, and 99281) simply to minimize administrative burden (for example, charge-masters might include only one level of service).
This situation changed with the implementation of the OPPS. The OPPS requires correct reporting of services using HCPCS codes as a prerequisite to payment. For emergency and clinic visits, the OPPS distinguishes three levels of service for payment purposes. These are referred to as “low-level,” “mid-level,” and “high-level” emergency or clinic visits. Low-level clinic and emergency visits include CPT codes for level one and two services (for example, CPT codes 99201, 99211, and 99281), mid-level visits include level three services (for example, CPT codes 99203, 99213, and 99283), and high-level visits include level four and five services (for example, CPT codes 99205, 99215, and 99285). Payment rates for low-level visits are less than for mid-level visits, which are less than rates for high-level visits.
In the April 7, 2000 final rule (65 FR 18434), we stated that to pay hospitals properly, it was important that emergency and clinic visits be coded properly. To facilitate proper coding, we required each hospital to create an internal set of guidelines to determine what level of visit to report for each patient. We stated in the rule, that if hospitals set up these guidelines and follow them, they would be in compliance with OPPS coding requirements for the visits. Furthermore, we announced that we would be reviewing this issue and planned to set national guidelines for coding clinic and emergency visits in the future. In the August 24, 2001 proposed rule (66 FR 44672), we asked for public comments regarding national guidelines for hospital coding of emergency and clinic visits. We also announced that we would compile these comments and present them to our APC Panel at the January 2002 meeting. We also announced that we planned to propose uniform national facility coding guidelines in the proposed rule for the 2003 OPPS.
During its January 2002 meeting, the APC Panel reviewed written comments, heard oral testimony, discussed the issue, and made recommendations concerning establishment of facility coding guidelines for emergency and clinic visits. Among those who submitted oral and written comments to us and to the Panel were national hospital organizations, national physician organizations, hospital systems, individual hospitals, coding organizations, and consultants.
Discussion
We set forth below, by issue, a summary of the comments we received:
- The need for national coding guidelines.
Except for the American Medical Association (AMA) and one other physician organization, commenters unanimously agreed that national guidelines for facility coding of emergency and clinic visits were required. Furthermore, most commenters requested that we establish these guidelines as soon as possible, but, in any event, not later than January 2003. Among the reasons cited were the following:
+ The need for facilities to comply with the requirements of the Health Insurance Portability and Accountability Act (HIPAA), no later than October 16, 2003 (October 16, 2002 for those entities that do not obtain a one-year extension). Commenters expressed concern that use of CPT E/M codes with different reporting rules when used by facilities (as opposed to use by physicians) would violate HIPAA requirements.
+ The need for facilities to set up effective audit and compliance programs.
+ The need to minimize confusion on the part of coders.
+ The need to minimize inaccurate payments.
+ The need to prevent gaming of the system by facilities.
The AMA recommended that we wait for the CPT Editorial Panel to develop coding guidelines for hospitals to assure that coding guidelines will be minimally burdensome to hospitals.
- The need to establish principles against which facility E/M coding guidelines would be measured. Commenters unanimously agreed that any set of coding guidelines for facilities would have to satisfy a uniform set of basic principles to be acceptable to, and accepted by, hospitals. These include the following:
+ Coding guidelines for emergency and clinic visits should be based on emergency department or clinic facility resource use, not physician resource use.
+ Coding guidelines should be clear, facilitate accurate payment, be usable for compliance purposes and audits, and meet HIPAA requirements.
+ Coding guidelines should only require documentation that is clinically necessary for patient care. Preferably, coding guidelines should be based on current hospital documentation requirements.
+ Coding guidelines should not facilitate upcoding or gaming.
We would add one other requirement to these principles: The distribution of codes should result in a normal curve. Documentation guidelines should facilitate this result.
- Current use of hospital coding guidelines is inconsistent and much more prevalent in the emergency department.
Several commenters noted that many hospitals have developed their own coding guidelines but that no specific Start Printed Page 52132set of guidelines is in widespread use at the present time. These commenters noted that guidelines have been used much more in the emergency department setting than in the clinic setting. They also noted that only one set of guidelines has undergone any sort of testing. These are the facility coding guidelines for emergency departments, developed and copyrighted by the American College of Emergency Physicians (ACEP). Unfortunately, the testing was not done by protocol, no quantitative data were collected, and only a small number of facilities participated.
- Development of two sets of guidelines: one for emergency department visits and one for clinic visits.
Several commenters noted that the types and intensity of hospital resources used for emergency department visits were significantly different from the types and intensity of resources used for clinic visits. These commenters recommended that we adopt different guidelines for emergency department and clinic visits.
- The need to develop new descriptors and codes for facility emergency and clinic visits.
Commenters unanimously agreed that the current CPT descriptors for E/M services were not only inappropriate for facility coding of emergency and clinic visits but also were confusing and misleading to both facility coders and our reviewers. Commenters stated that patients whose complexity level was low in terms of physician work could frequently require highly intensive and complex facility services (for example, patients with gastroenteritis who require intravenous fluids, patients in motor vehicle accidents who require multiple X-rays, or patients with congestive heart failure or diabetes who require extensive education). In these cases, lack of agreement between physician and hospital coding would be clinically appropriate but could be the source of an investigation given the current code descriptors and hospital reporting guidelines. Commenters were also concerned that internal hospital-specific coding guidelines could vary greatly because the current CPT descriptors exclude any reference to facility services and, therefore, are highly susceptible to individual interpretation. A third concern was HIPAA compliance. Commenters believe that development by individual hospitals of a second set of descriptors that the hospital uses when reporting E/M codes could violate HIPAA requirements. These commenters believe that when HIPAA is first implemented on October 16, 2002 (October 16, 2003 for those entities that obtain a one-year extension), Healthcare Common Procedure Coding System (HCPCS) codes must be used uniformly by all providers. Two sets of descriptors for a single set of codes would require that different providers (that is, physicians and hospitals) use the codes differently. Based on these concerns, all commenters recommended that we develop, on an interim basis, HCPCS codes for emergency and clinic visits with descriptors specific for hospital coding.
- Maintenance of five levels of service.
Although a few commenters were not certain that facilities needed to differentiate among five levels of service, they believe that reducing the number of levels of service, even if clinically appropriate, would cause significant confusion among coders and reviewers. Therefore, they recommended maintaining five levels of service on an interim basis until more data on this issue can be obtained.
- Recommendations concerning adoption of specific guidelines.
Commenters recommended four basic types of guidelines for adoption.
1. Guidelines based on the number or type of staff interventions. Under this model, the level of service reported would be based on the number and/or type of interventions performed by nursing or ancillary staff. In the intervention model, baseline care (including registration, triage, initial nursing assessment, periodic vital signs as appropriate, simple discharge instructions, and exam room set up/clean up) and possibly a single minor intervention (for example, suture removal, rapid strep test, visual acuity) would be reported by the lowest level of service. Higher levels of service would be reported as the number and/or complexity of staff interventions increased.
The most commonly recommended intervention-based guidelines were the facility-coding guidelines developed by ACEP. The ACEP model uses examples of interventions to illustrate appropriate coding. Coders extrapolate from these examples to determine the correct level of service to report. The ACEP model uses the type of intervention rather than the number of interventions to determine the appropriate level of service. This means that the single most complex intervention determines the level of service whether it was the only service provided (in addition to baseline care), whether other similarly complex interventions were also provided, or whether other interventions of less complexity were also provided. The intervention model is based on emergency/clinic resource use, is simple, reflects the care given to the patient, and does not require additional facility documentation. However, we are concerned that the intervention model may provide an incentive to provide unnecessary services and that it is susceptible to upcoding. Furthermore, the ACEP model requires extrapolation from a set of examples that could make it prone to variability across hospitals.
2. Guidelines based on the time staff spent with the patient. Under this model, the level of service would be determined based on the amount of time hospital staff spent with the patient. The underlying assumption is that staff time spent with the patient is an appropriate proxy for total facility resource consumption. In this model, if only baseline care (as described above) were provided a Level 1 service would be reported. Higher levels of service would be reported based on increments of staff time beyond baseline care (for example, Level 2 would be reported for 11 to 20 minutes beyond baseline care, and Level 3 would be reported for 21 to 30 minutes beyond baseline care). This model is simple, it correlates with total facility resource use, and it would provide an objective standard for all hospitals to follow. However, extra, potentially burdensome, documentation (that is, documentation of staff time that is not normally required for clinical care) would be necessary, there would be an incentive to work slowly or use less efficient personnel, and there would be significant potential for upcoding and gaming.
3. Guidelines based on a point system where a certain number of points is assigned to each staff intervention based on the time, intensity, and staff type required for the intervention. In this model, points or weights are assigned to each facility service and/or intervention provided to a patient in the clinic or emergency department. The level of service is determined by the sum of the points for all services/interventions provided. Commenters recommended various approaches to a point system including point systems that assigned points based on the amount of staff time spent with the patient, the number of activities performed during the emergency department or clinic visit, and a combination of patient condition and activities performed. A point system would correlate with facility resource consumption and provide an objective standard. However, a point system could present significant burdens for hospitals in terms of requiring extra, clinically unnecessary, documentation. Point systems are Start Printed Page 52133extremely complex, would probably require dedicated staff to monitor and maintain, and would be susceptible to upcoding and gaming.
4. Guidelines based on patient complexity. Several variations were recommended including assignment of level of service based on ICD-9-CM (International Classification of Diseases, Ninth Edition, Clinical Modification) diagnosis codes, assignment of level of service based on complexity of medical decision making, or assignment of level of service based on presenting complaint or medical problem. The premise for these systems is that many emergency departments follow established protocols based on patients presenting complaints and diagnoses. Therefore, assigning a level of service based on patient diagnosis should correlate with facility resource consumption. These systems require the use of a coding “grid,” which lists more than 100 examples of patient conditions and diagnosis and assigns a level of service to each example. When a patient has a condition that does not appear on the grid, the coder must extrapolate from the grid to the individual patient. These systems are extremely complex, demand significant interpretive work on the part of a coder (who may not have clinical experience), and are subject to variability across hospitals. No clinically unnecessary documentation would be required but, because the system is based on diagnosis, there is a significant potential for upcoding and gaming.
APC Panel Recommendations
The APC Panel reviewed the comments that we received, reviewed background material we prepared, and heard oral testimony. Most commenters recommended that we adopt the ACEP guidelines. However, one organization representing cancer centers stated that the most appropriate proxy for facility resource consumption in cancer care is staff time and asked that we consider basing our guidelines on staff time. Commenters agreed that we needed to address this problem in the proposed rule for CY 2003. They also agreed that to address potential HIPAA compliance issues, we should develop new HCPCS codes for facility visits; and that we should maintain five levels of service for emergency and clinic visits until data are available to show that only three levels of service are required to ensure accurate payments. Commenters also agreed that, for the same level of service, clinic resource consumption should be similar for new, established, and consultation patients. Therefore, we need only create a single set of five codes for clinic visits.
After a thorough discussion, the APC technical panel made the following recommendations:
1. Propose and make final facility coding guidelines for E/M services for calendar year 2003.
2. Create a series of G codes with appropriate descriptors for facility E/M services.
3. Maintain a single set of codes, with five levels of service, for emergency department visits.
4. Develop a single set of codes, with five levels of service, for clinic visits. The Panel specifically recommended that we not differentiate among visit types (for example, new, established, and consultation visits) for the purposes of facility coding of clinic visits.
5. Adopt the ACEP facility coding guidelines as the national guidelines for facility coding of emergency department visits.
6. Develop guidelines for clinic visits that are modeled on the ACEP guidelines but are appropriate for clinic visits.
7. Implement these guidelines as interim and continue to work with appropriate organizations and stakeholders to develop final guidelines.
Proposal
We have reviewed the written comments, the oral testimony before the APC Panel, and the Panel's recommendations. We agree that facility coding guidelines should be implemented as soon as possible. We are particularly concerned that facilities be able to comply with HIPAA requirements. We have worked, and will continue to work, on this issue, with hospitals, organizations representing hospitals, physicians, and organizations representing physicians. We note that the AMA CPT Editorial Panel is not currently considering the issue of facility coding guidelines for clinic visits and that the earliest any CPT guidelines could be implemented would be in January 2004. Additionally, consistent with the intent of the outpatient prospective payment system, we want to ensure that reporting of hospital emergency and clinic visits is resource based.
After careful review and consideration of written comments, oral testimony and the APC Panel's recommendations, we propose the following (for implementation no earlier than January 2004):
1. To develop five G codes to describe emergency department services: GXXX1—Level 1 Facility Emergency Services, GXXX2—Level 2 Facility Emergency Services, GXXX3—Level 3 Facility Emergency Services, GXXX4— Level 4 Facility Emergency Services, and GXXX5—Level 5 Facility Emergency Services.
2. To develop five G codes to describe clinic visits: GXXX6—Level 1 Facility Clinic Services, GXXX7—Level 2 Facility Clinic Services, GXXX8—Level 3 Facility Clinic Services, GXXX9—Level 4 Facility Clinic Services, and GXXX10—Level 5 Facility Clinic Services.
3. To replace CPT Visit Codes with the 10 new G codes for OPPS payment purposes.
4. To establish separate documentation guidelines for emergency visits and clinic visits.
With regard to the documentation guidelines, our primary concerns are to make appropriate payment for medically necessary care, to minimize the information collection and reporting burden on facilities, and to minimize any incentive to provide unnecessary or low quality care. We realize that many facilities use complaint or diagnosis driven care protocols and that current documentation standards do not include documentation of staff time or the complexity of diagnostic and therapeutic services provided. Therefore, in the interest of facilitating the delivery of medically necessary care in a clinically appropriate way, we believe that the potential drawbacks of each of the recommended sets of guidelines outweigh the potential benefits of creating uniformity and reproducibility. For example, any documentation system requiring counting or quantification of resource use has the potential to be burdensome, require clinically unnecessary documentation, and be susceptible to upcoding and gaming. Documentation systems using coding grids or a series of clinical examples for each level of service are subject to interpretation, may induce variability, may be overly complex and burdensome, and may result in disagreements with medical reviewers. We are also concerned that all the proposed guidelines allow counting of separately paid services (for example, intravenous infusion, x-ray, EKG, lab tests, etc.) as “interventions” or “staff time” in determining a level of service. We believe that, within the constraints of clinical care and management protocols, the level of service for emergency and clinic visits should be determined by resource consumption that is not otherwise separately payable.
To address these concerns, in addition to reviewing written comments, oral comments, and the APC Start Printed Page 52134Panel recommendations, we have also reviewed the current distribution of paid emergency and clinic visit codes in the OPPS. With regard to emergency visits, we have observed that well over 50 percent of the visits are considered “multiple procedure claims” because the claim includes services such as diagnostic tests (for example, EKGs, x-rays) or therapeutic interventions (for example, intravenous infusions). The distribution of all emergency services is in a bell-shaped curve with a slight left shift because there are more claims for CPT codes 99281 and 99282 than for CPT codes 99284 and 99285. This pattern of coding is significantly different from physician billing for emergency services, which is skewed and peaks at CPT code 99284. We also note that the median costs for successive levels of emergency visits show an expected increase across APCs.
With regard to clinic visits, we have observed that more than 50 percent of the services are considered “single claims” meaning that they are billed without any other significant procedures such as diagnostic tests or therapeutic interventions. We also note that the distribution of clinic visits is skewed with the majority being low-level clinic visits. This distribution is consistent with pre-OPPS billing patterns where many facilities billed all clinic visits as low level visits. However, the median costs for different levels of clinic services, while similar within an APC, do not show the expected increase across the clinic visit APCs.
Based on our review, on the current distribution of coding for emergency and clinic visits, and on our understanding that hospitals set charges for services based on the resources used to provide those services, we believe that an incremental approach to developing and implementing documentation guidelines for emergency and clinic visits is appropriate. As hospitals become more familiar with the OPPS and with the need to differentiate emergency and clinic visits based on resource consumption, we will continue to review the advantages and disadvantages of detailed, uniform documentation guidelines. We plan to begin the development of uniform guidelines over the next year. If we are ready, we would propose the guidelines for comments in our Federal Register document for the calendar year 2004 update. For calendar year 2003, we propose the following new codes:
Emergency Visits
Our data indicate that, in general, hospitals under the OPPS are reporting emergency visits appropriately. We believe that insofar as hospitals have existing guidelines for determining the level of emergency service, those guidelines reflect facility resource consumption. Therefore, we propose that GXXX1—Level 1 Facility Emergency Services be reported when facilities deliver, and document, basic emergency department services. These services include registration, triage, initial nursing assessment, minimal monitoring in the emergency department (for example, one additional set of vital signs), minimal diagnostic and therapeutic services (for example, rapid strep test, urine dipstick), nursing discharge (including brief home instructions), and exam room set up/clean up. We would expect that these services would be delivered to patients who present with minor problems of low acuity.
With regard to GXXX2 through GXXX5, we propose to require that facilities develop internal documentation guidelines based on hospital resource consumption (for example, staff time). These guidelines must be appropriate for the type of services provided in the hospital and must also clearly differentiate the relative resource consumption for each level of service so that a medical reviewer can easily infer the type, complexity, and medical necessity of the services provided and validate the level of service reported. Because there is great variability in available facility resources, staff, and clinical protocols among facilities, we do not believe that it is advisable to require a single set of guidelines for all facilities. Instead, we believe it is appropriate for each facility to develop its own documentation guidelines that take into account the facility's clinical protocols, available facility resources, and staff types. As stated above, we are not proposing any specific requirements with regard to the basis of these guidelines. However, the guidelines must be tied to actual resource consumption in the emergency department such as number and type of staff interventions, staff time, clinical examples, or patient acuity. We also propose to require that facilities have documentation guidelines available for review upon request. The guidelines must emphasize relative resource consumption and must not, to the extent possible, set minimal requirements as a basis for determining the level of service (for example, require 30 minutes of staff time or five staff interventions to bill a Level 3 emergency visit).
If made final, these requirements would be interim. We will work with interested parties to revise these requirements and would propose any revision to these requirements in a future proposed rule.
Clinic Visits
The current distribution of codes for clinic visits may be due to a facility's continued use of pre-OPPS coding policies for clinic visits. We believe that over time facilities will become as experienced differentiating levels of clinic visits as they are at differentiating levels of emergency visits. Therefore, we propose a set of guidelines for clinic visits that parallels the requirements for emergency visits. We propose that GXXX6—Level 1 Facility Clinic Services, be reported when facilities deliver, and document, basic clinic services. These services include registration, triage, initial nursing assessment, minimal monitoring in the clinic (for example, one additional set of vital signs), minimal diagnostic and therapeutic services (for example, rapid strep test, urine dipstick), nursing discharge (including brief home instructions), and exam room set up/clean up. Our proposal for GXXX7 through GXXX10 is the same as for GXXX2 through GXXX5 except that the facility-specific guidelines must be tied to actual resource consumption in the clinic such as number and type of staff intervention, staff time, clinical examples, or patient acuity. The guidelines must also differentiate the relative resource consumption in the clinic for each level of service sufficiently so that a medical reviewer could easily infer the type, complexity, and medical necessity of the services provided to validate the level of service provided.
This proposal, if made final, would also be interim while we work with interested parties to revise the requirements. Any revision would be proposed in a future proposed rule.
We propose to make final, in the 2003 OPPS final rule, changes in coding for clinic and emergency department visits and requirements related to the development of documentation guidelines for the new codes. However, we propose to implement the new codes and documentation guidelines no earlier than January 1, 2004. This will give hospitals time to develop documentation guidelines for the new codes and prepare their internal billing systems to accommodate the changes. We will continue to work with hospitals throughout CY 2003 as they develop the Start Printed Page 52135documentation guidelines. We solicit comments on this proposal overall as well as the specific components of the proposal.
B. Observation Services
Coding and Billing Instructions
On November 30, 2001, we published a final rule updating changes to the OPPS for 2002. We implemented provisions that allow separate payment for observation services under certain conditions. That is, a hospital may bill for a separate APC payment (APC 0339) for observation services for patients with diagnoses of chest pain, asthma, or congestive heart failure when certain criteria are met. The criteria discussed in the November 30, 2001 final rule and as corrected in the March 1, 2002 final rule are also explained in detail in section XI of a Program Memorandum to intermediaries issued on March 28, 2002 (Transmittal A-02-026). Payment for HCPCS code G0244, observation care provided by a facility to a patient with congestive heart failure, chest pain or asthma, minimum eight hours, maximum 48 hours, was effective for services furnished on or after April 1, 2002.
Section XI of Transmittal A-02-026 that was issued on March 28, 2002 provides additional billing and coding instructions and requirements that flow from the basic criteria that we implemented in the November 30, 2001 and the March 1, 2002 final rules. Although we do not address them explicitly in the final rules, the additional instructions and requirements in Transmittal A-02-026 were developed to implement the basic observation criteria within the programming logic of the outpatient code editor (OCE), which is used to process claims submitted by hospitals for payment under the OPPS. For example, in the November 30, 2001 final rule, we state that an emergency department visit (APC 0610, 0611, or 0612) or a clinic visit (APC 0600, 0601, or 0602) must be billed in conjunction with each bill for observation services (66 FR 59879). In section XI of Transmittal A-02-026, we state that an Evaluation and Management (E/M) code (referred to, incorrectly, in Transmittal A-02-026 as an “Emergency Management” code), for the emergency room, clinic visit, or critical care is required to be billed on the day before or the day that the patient is admitted to observation. That is, unless one of the CPT codes assigned to APCs 0600, 0601, 0602, 0610, 0611, 0612, or 0620 is billed on the day before or the day that the patient is admitted to observation, separate payment for G0244 is not allowed. The codes assigned to these APCs are categorized by CPT as E/M codes. Although we did not include APC 0620, Critical Care, among the APCs that must be billed in order to receive separate payment for observation services, we added it in the program memorandum because critical care is an E/M service which can be furnished in a clinic or an emergency department. Critical care may appropriately precede admission to observation for chest pain, asthma, or congestive heart failure. We clarify in Transmittal A-02-026 that both the associated E/M code and G0244 are paid separately if the observation criteria are met. We also specify that the E/M code associated with observation must be billed on the same claim as the observation service.
Similarly, in the November 30, 2001 and the March 1, 2002 final rules, we require that certain diagnostic tests be performed in order to bill for separate payment for observation services. In Transmittal A-02-026, in section XI.B.2, we list the diagnostic tests that the OCE looks for on a bill for G0244. This list, which amplifies what we published in the November 30, 2001 and March 1, 2002 final rules, is incomplete and should read as follows to reflect the current OCE logic that is applied to claims for G0244:
- For chest pain, at least two sets of cardiac enzymes [either two CPK (82550, 82552, or 82553), or two troponin (84484 or 84512)], and two sequential electrocardiograms (93005);
- For asthma, a peak expiratory flow rate (94010) or pulse oximetry (94760, 94761, or 94762);
- For congestive heart failure, a chest x-ray (71010, 71020, or 71030) and an electrocardiogram (93005) and pulse oximetry (94760, 94761, or 94762).
- Note: Pulse oximetry codes 94760, 94761, and 94762 are treated as packaged services under the OPPS. Although as packaged codes no separate payment is made for these codes, hospitals must separately report the HCPCS code and a charge for pulse oximetry in order to establish that observation services for congestive heart failure and asthma diagnoses meet the criteria for separate payment.
Transmittal A-02-026 also provides specific coding instructions that hospitals must use when billing for observation services that do not meet the criteria for separate payment under APC 0339. In addition, Transmittal A-02-026 addresses the use of modifier “25 with the E/M code billed with G0244.
Direct Admissions to Observation
Since implementation of the provision for separate payment for observation services under APC 0339, a number of hospitals, hospital associations, and other interested parties have asked if separate payment for observation services would be allowed for a patient with chest pain, asthma, or congestive heart failure who is admitted directly into observation by order of the patient's physician but without having received critical care or E/M services in a hospital clinic or the emergency department on the day before or the day of admission to observation. We have responded during monthly CMS hospital open forum calls that, consistent with the criteria in the November 30, 2001 final rule, effective for services furnished on or after April 1, 2002, separate payment for observation services requires that an admission to observation be made by order of a physician in a hospital clinic or in a hospital emergency department. If a patient is directly admitted to observation but without an associated E/M service (including critical care) shown on the same bill, the hospital should bill observation services using revenue code 762 alone or revenue code 762 with one of the HCPCS codes for packaged observation services (CPT codes 99218, 99219, 99220, 99234, 99235, or 99236).
A related question has arisen in connection with a policy interpretation that was posted as a response to a “Frequently Asked Question” (FAQ) on our web site on September 12, 2000. The FAQ follows:
“Q.97: If a patient is admitted from the physician's office to the observation room, will there be no reimbursement?”
“A.97: Since observation is a packaged service, payment cannot be made if it is the only OPPS service on a claim. However, we believe that the “admission” of a patient to observation involves a low-level visit billed by the hospital, as well as whatever office visit the physician who arranged for the admission billed. Thus, when a patient arrives for observation arranged for by a physician in the community (that is, “direct admit to observation”), and is not seen or assessed by a hospital-based physician, the hospital may bill a low-level visit code. This low-level visit code will capture the baseline nursing assessment, the creation of a medical record, the recording and initiation of telephone orders, etc. This visit may be coded only once during the period of observation. The observation charges should be shown in revenue code 762. The number of hours the patient was in Start Printed Page 52136observation status should be shown in the units field. Payment for those services is packaged into the APC for the visit. Other services performed in connection with observation, such as lab, radiology, etc., should be billed for as well * * *”
We have been asked to clarify whether or not the low-level visit code suggested in the FAQ for patients directly admitted for observation services would satisfy the requirement that a line item for a hospital emergency visit, hospital clinic visit, or critical care appear on the same bill as HCPCS code G0244. Our response is that when we established the final criteria effective for services furnished on or after April 1, 2002, we did not contemplate that the low-level visit described in the FAQ would satisfy the requirement for the E/M code that a hospital must bill to show a hospital clinic visit or hospital emergency department visit was performed before observation services for asthma, congestive heart failure, or chest pain to bill and receive payment for G0244 under APC 0339.
In light of these questions, we have reviewed the criteria for separate payment for observation services under APC 0339, and we propose to modify the criteria and coding for observation services furnished on or after January 1, 2003. Specifically, we propose to create two new codes. These additional codes would allow us to collect data on the extent to which patients are directly admitted to hospital observation services without an associated hospital clinic visit or emergency department visit. The proposed codes are as follows:
G0LLL—Initial nursing assessment of patient directly admitted to observation with diagnosis of congestive heart failure, chest pain, or asthma.
G0MMM—Initial nursing assessment of patient directly admitted to observation with diagnosis other than congestive heart failure, chest pain, or asthma.
If a hospital directly admits to observation from a physician's office a patient with a diagnosis of congestive heart failure, asthma, or chest pain, we propose to require that G0LLL be billed with G0244. The current requirement that the hospital bill an emergency department visit (APC 0600, 0601, or 0602) or a clinic visit (APC 0610, 0611, or 0612) or a critical care service (APC 0620) in order to receive separate payment for observation services for patients not admitted directly from a physician's office would remain in effect. However, because the initial nursing assessment is part of any observation service, we propose not to make separate payment for G0LLL. Rather, we propose to assign status indicator “N” to G0LLL, to designate that charges submitted with G0LLL would be packaged into the costs associated with APC 0339. If G0LLL is billed, we would require that the medical record show that the patient was admitted directly from a physician's office for purposes of evaluating and treating chest pain, asthma, or congestive heart failure.
G0MMM describes the initial nursing assessment of a patient directly admitted to observation with a diagnosis other than chest pain, asthma, or congestive heart failure. We propose to assign G0MMM for payment under APC 0706, New Technology—Level I. We propose to require hospitals to bill G0MMM instead of the low level clinic visit referred to in the FAQ above to describe the initial nursing assessment of a patient directly admitted to observation with a diagnosis other than chest pain, asthma, or congestive heart failure. Separate payment would not be made for observation services billed with G0MMM. Rather, when billing G0MMM, hospitals would be required to use revenue code 762 alone or revenue code 762 with one of the HCPCS codes for packaged observation services (99218, 99219, 99220, 99234, 992335, or 99236). We propose to create G0MMM to establish a separately payable code into which costs for observation care for patients directly admitted for diagnoses other than asthma, chest pain, or congestive heart failure can be packaged and recognized.
We would use billing data for G0LLL and G0MMM in reviewing the provisions for payment of observation services in future updates of the OPPS. We invite comment on the extent to which these codes address the concerns that have been raised in connection with patients who are directly admitted to observation services.
Billing Intravenous Infusions With Observation
Based on questions and concerns raised by hospitals since implementation of payment for APC 0339 effective April 1, 2002, we have also reviewed the current status of billing intravenous infusions with observation. Several hospitals have noted that claims for G0244 when billed with intravenous infusion services reported with HCPCS code Q0084 are denied because of the “T” status indicator assigned to HCPCS code Q0084. Our current payment rules for G0244 require that G0244 be denied if a service with status indicator “T” is performed the day before, the day of, or the day after observation care. Because patients in observation may require intravenous infusions of fluid, we propose to create code G0EEE, Intravenous infusion during separately payable observation stay, per observation, payable under APC 0340 with status indicator “X.” When observation services that otherwise meet the billing requirements for separate payment under APC 0339 include an intravenous infusion administered as part of the observation care, G0EEE would be used to report the infusion service. We include instructions on the use of G0EEE in the program memorandum issued to implement OPPS coding changes for the October 1, 2002 OCE. We solicit comment on the use of this code.
We discuss this and other new Level II HCPCS codes proposed for payment under the OPPS in section II.B.3 of this preamble. We instruct hospitals to use G0EEE only when billing for payment under APC 0339. G0EEE includes placement of the IV access and should not be billed with CPT code 36000.
Annual Update of ICD-9 Diagnosis Codes
To receive payment for G0244, we require hospitals to bill specified ICD-9-CM diagnosis code(s). Because ICD-9-CM codes are updated effective October 1 of each year, we propose to issue by Program Memorandum any changes in the diagnosis codes required for payment of G0244 resulting from the ICD-9-CM annual update.
In the March 1, 2002 final rule (67 FR 9559) and in Transmittal A-02-026 issued on March 28, 2002, we listed the diagnosis codes required in order for separate payment of observation services under APC 0339 to be made for patients with congestive heart failure. We added by program memorandum the following new ICD-9-CM codes to the list of allowed diagnosis codes for separate payment for observation of patients with congestive heart failure, effective for services furnished on or after October 1, 2002:
428.20 unspecified systolic heart failure
428.21 acute systolic heart failure
428.22 chronic systolic heart failure
428.23 acute on chronic systolic heart failure
428.30 unspecified diastolic heart failure
428.31 acute diastolic heart failure
428.32 chronic diastolic heart failure
428.33 acute on chronic diastolic heart failure
428.40 unspecified combined systolic and diastolic heart failure
428.41 acute combined systolic and diastolic heart failure Start Printed Page 52137
428.42 chronic combined systolic and diastolic heart failure
428.43 acute on chronic combined systolic and diastolic heart failure
We invite comment on the addition of these diagnosis codes to the criteria for separate payment for observation services under APC 0339.
C. Payment Policy When a Surgical Procedure on the Inpatient List Is Performed on an Emergency Basis
As we state in section II.B.5 of this preamble, the inpatient list specifies those services that are only paid when provided in an inpatient setting. The inpatient list proposed for 2003 is printed as Addendum E. In Addendum B, status indicator C designates a HCPCS code that is on the inpatient list.
Over the past year, some hospitals and hospital associations have asked how a hospital could receive Medicare payment for a procedure on the inpatient list that had to be performed to resuscitate or stabilize a patient with an emergent, life-threatening condition who was transferred or died before being admitted as an inpatient. We reviewed within the context of our current policy the cases brought to our attention for which payment under the OPPS was denied because a procedure with status indicator C was on the bill. Based on that review, we propose to clarify our policy regarding Medicare payment when a procedure with status indicator C is performed under certain life-threatening, emergent conditions. We solicit comments on the extent to which the payment policy described below addresses hospitals' concerns. These comments would be most helpful if they are supported by specific examples of cases when hospitals have, in these instances, submitted bills for a procedure with OPPS status indicator C that were not paid.
1. Current Policy
In the April 7, 2000 final rule (65 FR 18451), in response to comments about the appropriate level of payment for patients who die in the emergency department, we set forth the following guidelines for fiscal intermediaries to use in determining how to make payment when a patient dies in the emergency department or is sent directly to surgery and dies there.
- If the patient dies in the emergency department, make payment under the outpatient PPS for services furnished.
- If the emergency department or other physician orders the patient to the operating room for a surgical procedure, and the patient dies in surgery, payment will be made based on the status of the patient. If the patient had been admitted as an inpatient, pay under the hospital inpatient PPS (a DRG-based payment).
- If the patient was not admitted as an inpatient, pay under the outpatient PPS (an APC-based payment).
- If the patient was not admitted as an inpatient and the procedure is designated as an inpatient-only procedure (payment status indicator C), no Medicare payment will be made for the procedure, but payment will be made for emergency department services.
The OPPS outpatient code editor (OCE) currently has an edit in place that generates a “line item denial” for a line on a claim that has a status indicator C. A line item denial means that the claim can be processed for payment but with some line items denied for payment. A line item denial can be appealed under the provisions of section 1869 of the Act. The OCE includes another edit that denies all other line items furnished on the same day as a line item with a status indicator C. The rationale for this edit is that all line items for services furnished on the same date as the procedure with status indicator C would be considered inpatient services and paid under the appropriate DRG.
As part of the definition of line item denial in the program memorandum that we issue quarterly to update the OCE specifications (for example, see Program Memorandum/Intermediaries, Transmittal A-02-052, June 18, 2002, which is available on our website at http://www.hcfa.gov/pubforms/transmit/A02052.pdf), we state that a line item denial cannot be resubmitted except for an emergency room visit in which a patient dies during a procedure that is categorized as an inpatient procedure: “Under such circumstances, the claim can be resubmitted as an inpatient claim.”
In Addendum D of the March 1, 2002 final rule, we designate payment status indicator “C” as follows: “Admit patient; bill as inpatient.”
2. Hospital Concerns
Hospitals have requested clarification regarding billing and payment in certain situations that our current policy does not seem to explicitly address. The following scenarios synthesize cases described by hospitals for which they have encountered problems when billing for a procedure with status indicator C.
Scenario A: A procedure assigned status indicator C under the OPPS is performed to resuscitate or stabilize a beneficiary who appears with or suddenly develops a life-threatening condition. The patient dies during surgery or postoperatively before being admitted.
Scenario B: An elective or emergent surgical procedure payable under the OPPS is being performed. Because of sudden, unexpected intra-operative complications, the physician must alter the surgical procedure and perform a procedure with OPPS status indicator C. The patient dies during the operation before he or she is admitted as an inpatient.
Scenario C: A procedure with status indicator C is performed to resuscitate or stabilize a beneficiary who appears with or suddenly develops a life-threatening condition. After the procedure, the patient is transferred to another facility for postoperative care.
3. Clarification of Payment Policy
We propose the following policy for fiscal intermediaries and providers to use in determining the appropriate Medicare payment in cases such as those described in the section above.
A procedure assigned status indicator C under the OPPS is never payable under the OPPS. Therefore, for a hospital to receive payment when a procedure with OPPS status indicator C is performed and: (1) the patient dies during or after the procedure, before being admitted, or (2) the patient survives the procedure and is transferred following the procedure, the patient's medical record must contain all of the following information:
- Either orders to admit written by the physician responsible for the patient's care at the hospital to which the patient was to be admitted, the hospital following the procedure for the purpose of receiving inpatient hospital services and occupying an inpatient bed, or written orders to admit and transfer the patient to another hospital following the procedure.
- Documentation that the reported HCPCS code for the surgical procedure with OPPS payment status indicator C (such as CPT code 61345) was actually performed.
- Documentation that the reported surgical procedure with status indicator C was medically necessary.
- If the patient is admitted and subsequently transferred to another facility, documentation that the transfer was medically necessary, such as the patient requiring postoperative treatment unavailable at the transferring facility.
Because these services would be paid according to the appropriate DRG or per diem (see below), all services that were furnished before admission that would otherwise be payable under the OPPS would be paid in accordance with the Start Printed Page 52138provisions of section 3610.3 of the Medicare Intermediary Manual (“3-day rule”) and section 415.6 of the Medicare Hospital Manual.
In the case of a patient who dies during performance of a procedure with OPPS status indicator C before being admitted, the hospital would submit a claim for all services provided, including a line item for the status indicator C procedure. The claim would be rejected for payment under the OPPS and returned to the hospital. The hospital would resubmit the claim for payment as an inpatient stay under the appropriate DRG.
In the case of a patient who is admitted and transferred, the transferring hospital would be paid a per diem DRG rate if all the above conditions are met. (We propose to revise section 3610.5 of the Medicare Intermediary Manual accordingly.)
Note that a physician's order to admit a patient to an observation bed following a procedure designated with OPPS status indicator C would not constitute an inpatient admission and, therefore, would not qualify the procedure with status indicator C for payment. In this instance, the only allowable Medicare payment would be for a code payable under APC 0610, 0611, or 0612 if those services were provided. Payment would not be allowed for either the procedure with status indicator C or for any ancillary services furnished on the same date.
4. Orders To Admit
Some hospitals have raised questions about the timing of a physician's order to admit a patient. The requirements for the authenticating physician orders and the standards for medical record keeping fall outside the scope of this proposed rule and OPPS payment policy. The payment guidelines proposed above are to assist hospitals and contractors in determining how to bill and pay for services appropriately under Medicare. The patient's admission status, as documented by the medical records, determines what Medicare payment is appropriate. Medical record keeping and documentation requirements are addressed in the Medicare hospital conditions of participation at § 482.24, and are governed by applicable State law and State licensing rules and hospital accreditation standards.
D. Status Indicators
The status indicators we assign to HCPCS codes and APCs under the OPPS have an important role in payment for services under the OPPS because they indicate if a service represented by a HCPCS code is payable under the OPPS or another payment system and also if particular OPPS policies apply to the code. We are providing our proposed status indicator assignments for APCs in Addendum A, HCPCS codes in Addendum B, and definitions of the status indicators in Addendum D.
The OPPS is based on HCPCS codes for medical and other health services. These codes are used for a wide variety of payment systems under Medicare, including, but not limited to, the Medicare fee schedule for physician services, the Medicare fee schedule for durable medical equipment and prosthetic devices, and the Medicare clinical laboratory fee schedule. For purposes of making payment under the OPPS, we need a way to signal the claims processing system which HCPCS codes are paid under the OPPS and those codes to which particular OPPS payment policies apply. We accomplish this identification in the OPPS through the establishment of a system of status indicators with specific meanings. Addendum D defines the meaning of each status indicator for purposes of the OPPS.
We assign one and only one status indicator to each APC and to each HCPCS code. Each HCPCS code that is assigned to an APC has the same status indicator as the APC to which it is assigned.
Specifically, in 2003, we propose to use the status indicators in the following manner:
- We use A to indicate services that are paid under some payment method other than OPPS, such as the Durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) fee schedule or the physician fee schedule. Some but not all of these other payment systems are identified in Addendum D.
- We use “C” to indicate inpatient services that are not payable under the OPPS.
- We use “D” to indicate a code that was deleted effective with the beginning of the calendar year.
- We use “E” to indicate services for which payment is not allowed under the OPPS or that are not covered by Medicare.
- We use “F” to indicate acquisition of corneal tissue, which is paid at reasonable cost.
- We use “G” to indicate drugs and biologicals that are paid under OPPS transitional pass-through rules.
- We use “H” to indicate devices that are paid under OPPS transitional pass-through rules.
- We use “K” to indicate drugs and biologicals (including blood and blood products) and certain brachytherapy seeds that are paid in separate APCs under the OPPS, but that are not paid under OPPS transitional pass-through rules.
- We use “N” to indicate services that are paid under the OPPS for which payment is packaged into another service or APC group.
- We use “P” to indicate services that are paid under the OPPS but only in partial hospitalization programs.
- We use “S” to indicate significant procedures that are paid under OPPS but to which the multiple procedure reduction does not apply.
- We use “T” to indicate significant services that are paid under the OPPS and to which the multiple procedure payment discount under OPPS applies.
- We use “V” to indicate medical visits (including clinic or emergency department visits) that are paid under the OPPS.
- We use “X” to indicate ancillary services that are paid under the OPPS.
The software that controls Medicare payment looks to the status indicators attached to the HCPCS codes and APCs for direction in the processing of the claim. Therefore, the assignment of the status indicators has significance for the payment of services. We sometimes change these indicators in the course of a year through Program Memoranda. Moreover, indicators are established for new codes that we establish in the middle of the year, either as a result of a national coverage decision or otherwise. A status indicator, as well as an APC, must be assigned so that payment can be made for the service identified by the new code.
We are proposing the status indicators identified for each HCPCS code and each APC in Addenda A and B and are requesting comments on the appropriateness of the indicators we have assigned.
E. Other Policy Issues Relating To Pass-Through Device Categories
1. Reducing Transitional Pass-Through Payments To Offset Costs Packaged Into APC Groups
In the November 30, 2001 final rule, we explain the methodology we used to estimate the portion of each APC rate that could reasonably be attributed to the cost of associated devices that are eligible for pass-through payments (66 FR 59904). Effective with implementation of the 2002 OPPS update on April 1, 2002, we deduct from the pass-through payments for those devices an amount that offsets the portion of the otherwise applicable APC payment amount that we determined is associated with the device, as required Start Printed Page 52139by section 1833(t)(6)(D)(ii) of the Act. In the March 1, 2002 final rule, we published the applicable offset amounts for 2002, which we had recalculated to reflect certain device cost assignments that were corrected in the same final rule (67 FR 9557).
For the 2003 OPPS update, we propose to estimate the portion of each APC rate that could reasonably be attributed to the cost of an associated pass-through device that is eligible for pass-through payment using claims data for services furnished between July 1, 2001 through December 31, 2001. We propose to use only the last 6 months of 2001 claims data because bills for pass-through devices submitted during this time period would use only device category codes, allowing a more consistent analysis than would result were we to include pre-July 1 claims that might still show item-specific codes for pass-through devices. Using these claims, we would calculate a median cost for every APC without packaging the costs of associated C-codes for device categories that were billed with the APC. We would then calculate a median cost for every APC with the costs of associated C-codes for device categories that were billed with the APC packaged into the median. Comparing the median APC cost minus device packaging by the median APC cost including device packaging would allow us to determine the percentage of the median APC cost that is attributable to associated pass-through devices. By applying these percentages to the median APC cost, we would determine the applicable offset amount. Table 9 shows the offsets that we propose be applied in 2003 to each APC that contains device costs. APCs were included for offsets if their device costs comprised at least 1 percent of the APC's costs. (However, if any APC's calculated offset had been less than 1 dollar, that APC and offset would not have been included.)
Table 9.—Proposed Offsets To Be Applied for Each APC That Contains Device Costs
APC Description APC percent attributed to devices Device related cost to be subtracted from pass-through payment 0032 Insertion of Central Venous/Arterial Catheter 6.12 $22.73 0046 Open/Percutaneous Treatment Fracture or Dislocation 1.06 16.00 0048 Arthroplasty with Prosthesis 5.78 111.02 0051 Level III Musculoskeletal Procedures Except Hand and Foot 1.24 21.95 0052 Level IV Musculoskeletal Procedures Except Hand and Foot 3.05 67.21 0080 Diagnostic Cardiac Catheterization 4.36 80.82 0081 Non-Coronary Angioplasty or Atherectomy 7.29 86.03 0082 Coronary Atherectomy 47.58 1,866.34 0083 Coronary Angioplasty and Percutaneous Valvuloplasty 20.08 499.51 0085 Level II Electrophysiologic Evaluation 10.22 168.87 0086 Ablate Heart Dysrhythm Focus 20.36 462.74 0087 Cardiac Electrophysiologic Recording/Mapping 15.19 45.90 0088 Thrombectomy 4.08 72.06 0089 Insertion/Replacement of Permanent Pacemaker and Electrodes 68.56 3,883.80 0090 Insertion/Replacement of Pacemaker Pulse Generator 64.17 2,574.81 0091 Level II Vascular Ligation 1.75 24.60 0093 Vascular Repair/Fistula Construction 1.63 22.29 0104 Transcatheter Placement of Intracoronary Stents 40.26 1,522.67 0105 Revision/Removal of Pacemakers, AICD, or Vascular 5.79 57.64 0106 Insertion/Replacement/Repair of Pacemaker and/or Electrodes 18.05 274.40 0107 Insertion of Cardioverter-Defibrillator 83.18 7,852.32 0108 Insertion/Replacement/Repair of Cardioverter-Defibrillator Leads 82.11 9,936.93 0109 Removal of Implanted Devices 1.70 6.79 0115 Cannula/Access Device Procedures 7.22 88.17 0119 Implantation of Devices 13.61 183.19 0122 Level II Tube changes and Repositioning 2.21 4.47 0124 Revision of Implanted Infusion Pump 9.82 119.87 0142 Small Intestine Endoscopy 1.03 4.40 0151 Endoscopic Retrograde Cholangio-Pancreatography (ERCP) 2.71 25.69 0152 Percutaneous Abdominal and Biliary Procedures 9.96 32.01 0153 Peritoneal and Abdominal Procedures 1.69 22.84 0154 Hernia/Hydrocele Procedures 2.66 37.33 0167 Level III Urethral Procedures 11.54 162.95 0168 Level II Urethral Procedures 5.20 65.18 0179 Urinary Incontinence Procedures 34.30 1,449.96 0182 Insertion of Penile Prosthesis 42.39 1,847.50 0202 Level VIII Female Reproductive Proc 10.67 216.92 0222 Implantation of Neurological Device 65.75 4,806.58 0223 Implantation of Pain Management Device 11.54 121.84 0225 Implantation of Neurostimulator Electrodes 33.33 770.87 0226 Implantation of Drug Infusion Reservoir 70.33 1,616.75 0227 Implantation of Drug Infusion Device 75.38 5,019.34 0229 Transcatherter Placement of Intravascular Shunts 46.89 1,194.96 0245 Level I Cataract Procedures without IOL Insert 3.24 24.25 0246 Cataract Procedures with IOL Insert 1.20 14.72 0259 Level III ENT Procedures 75.29 11,396.81 0279 Level II Angiography and Venography except Extremity 1.56 6.82 0280 Level III Angiography and Venography except Extremity 5.02 40.49 0281 Venography of Extremity 1.39 3.78 Start Printed Page 52140 0297 Level II Therapeutic Radiologic Procedures 1.91 7.75 0656 Transcatheter placement of drug eluting stents 54.15 2668.28 0670 Intravenous and Intracardiac Ultrasound 51.03 392.26 0680 Insertion of Patient Activated Event Recorders 68.48 1,850.24 0681 Knee Arthroplasty 64.57 5,310.69 0684 Prostate Brachytherapy 67.49 3631.89 0686 Level III Skin Repair 4.00 23.51 0687 Revision/Removal of Neurostimulator Electrodes 1.50 15.21 0688 Revision/Removal of Neurostimulator Pulse Generator Receiver 22.15 352.28 0693 Level II Breast Reconstruction 1.00 20.44 0981 New Technology—Level XII ($2000—$2500) 13.32 299.70 2. Devices Paid With Multiple Procedures
As explained above, under section 1833(t)(6)(D)(ii) of the Act, the amount of additional payment for a device eligible for pass-through payment is the amount by which the hospital's cost exceeds the portion of the otherwise applicable APC payment amount that the Secretary determines is associated with the device. Thus, for devices eligible for pass-through payment, we reduce the pass-through payment amount by the cost attributable to the device that is already packaged into the APC payment for an associated procedure. For 2002, we developed offset amounts, for 59 APCs (March 1, 2002 final rule, 67 FR 9556 through 9557, Table 1).
In our November 30, 2001 final rule (66 FR 59856), we articulated a policy regarding the calculation of the offsets for device costs already reflected in APCs in cases where the payment for the associated APC is reduced due to the multiple procedure discount. The policy was in response to several commenting parties that recommended that we apply the multiple procedure discount only to the non-device-related portion of the APC payment amount (66 FR 59906).
We agreed with the commenters that the full pass-through offset should not be applied when the APC payment is subject to the multiple procedure discount of 50 percent.
The purpose of the offset is to ensure that the OPPS is not making double payments for any portion of the cost associated with the use of the pass-through item. We stated in the November 30, 2001 rule that the offset should reflect that portion of the cost for the pass-through device actually reflected in the payment that is received for the associated APC. We consequently ruled that the most straightforward methodology for applying this principle is to reduce the amount of the offset amount by 50 percent whenever the multiple procedure discount applies to the associated APC. This discounting of the offset is applied in 2002 to bills subject to multiple procedure discounting that also include devices eligible for pass-through payment.
The significant number of device categories that are expiring in 2003 combined with our proposal to package 100 percent of device costs into their associated APCs has prompted us to revisit the current policy of reducing offsets for pass-through devices in instances when multiple procedure discounts are applied to procedures associated with pass-through device categories. In order to determine the impact of multiple procedure discounting on APCs with full packaging of device costs, we reviewed the median costs of all APCs after incorporation of device costs and arrayed them in order of descending median cost. We also determined the contribution (in absolute dollars and as a percentage) of device costs to the median costs of each APC. We did this by examining claims submitted during the last 6 months of 2001 during which only device category codes were used to bill for pass-through devices because those were the only claims where we could specifically identify the contribution of device costs to the cost of each APC.
We then determined which APCs containing devices would be billed together. For example, the APC for insertion of a pacemaker would not be billed with the APC for insertion of neurostimulator electrodes, whereas the APC for coronary stent placement might be billed with the APC for coronary angioplasty. We next determined, based on median cost data, which device containing APCs would be subject to the 50 percent multiple procedure reduction. After identifying these APCs, we applied a 50 percent reduction to arrive at a discounted payment amount. We then reviewed the contribution of device costs to the discounted APC both as a percentage and in absolute dollars to determine if applying the 50 percent reduction would result in underpayment for the service. We determined that the reduced payment was adequate to pay both for the devices incorporated into the APC and for the procedure cost in the context of performing multiple procedures. We obtained the same results even when we overstated device costs in our model by 5 or 10 percent to offset concerns expressed by some manufacturers and physicians that hospital charges for transitional pass-through devices may be understated.
To illustrate this analysis, assume APCs 0104 and 0083 are billed together. The median cost of APC 0104 is $3,960 with 40 percent of the cost attributable to devices. The median cost of APC 0083 is $2,605 with 20 percent of its cost attributable to devices. Under our existing multiple procedure discount payment rules, APC 0104 would be paid at 100 percent, and APC 0083 would be paid at 50 percent. This means that payment for APC 0083 would be $1,302 of which $520 (20 percent of $2,605) is attributable to devices. We believe this total payment accounts for the costs of the devices and the costs of the procedure when it is performed in conjunction with APC 0104.
We note that almost all APCs with high device costs (such as insertion of pacemakers, insertion of cardioverter-defibrillators, insertion of infusion pumps and neurostimulator electrodes) would never be subject to a multiple procedure discount. They have the highest relative weights in the OPPS, Start Printed Page 52141and we would not expect these procedures to be performed during the same operative session with a higher paying procedure with status indicator “T.” Therefore, we propose to continue our current policy of multiple procedure discounting. That is, when two or more APCS with status indicator “T” are billed together we propose to pay 100 percent for the highest cost APC and 50 percent for all other APCs with status indicator “T.” We propose not to adjust these payments to account for device costs in the APCs.
F. Outpatient Billing For Dialysis
Currently, hospitals are unable to bill for dialysis treatments furnished to End-Stage Renal Disease (ESRD) patients on an outpatient basis, unless the hospital also has a certified hospital-based ESRD facility. As a result of this policy, there has been an increase in denials by the PROs for inappropriate hospital admissions.
When ESRD patients come to the hospital for a medical emergency or for problems with their access sites, they typically miss their regularly scheduled dialysis appointments. If the ESRD patient's usual facility is unable to reschedule the dialysis treatment, the beneficiary has to wait until the next scheduled dialysis appointment. CMS is concerned that by maintaining this policy, beneficiaries may be receiving interrupted care because there will be unnecessary lapses in treatment. The ESRD patient should not be prevented from receiving her or his normal dialysis because he or she experienced another unrelated medical situation. Therefore, we propose to allow payment for dialysis treatments for ESRD patients in the outpatient department of a hospital in specific situations. Payment would be limited to unscheduled dialysis for ESRD patients in exceptional circumstances. Outpatient dialysis for acute patients would not be included in this payment mechanism.
We propose to limit this payment to medical situations in which the ESRD patient cannot obtain her or his regularly scheduled dialysis treatment at a certified ESRD facility. Situations that we propose to allow are limited to: (1) dialysis performed following or in connection with a vascular access procedure; (2) dialysis performed following treatment for an unrelated medical emergency. For example, if a patient goes to the emergency room for chest pains and misses a regularly scheduled dialysis treatment that cannot be rescheduled, we would allow the hospital to provide and bill Medicare for the dialysis treatment; and (3) emergency dialysis—Currently, the only mechanism available for payment in this situation is through an inpatient admission. We will maintain our policy that routine treatments in non-ESRD certified hospitals would not be payable under OPPS.
We believe it is important to make this change in policy for two reasons: (1) to ensure that hospital outpatient departments are paid for providing this much needed service; and (2) to prevent dialysis patients from receiving interrupted care. Non-ESRD certified hospital outpatient facilities would bill Medicare using a new G code, G0GGG, “Unscheduled or emergency treatment for dialysis for ESRD patient in the outpatient department of a hospital that does not have a certified ESRD facility.” We propose that this new code will have status indicator “S” and be assigned to APC 0170. Payment would be roughly equivalent to the reimbursement rate for acute dialysis. We propose to implement this change effective January 1, 2003. Effective January 1, 2003, this would be the only way for non-ESRD certified hospital outpatient facilities to bill Medicare and be paid for providing outpatient dialysis to ESRD beneficiaries.
CMS will be monitoring the use of this new code to ensure that (1) certified dialysis facilities are not incorrectly using this code; and (2) the same dialysis patient is not repeatedly using this code, which would indicate routine dialysis treatment.
When ESRD patients receive outpatient dialysis in non-ESRD certified hospital outpatient facilities, the patient's home facility would be responsible for obtaining and reviewing the patient's medical records to ensure that appropriate care was provided in the hospital and that modifications are made, if necessary, to the patient's plan of care upon her or his return to the facility. This ensures continuity of care for the patient.
IX. Summary of and Responses to MedPAC Recommendations
The Medicare Payment Advisory Commission (MedPAC) in its March 2002 Report to the Congress: “Medicare Payment Policy,” makes a number of recommendations relating to the OPPS. This section provides responses to those recommendations.
Recommendation: For calendar year 2003, the Secretary should increase the payment rates for services covered by the OPPS by the rate of increase in the hospital market basket.
Response: Section 1833(t)(3)(C)(ii) of the Act requires the Secretary to update the conversion factor annually. Under section 1833(t)(3)(C)(iv) of the Act, the update is equal to the hospital market basket percentage increase applicable under the hospital inpatient PPS, minus one percentage point for the years 2000 and 2002. The Secretary has the authority under section 1833(t)(3)(C)(iv) of the Act to substitute a market basket that is specific to hospital outpatient services. In the September 8, 1998 proposed rule on the OPPS, we indicated that we were considering the option of developing an outpatient-specific market basket and invited comments on possible sources of data suitable for constructing one (63 FR 47579). We received no comments in response to this invitation, and we therefore announced in the April 7, 2000 final rule that we would update the conversion factor by the hospital inpatient market basket increase, minus one percentage point, for the years 2000, 2001, and 2002 (65 FR 18502). (As required by section 401(c) of the BIPA, we made payment adjustments effective April 1, 2001 under a special payment rule that had the effect of providing a full market basket update in 2001.) For 2003, we propose to increase payment rates by the rate of increase in the hospital market basket.
Recommendation: The Congress should—
- Replace hospital-specific payments for pass-through devices with national rates.
- Give the Secretary authority to consider alternatives to average wholesale price (AWP) when determining payments for pass-through drugs and biologicals.
Response: Regarding the pricing of transitional pass-through devices, we share the Commission's concern that the current methodology provides incentives for hospitals to inflate charges for transitional pass-through devices to increase payments. However, we believe that alternative approaches are not necessarily superior. Further, the salience of this problem should be much less in the future.
At present, the payment for a transitional pass-through device is set, on a claim-by-claim basis, relative to the hospital's charge for that device. The charge is reduced to a measure of cost by application of a hospital-specific cost-to-charge ratio, and a subtraction is made to reflect the portion of device costs already recognized in the payment for the associated procedure APC. This procedure means that a higher charge by a hospital will result in a higher payment from Medicare. The Commission notes that this method embodies an incentive for hospitals, perhaps prompted by manufacturers, to increase charges as a means of Start Printed Page 52142increasing payments. The Commission is concerned that this situation may lead to excessive payments and may bias the charges used to revise, from year to year, relative weights in the OPPS.
In fact, the extent to which hospitals raising their charges on devices is problematic depends on the outcomes. In general, we anticipate that hospital charge structures, on average, reflect their costs; this assumption helps support the use of charge data to revise relative weights in hospital prospective payment systems. Accordingly, whether payments to hospitals for transitional pass-through devices might be considered excessive depends on whether hospitals inflate charges beyond the levels appropriate to recover their costs. Whether their behavior leads to biases in charge data depends on whether they set charges on transitional pass-through devices significantly differently than on other services.
Moving to a fee schedule for transitional pass-through devices would remove the particular incentive problem that the Commission noted, which we agree would be desirable. However, the establishment of appropriate national rates would then become the focus. In the absence of field data on actual costs, we will be inevitably reliant on information that manufacturers provide. At present, manufacturers are asked for information about prices on applications for pass-through status. Anecdotal information suggests this information is not fully reliable as a measure of what hospitals actually pay.
The Commission's report discusses the possibility of CMS setting the rate for a device based on analysis of the manufacturer's costs, including an appropriate rate of return on equity. This approach would confront a number of accounting, legal, and operational difficulties.
- First, it would take some time to complete the analysis for a new product, which could significantly delay establishment of a rate. The rate that would be used in the meantime, or whether billing would be permitted at all, would be open to question.
- Second, it appears that large firms with multiple product lines supply most devices, which would make determining the costs of a particular device difficult. This problem would be compounded when multiple enterprises are involved in bringing a product to market, which is not uncommon in the device industry, where invention and initial development may occur in one firm and final development, manufacturing, and marketing in another.
- Third, the government generally does not have access to manufacturers cost information. While legal authority could be enhanced, manufacturers would face incentives that raise questions about the reliability of information provided, and the need for government accounting and auditing resources would be high.
- Fourth, as the Commission's report notes, an appropriate rate of return on equity would have to be established.
- Fifth, devices are now paid, under BIPA, on the basis of categories. As a result, if a manufacturer brings to market a product that fits the description of a category, hospitals can bill for that manufacturer's product without any change in coding or notification of CMS. Consequently, we do not know what specific devices are actually being billed in these categories, or who manufactures them. Whatever rate might be established on the basis of an initial application for a category would presumably be based on the applicant's costs. Later entrants might have significantly different cost structures, but this information would not come into account unless a more elaborate process was implemented to include it.
Finally, whether a rate set in this fashion would pay less or more than the current method is unclear. The current method is based on actual experience in the field, and it will reflect, though perhaps somewhat tenuously, whatever competitive market pressures exist. Any method that we use aimed at ensuring a more reliable price could yield a price that is too high, since it will not reflect market activity. Whether a rate set by ex ante analysis of this sort would produce superior results does not appear obvious.
The Commission's report also mentions the possibility of using competitive bidding to set rates for transitional pass-through devices. While competitive bidding appears attractive as a means of setting a market-related price, it has not proven an easy process for Medicare to implement. Competitive bidding seems best suited for established products with multiple suppliers. However, transitional pass-through devices are by definition new to the market and will frequently have only one manufacturer, at least at the start of the 2 to 3 year transitional pass-through period. Even in those instances in which this technique would be possible, it involves a fair amount of administrative resources and time, and using it to establish a rate that will be used at the most for 3 years does not appear to be an effective use of resources.
Both of the suggestions discussed above reflect procedures that involve relatively high overhead on the part of CMS and of other actors. It is not obvious whether either would produce results that are superior to those derived from the present method. While they would change incentives on hospitals, incentives of manufacturers would still be a source of concern. We agree with the Commission that further investigation would be necessary to determine a feasible alternative to cost-based pass-through payments.
In considering the advantages of various approaches, it is important to keep the size of the problem in mind, especially when contemplating procedures for setting rates that would involve substantial administrative resources. As of July 1, 2002, the OPPS pays for 100 categories of devices. As is explained in section III.C of this preamble, we are proposing that 95 categories will lose pass-through status and be retired as of January 1, 2003.[3] Since the initial categories were established in April 2001, we have added only three categories. While several applications are pending, given the extensiveness of the existing categories, it appears likely that the number of new categories to be established in future years will be small.[4] The likely volume of claims represented by these new categories is of course speculative, but it also does not seem likely to be large relative to the size of the OPPS system. As discussed below, we developed criteria for the establishment of new categories that were specifically intended to limit future pass-through payments to devices that provide a substantial clinical improvement.
Considering that the identified alternatives do not appear to be manifestly superior to the current system but do involve significantly more administrative resources, and given the anticipated small volume of transitional pass-through devices in the future, we think on balance it would be best to let more experience develop with the current system before making significant changes to the current method.
However, we agree that it would be desirable to give the Secretary authority Start Printed Page 52143to use alternatives to AWP when determining payments for pass-through drugs and biologicals. At present, total payment for these items is governed by the general rule (section 1842(o) of the Act) for Medicare pricing of drugs, which requires they be paid at 95 percent of AWP. This rule also covers most drugs delivered “incident to” physicians' services in physicians' offices and elsewhere. The Congress is at present considering various changes to the AWP as the basis for Medicare payment for drugs, and if a change is adopted to this standard, it may be an appropriate standard for transitional pass-through drugs and biologicals as well.
Recommendation: The Secretary should do the following:
- Ensure additional payments are made only for new or substantially improved technologies that are expensive in relation to the applicable ambulatory payment classification rate.
- Avoid basing national rates only on reported costs.
- Ensure that the same broad principles guide payments for new technologies in the inpatient and outpatient payment systems.
Response: We agree that additional payments should be limited to items that have the greatest merit and that have high costs not well captured in the existing payment structure. The Commission notes that limiting the number of transitional pass-through items limits the burdens on hospitals and us; reduces the likelihood of exceeding the statutory cap on aggregate pass-through payment, necessitating a uniform reduction in transitional pass-through payments; and limits the redistribution of funds across hospitals that are low versus high users of transitional pass-through items. We agree with these points. On November 2, 2001, we published an interim final rule with comment period in the Federal Register (66 FR 55850 to 55857) that set forth criteria we will use to evaluate whether to establish new categories of devices in the future. These criteria include tests of whether a device is new, whether it represents a substantial medical improvement for Medicare beneficiaries, and whether its costs are high relative to the payments that would otherwise be made.
Section 1833(t)(6)(D) of the Act prescribes the method for setting payment for transitional pass-through drugs and devices. The issue of possible alternatives is discussed above.
We agree that the same principles should govern payments for new technologies in the inpatient and outpatient prospective payment systems. Criteria governing extra new technology payments in the IPPS were established in a final rule published in the Federal Register (66 FR 46902 to 46925) on September 7, 2001. The criteria have the same general form as those for the OPPS. They differ in some particulars, largely traceable to the difference of the two payment systems. In particular, the IPPS system pays on the basis of an episode of care. As a result, the bundle of payment is generally larger and hospitals are better able to absorb minor cost differences. Considering the impact of new technology on all costs of the episode is also pertinent. Consequently, the criteria for special payment for inpatient new technologies require examination of the net effect on costs of the entire episode (not just the added costs of a new technology), and the relative cost standard we established is somewhat more stringent than for the OPPS. We believe it is premature to judge whether it will make sense to make these criteria even closer in the future, as the Commission's discussion suggests.
X. Summary of Proposed Changes for 2003
A. Changes Required by Statute
We are proposing the following changes to implement statutory requirements:
- Add APCs, delete APCs, and modify the composition of some existing APCs.
- Recalibrate the relative payment weights of the APCs.
- Update the conversion factor and the wage index.
- Revise the APC payment amounts to reflect the APC reclassifications, the recalibration of payment weights, and the other required updates and adjustments.
- Cease transitional pass-through payments for drugs and biologicals (including blood and blood products) and devices (including brachytherapy), that will, on January 1, 2003, have been paid under transitional pass-through methodology for at least 2 years.
B. Additional Changes to OPPS and Payment Suspension Provisions
We are proposing the following additional changes to the OPPS and Payment Suspension Provisions:
- Creation of new evaluation and management service codes for outpatient clinic and emergency department encounters for implementation no earlier than January 1, 2004.
- Changes to the list of services that we do not pay in outpatient departments because we define them as “inpatient only” procedures.
- Changes to our policy of nonpayment for procedures on the “inpatient only” list in special cases involving death or transfer before inpatient admission.
- Changes to our policy governing observation in cases of direct admission to observation.
- Changes to status indicators for HCPCS codes.
- Changes to our policies governing dialysis for ESRD patients and regarding partial hospitalization.
In addition, we are making changes to payment suspension policies.
C. Changes to the Regulations Text
A. We propose to make the following changes to our regulations:
- Amend § 410.43(b) to add clinical social worker services (for the diagnosis and treatment of mental illnesses) that meet the requirements of section 1861(hh)(2) of the Act to the specified professional services that are separately covered and not paid as partial hospitalization services.
- Amend § 419.66(c)(1) to specify that we must establish a new category for a medical device if it is not described by any category previously in effect as well as an existing category.
XI. Summary of Proposed Payment Suspension Provisions
In this rule, we propose to revise § 405.371 (c) to specify that we may suspend Medicare payments “in whole or in part” if a provider has failed to timely file an acceptable cost report. This provision is consistent with the existing provisions in § 405.371(a) governing the suspension of Medicare payments “in whole or in part” under certain conditions. We believe the Medicare program would benefit because immediate complete payment suspension can be disruptive to providers and may negatively affect the care of Medicare patients.
XII. Collection of Information Requirements
Under the Paperwork Reduction Act of 1995, we are required to provide 60-day notice in the Federal Register and solicit public comment before a collection of information requirement is submitted to the Office of Management and Budget (OMB) for review and approval. In order to fairly evaluate whether an information collection should be approved by OMB, section 3506(c)(2)(A) of the Paperwork Reduction Act of 1995 requires that we solicit comment on the following issues: Start Printed Page 52144
- The need for the information collection and its usefulness in carrying out the proper functions of our agency.
- The accuracy of our estimate of the information collection burden.
- The quality, utility, and clarity of the information to be collected.
- Recommendations to minimize the information collection burden on the affected public, including automated collection techniques.
This rule does not impose information collection and recordkeeping requirements. Consequently, it need not be reviewed by the Office of Management and Budget under the authority of the Paperwork Reduction Act of 1995.
XIII. Response to Public Comments
Because of the large number of items of correspondence we normally receive on a proposed rule, we are not able to acknowledge or respond to them individually. However, in preparing the final rule, we will consider all comments concerning the provisions of this proposed rule that we receive by the date and time specified in the DATES section of this preamble and respond to those comments in the preamble to that rule.
XIV. Regulatory Impact Analysis
The regulatory impact analysis for this proposed rule consists of an impact analysis for the OPPS provisions and a regulatory impact statement for the provision for payment suspension for unfiled cost reports.
A. OPPS
1. General
We have examined the impacts of this proposed rule as required by Executive Order 12866 (September 1993, Regulatory Planning and Review) and the Regulatory Flexibility Act (RFA) (September 16, 1980 Pub. L. 96-354). Executive Order 12866 directs agencies to assess all costs and benefits of available regulatory alternatives and, if regulation is necessary, to select regulatory approaches that maximize net benefits (including potential economic, environmental, public health and safety effects, distributive impacts, and equity). A regulatory impact analysis (RIA) must be prepared for major rules with economically significant effects ($100 million or more annually).
We estimate the effects of the provisions that would be implemented by this proposed rule would result in expenditures exceeding $100 million in any 1 year. We estimate the total increase (from changes in the proposed rule as well as enrollment, utilization, and case mix changes) in expenditures under the OPPS for CY 2003 compared to CY 2002 to be approximately $1.372 billion. Therefore, this proposed rule is an economically significant rule under Executive Order 12866, and a major rule under 5 U.S.C. 804(2).
The RFA requires agencies to determine whether a rule will have a significant economic impact on a substantial number of small entities. For purposes of the RFA, small entities include small businesses, nonprofit organizations and government agencies. Most hospitals and most other providers and suppliers are small entities, either by nonprofit status or by having revenues of $6 to $29 million or less in any 1 year (see 65 FR 69432).
For purposes of the RFA we have determined that approximately 37 percent of hospitals and 98 percent of mental health practitioners would be considered small entities according to the Small Business Administration (SBA) size standards. We do not have data available to calculate the percentages of entities in the pharmaceutical preparation manufacturing, biological products, or medical instrument industries. For the pharmaceutical preparation manufacturing industry (NAICS 325412), the size standard is 750 or fewer employees and $67.6 billion in annual sales (1997 business census). For biological products (except diagnostic) (NAICS 325414) $5.7 billion and medical instruments (NAICS 339112), with $18.5 billion in annual sales, the standard is 50 or fewer employees (see the standards web site at http://www.sba.gov/regulations/siccodes/). Individuals and States are not included in the definition of a small entity.
In addition, section 1102(b) of the Act requires us to prepare a regulatory impact analysis if a rule may have a significant impact on the operations of a substantial number of small rural hospitals. This analysis must conform to the provisions of section 603 of the RFA. With the exception of hospitals located in certain New England counties, for purposes of section 1102(b) of the Act, we define a small rural hospital as a hospital that is located outside of a Metropolitan Statistical Area (MSA) and has fewer than 100 beds (or New England County Metropolitan Area (NECMA)). Section 601(g) of the Social Security Amendments of 1983 (Pub. L. 98-21) designated hospitals in certain New England counties as belonging to the adjacent NECMA. Thus, for purposes of the OPPS, we classify these hospitals as urban hospitals. We believe that the changes in this proposed rule would affect both a substantial number of rural hospitals as well as other classes of hospitals and that the effects on some may be significant. Therefore, we conclude that this proposed rule has a significant impact on a substantial number of small entities. However, the statute provides for small rural hospitals (of less than 100 beds) to be held harmless by the law and to continue to be paid at cost; therefore this proposed rule has no impact on them.
Unfunded Mandates
Section 202 of the Unfunded Mandates Reform Act of 1995 (Pub. L. 104-4) also requires that agencies assess anticipated costs and benefits before issuing any rule that may result in an expenditure in any 1 year by State, local, or tribal governments, in the aggregate, or by the private sector, of $110 million. This proposed rule would not mandate any requirements for State, local, or tribal governments. This proposed rule imposes no unfunded mandates on the private sector.
Federalism
Executive Order 13132 establishes certain requirements that an agency must meet when it publishes a proposed rule (and subsequent final rule) that imposes substantial direct costs on State and local governments, preempts State law, or otherwise has Federalism implications.
We have examined this proposed rule in accordance with Executive Order 13132, Federalism, and have determined that it will not have an impact on the rights, roles, and responsibilities of State, local or tribal governments. The impact analysis (see table 10) shows that payments to governmental hospitals (including State, local and tribal governmental hospitals) would increase by 5 percent under the proposed rule.
2. Changes in this Proposed Rule
We are proposing several changes to the OPPS that are required by the statute. We are required under section 1833(t)(3)(C)(ii) of the Act to update annually the conversion factor used to determine the APC payment rates. We are also required under section 1833(t)(9)(A) of the Act to revise, not less often than annually, the wage index and other adjustments. In addition, we must review the clinical integrity of payment groups and weights at least annually. Accordingly, in this proposed rule, we are updating the conversion factor and the wage index adjustment for hospital outpatient services furnished beginning January 1, 2003 as Start Printed Page 52145we discuss in sections VI and IV, respectively, of this preamble. We are also proposing revisions to the relative APC payment weights based on claims data from January 1, 2001 through December 31, 2001. Finally, we are proposing to remove 95 devices and more than 200 drugs and biologicals from pass-through payment status.
Under this proposed rule, the change to the conversion factor as provided by statute would increase total OPPS payments by 3.5 percent in 2003. The changes to the wage index and to the APC weights (which incorporates the cessation of pass-through payments for many drugs and devices) do not increase OPPS payments because the OPPS is budget neutral. However, the wage index and APC weight changes do change the distribution of payments within the budget neutral system as shown in Table 10 and described in more detail in this section.
Alternatives Considered
Alternatives to the changes we propose and the reason that we did not choose to propose them are discussed throughout this proposed rule. Below we discuss options we considered when analyzing methodologies to appropriately recognize the costs of former pass-through items. For a more detailed discussion, see section III.C.1 regarding the expiration of pass-through payment for devices and section III.C.2 regarding the expiration of pass-through payment for drugs and biologicals.
Payment for Categories of Devices
We considered establishing separate APCs for categories of devices and paying for them separately. We did not propose this option because we believe that to the extent possible, hospital payment for procedures and visits should include all of the costs required to provide the procedures and visits.
A second option we considered involved (1) packaging some categories of devices into the procedures with which they were billed in 2001 and (2) paying the rest through separate APCs (as discussed in section III.C.). We did not propose this option because we believe that devices are routinely used in the services for which they are needed and therefore are consistently paid at the cost of providing the service. Furthermore, criteria that would provide a basis for some devices to be packaged and for others to be paid separately would have to be developed and approved, thereby further complicating an already complex payment system.
Payment for Drugs and Biologicals
We considered continuing to make separate payment for all drugs and biologicals through separate APCs. We did not propose to pay separately for all drugs through separate APCs because we believe that, to the extent possible, hospital payment for services should include all of the costs of the services. We believe that drugs should be packaged with the services in which they are furnished except when we determine that there is a valid reason to do otherwise. However, we recognize that (unlike the stability that exists with device usage with the applicable procedures) the use of drugs may vary widely depending upon patient and disease characteristics. Therefore, packaging payment for all drugs may, in some cases, provide inadequate payment for the services furnished. Where a hospital has a disproportionate share of patients who need greater amounts of expensive drugs, underpayment for the drugs needed by these patients could result in cessation of needed services. For the first year that we are ceasing transitional pass-through payment for drugs, we decided to proceed cautiously by proposing to pay separately for drugs when the cost per encounter was more than $150 or when special characteristics existed (for example, orphan drugs, blood products).
We also considered packaging the costs of all drugs into the cost of the associated procedures with which they were billed in 2001. We did not package all payment for drugs into the payment for the procedures because, while this packaging is ultimately our goal, we believe, for the reasons indicated above, that we need to proceed cautiously to ensure that we do not inadvertently threaten access to needed care.
Conclusion
It is clear that the changes in this proposed rule would affect both a substantial number of rural hospitals as well as other classes of hospitals, and the effects on some may be significant. Therefore, the discussion below, in combination with the rest of this proposed rule, constitutes a regulatory impact analysis.
The OPPS rates proposed for CY 2003 would have, overall, a positive effect for every category of hospital with the exception of children's hospitals, which are held harmless under the OPPS. The changes in the OPPS proposed for 2003 would result in an overall 3.5 percent increase in Medicare payments to hospitals, exclusive of outlier and transitional pass-through payments and transitional corridor payments. As described in the preamble, budget neutrality adjustments are made to the conversion factor and the weights to assure that the revisions in the wage index, APC groups, and relative weights do not affect aggregate payments. The impact of the wage and recalibration changes does vary somewhat by hospital group. Estimates of these impacts are displayed on Table 10.
The overall projected increase in payments for urban hospitals is slightly lower (2.5 percent) than the average increase for all hospitals (3.5 percent) while the increase for rural hospitals is significantly greater (7.6 percent) than the average increase. Rural hospitals gain 2.3 percent from the wage index change, and also gain 1.6 percent from APC changes. A discussion of the distribution of outlier payments that we project under this proposed rule can be found under section D below. Table 11 presents the outlier distribution that we expect to see under this proposed rule.
3. Limitations of Our Analysis
The distributional impacts represent the projected effects of the proposed policy changes, as well as statutory changes effective for 2003, on various hospital groups. We estimate the effects of individual policy changes by estimating payments per service while holding all other payment policies constant. We use the best data available but do not attempt to predict behavioral responses to our policy changes. In addition, we do not make adjustments for future changes in variables such as service volume, service mix, or number of encounters.
4. Estimated Impacts of This Proposed Rule on Hospitals
The OPPS is a budget neutral payment system under which the increase to the total payments made under OPPS is limited by the increase to the conversion factor set under the methodology in the statute. The impact tables show the redistributive effects of the wage index and APC changes. In some cases, under this proposed rule, hospitals would receive more total payment than in 2002 while in other cases they would receive less total payment than they received in 2002. The impact of this proposed rule would depend on a number of factors, most significant of which are the mix of services furnished by a hospital (for example, how the APCs for the hospital's most frequently furnished services would change) and the impact of the wage index changes on the hospital.
Column 4 in Table 10 represents the full impact on each hospital group of all Start Printed Page 52146the changes for 2003. Columns 2 and 3 in the table reflect the independent effects of the proposed change in the wage index and the APC reclassification and recalibration changes, respectively. We excluded critical access hospitals (CAHs) from the analysis of the impact of the proposed 2003 OPPS rates that is summarized in Table 10. For that reason, the total number of hospitals included in Table 10 (4,551) is lower than in previous years. CAHs are excluded from the OPPS.
In general, the wage index changes favor rural hospitals, particularly the largest in bed size and volume. The only rural hospitals that would experience a negative impact due to wage index changes are those in Puerto Rico, a decrease of 2.8 percent. Conversely, the urban hospitals are generally negatively affected by wage index changes, with the largest decreases occurring in those with 300-499 beds (−0.7 percent) and those in the Middle Atlantic (−1.3 percent), Pacific (−.09 percent) and Puerto Rico Regions (−1.8 percent). However, this effect is somewhat lessened by the distribution of outlier payments as discussed in more detail below.
The APC reclassification and recalibration changes also favor rural hospitals and have a negative effect on urban hospitals in excess of 200 beds. Specifically, urban hospitals with 200-299 beds (−0.5 percent decrease), urban hospitals with 300-499 beds (−2.0 percent decrease) and urban hospitals in excess of 500 beds (a −1.9 percent decrease) all show a decrease attributed to APC recalibration. We believe this occurs as a result of our folding 75 percent of estimated pass-through device costs into APC payments in the 2002 OPPS. Specifically, a comparison of the relative payment weights proposed for 2003, as listed in Addendum A, with the final 2002 relative payment weights in the March 1, 2002 final rule shows a decrease in the weights for certain APCs in 2002 that included a fold-in of 75 percent of estimated pass-through device costs. We relied on cost information supplied by device manufacturers in estimating the device costs to be folded in when calculating the median APC costs for the 2002 OPPS, whereas the proposed 2003 relative payment weights are based on actual hospital charges and utilization under the OPPS as reported by hospitals. We believe this downward tendency in the payment weights for APCs that include device costs, based on actual hospital experience, accounts in part for the lower positive effect of the proposed 2003 rates on urban hospitals and on teaching hospitals, which tend to perform a higher number of procedures involving costly new technology devices, in contrast with an increased positive effect in 2003 on rural and non-teaching hospitals, which tend to furnish a higher volume of clinic and preventive services than procedures associated with expensive new technology devices.
In both urban and rural areas, hospitals that provide a lower volume of outpatient services are projected to receive a larger increase in payments than higher volume hospitals. In rural areas, hospitals with volumes of fewer than 5000 services are projected to experience a significant increase in payments (8.1 percent). The less favorable impact for the high volume urban hospitals is attributable to both wage index and APC changes. For example, urban hospitals providing more than 42,999 services are projected to gain a combined 1.6 percent due to these changes.
Major teaching hospitals are projected to experience a smaller increase in payments (1.7 percent) than the aggregate for all hospitals (3.5 percent) due to negative impacts of the wage index (−0.5 percent) and recalibration (−1.2 percent). Hospitals with less intensive teaching programs are projected to experience an overall increase (2.0 percent) that is smaller than the average for all hospitals. There is little difference in impact among hospitals with that serve low-income patients.
Table 10.—Impact of Changes for CY 2003 Hospital Outpatient Prospective Payment System
[Percent change in total payment to hospitals (program and beneficiary); does not include the effects of outlier and transitional pass-through payments or of transitional corridor payments.]
Number of hospitals 1 (1) New wage index 2 (2) APC changes)3 (3) All CY 2003 changes 4 (4) ALL HOSPITALS 4,551 0.0 0.0 3.5 NON-TEFRA HOSPITALS 4,002 0.0 −0.1 3.4 URBAN HOSPS 2,429 −0.6 −0.5 2.5 LARGE URBAN (GT 1 MILL.) 1,398 −0.7 −0.1 2.6 OTHER URBAN (LE 1 MILL.) 1,031 −0.4 −0.9 2.2 RURAL HOSPS 1,573 2.3 1.6 7.6 BEDS (URBAN): 0-99 BEDS 554 −0.3 3.1 6.4 100-199 BEDS 882 −0.6 1.4 4.3 200-299 BEDS 488 −0.6 −0.5 2.3 300-499 BEDS 364 −0.7 −2.0 0.7 500+ BEDS 141 −0.3 −1.9 1.3 BEDS (RURAL): 0-49 BEDS 754 0.4 2.9 7.0 50-99 BEDS 479 1.5 2.3 7.6 100-149 BEDS 201 2.4 1.5 7.6 150-199 BEDS 73 5.5 0.1 9.5 200+ BEDS 66 3.3 0.0 7.0 VOLUME (URBAN): LT 5,000 188 0.9 6.5 10.9 5,000-10,999 305 −0.8 5.1 7.9 11,000-20,999 472 −0.7 2.6 5.5 21,000-42,999 657 −0.8 0.3 3.0 GT 42,999 807 −0.5 −1.4 1.6 VOLUME (RURAL): LT 5,000 326 0.2 4.2 8.1 5,000-10,999 446 0.6 4.4 8.7 Start Printed Page 52147 11,000-20,999 373 1.3 2.7 7.7 21,000-42,999 290 1.9 1.4 6.9 GT 42,999 138 4.3 −0.2 7.8 REGION (URBAN): NEW ENGLAND 127 −0.6 0.6 3.4 MIDDLE ATLANTIC 372 −1.3 0.2 2.3 SOUTH ATLANTIC 370 −0.2 −0.1 3.2 EAST NORTH CENT. 413 −0.7 −1.4 1.4 EAST SOUTH CENT. 153 −0.6 −1.0 1.9 WEST NORTH CENT. 172 −0.3 −1.6 1.6 WEST SOUTH CENT. 293 0.5 −0.7 3.3 MOUNTAIN 122 −0.4 −1.1 1.9 PACIFIC 368 −0.9 0.6 3.1 PUERTO RICO 39 −1.8 4.7 6.4 REGION (RURAL): NEW ENGLAND 40 1.6 1.3 6.5 MIDDLE ATLANTIC 63 2.2 1.3 7.2 SOUTH ATLANTIC 226 2.6 2.1 8.4 EAST NORTH CENT. 213 1.2 −0.2 4.6 EAST SOUTH CENT. 232 2.3 2.6 8.7 WEST NORTH CENT. 271 2.0 0.9 6.6 WEST SOUTH CENT. 278 1.8 3.2 8.8 MOUNTAIN 141 4.1 1.3 9.2 PACIFIC 104 5.6 2.7 12.1 PUERTO RICO 5 −2.8 10.4 11.1 TEACHING STATUS: NON-TEACHING 2,935 0.4 1.1 5.0 MINOR 782 −0.4 −1.1 2.0 MAJOR 284 −0.5 −1.2 1.7 DSH PATIENT PERCENT: 0 11 4.9 10.1 19.4 GT 0-0.10 982 −0.2 −0.4 3.0 0.10-0.16 873 0.7 −0.8 3.4 0.16-0.23 767 −0.6 −0.3 2.6 0.23-0.35 756 −0.2 0.1 3.4 GE 0.35 613 −0.1 2.2 5.8 URBAN IME/DSH: IME & DSH 982 −0.7 −1.2 1.6 IME/NO DSH 0 0.0 0.0 0.0 NO IME/DSH 1,441 −0.4 0.7 3.8 NO IME/NO DSH 6 5.4 9.8 19.7 RURAL HOSP. TYPES: NO SPECIAL STATUS 610 0.7 2.7 7.1 RRC 167 4.2 0.2 8.2 SCH/EACH 507 1.5 2.7 7.8 MDH 199 0.8 2.1 6.6 SCH AND RRC 75 4.0 0.5 8.2 TYPE OF OWNERSHIP: VOLUNTARY 2,440 −0.1 −0.4 3.1 PROPRIETARY 707 −0.6 0.9 3.8 GOVERNMENT 855 0.7 0.7 5.0 SPECIALTY HOSPITALS: EYE AND EAR 13 −1.4 11.5 13.7 TRAUMA 153 −0.3 −1.5 1.6 CANCER 10 0.5 −3.9 0.2 TEFRA HOSPITALS (NOT INCLUDED ON OTHER LINES): REHAB 166 10.3 2.8 16.9 PSYCH 198 0.1 15.9 20.1 LTC 143 1.3 15.9 20.4 CHILDREN 42 −1.4 −2.8 −0.9 Note: For CY 2003, under the OPPS transitional corridor policy, the following categories of hospitals are held harmless compared to their 1996 payment margin for these services: cancer and children's hospitals and rural hospitals with 100 or fewer beds. 1 Some data necessary to classify hospitals by category were missing; thus, the total number of hospitals in each category may not equal the national total. 2 This column shows the impact of updating the wage index used to calculate payment by applying the proposed FY 2003 hospital inpatient wage index after geographic reclassification by the Medicare Geographic Classification Review Board. The hospital inpatient proposed rule for FY 2003 was published in the Federal Register on May 9, 2002. 3 This column shows the impact of changes resulting from the reclassification of HCPCS codes among APC groups and the recalibration of APC weights based on 2001 hospital claims data. Start Printed Page 52148 4 This column shows changes in total payment from CY 2002 to CY 2003, excluding outlier and pass-through payments. It incorporates all of the changes reflected in columns 2 and 3. In addition, it shows the impact of the proposed CY 2003 payment update. The sum of the columns may be different from the percentage changes shown here due to rounding. As stated elsewhere in this preamble, we propose to allocate 2 percent of the estimated 2003 expenditures to outlier payments. In Table 11 below, we provide a distribution by percentage of the total projected outlier payments for the categories of hospitals that we show in the impact table (Table 10).
We project, based on the mix of services for the hospitals that will be paid under the OPPS in 2003, that most hospitals will receive outlier payments. It appears that, with the exception of some smaller bed hospitals, all Tax Equity & Fiscal Responsibility Act of 1982 (TEFRA) hospitals can be expected to receive outlier payments. This is because TEFRA hospitals provide an atypical mix of specialty services (which account for less than 1 percent of total OPPS payment before consideration of outliers). A greater percentage of non-TEFRA hospitals are not projected to receive outlier payments.
The anticipated outlier payments for urban hospitals can be expected to ameliorate the impact of the wage index and APC changes on payments to urban hospitals.
Table 11.—Distribution of Outlier Payments for CY 2003 Hospital Outpatient Prospective Payment System
Number of hosps Percent of total hosps Number of hosps with outliers Percent of total outlier payments ALL HOSPITALS 4,551 100.00 4,306 100.00 NON-TEFRA HOSPITALS 4,002 88.00 3,987 99.40 URBAN HOSPS 2,429 53.40 2,420 83.20 LARGE URBAN (GT 1 MILL.) 1,398 30.80 1,396 55.20 OTHER URBAN (LE 1 MILL.) 1,031 22.60 1,024 28.00 RURAL HOSPS 1,573 34.60 1,567 16.00 BEDS (URBAN): 0-99 BEDS 554 12.20 550 6.80 100-199 BEDS 882 19.40 877 18.20 200-299 BEDS 488 10.80 488 16.20 300-499 BEDS 364 8.00 364 21.00 500+ BEDS 141 3.00 141 21.00 BEDS (RURAL): 0-49 BEDS 754 16.60 751 4.20 50-99 BEDS 479 10.60 477 5.00 100-149 BEDS 201 4.40 200 2.60 150-199 BEDS 73 1.60 73 2.00 200+ BEDS 66 1.40 66 2.40 VOLUME (URBAN): LT 5,000 188 4.20 180 1.00 5,000-10,999 310 6.80 309 2.80 11,000-20,999 467 10.20 467 7.00 21,000-42,999 659 14.40 659 15.80 GT 42,999 805 17.60 805 56.60 VOLUME (RURAL): LT 5,000 326 7.20 321 1.00 5,000-10,999 447 9.80 446 2.60 11,000-20,999 372 8.20 372 3.80 21,000-42,999 290 6.40 290 4.20 GT 42,999 138 3.00 138 4.40 REGION (URBAN): NEW ENGLAND 127 2.80 126 6.20 MIDDLE ATLANTIC 372 8.20 371 22.80 SOUTH ATLANTIC 370 8.20 369 11.00 EAST NORTH CENT. 413 9.00 409 15.60 EAST SOUTH CENT. 153 3.40 152 3.40 WEST NORTH CENT. 172 3.80 172 4.40 WEST SOUTH CENT. 293 6.40 292 8.20 MOUNTAIN 122 2.60 122 3.00 PACIFIC 368 8.00 368 8.60 PUERTO RICO 39 0.80 39 0.20 REGION (RURAL): NEW ENGLAND 40 0.80 40 1.00 MIDDLE ATLANTIC 63 1.40 63 1.00 SOUTH ATLANTIC 226 5.00 223 3.00 EAST NORTH CENT. 213 4.60 212 3.00 EAST SOUTH CENT. 232 5.00 232 1.60 WEST NORTH CENT. 271 6.00 270 2.40 WEST SOUTH CENT. 278 6.20 278 1.60 MOUNTAIN 141 3.00 141 1.40 PACIFIC 104 2.20 103 1.20 PUERTO RICO 5 0.20 5 0.00 TEACHING STATUS: NON-TEACHING 2,935 64.40 2,920 39.80 Start Printed Page 52149 MINOR 782 17.20 782 27.20 MAJOR 284 6.20 284 32.20 DSH PATIENT PERCENT: 0 11 0.20 10 0.00 GT 0—0.10 982 21.60 978 24.80 0.10—0.16 873 19.20 873 19.40 0.16—0.23 767 16.80 765 17.60 0.23—0.35 756 16.60 753 20.00 GE 0.35 613 13.40 608 17.40 URBAN IME/DSH: IME & DSH 982 21.60 982 57.20 IME/NO DSH 0 0.00 0 0.00 NO IME/DSH 1,441 31.60 1,433 26.00 NO IME/NO DSH 6 0.20 5 0.00 RURAL HOSP. TYPES: NO SPECIAL STATUS 621 13.60 617 5.20 RRC 167 3.60 166 4.00 SCH/EACH 511 11.20 511 4.40 MDH 199 4.40 198 1.00 SCH AND RRC 75 1.60 75 1.40 TYPE OF OWNERSHIP: VOLUNTARY 2,440 53.60 2,435 73.60 PROPRIETARY 707 15.60 702 10.40 GOVERNMENT 855 18.80 850 15.20 SPECIALTY HOSPITALS: EYE AND EAR 13 0.20 13 0.20 TRAUMA 153 3.40 153 15.00 CANCER 10 0.20 10 3.80 TEFRA HOSPITALS (NOT INCLUDED ON OTHER LINES): REHAB 166 3.60 113 0.20 PSYCH 198 4.40 65 0.20 LTC 143 3.20 100 0.20 CHILDREN 42 1.00 41 0.20 5. Estimated Impacts of This Proposed Rule on Beneficiaries
For services for which the beneficiary pays a coinsurance of 20 percent of the payment rate, the beneficiary share of payment would increase for services for which OPPS payments would rise and would decrease for services for which OPPS payments would fall. For example for a mid level office visit (APC 0601), the minimum unadjusted copayment in 2002 was $9.67; under this proposed rule, the minimum unadjusted copayment would be $10.82 because the OPPS payment for the service would increase under this proposed rule. For some services (those services for which a national unadjusted copayment amount is shown in Addendum B), however, the beneficiary copayment is frozen based on historic data and would not change, therefore not presenting any potential impact on beneficiaries.
However, in all cases, the statute limits beneficiary liability for copayment for a service to the inpatient hospital deductible for the applicable year. This amount was $812 for 2002, but is not yet determined for 2003. In general, the impact of this proposed rule on beneficiaries would vary based on the service the beneficiary receives and whether the copayment for the service is one that is frozen under the OPPS.
B. Payment Suspension for Unfiled Cost Reports
Overall Impact
We have examined the impacts of this proposed rule as required by Executive Order 12866 (September 1993, Regulatory Planning and Review), the Regulatory Flexibility Act (RFA) (September 16, 1980, Pub. L. 96-354), section 1102(b) of the Social Security Act, the Unfunded Mandates Reform Act of 1995 (Pub. L. 104-4), and Executive Order 13132. (A description of each of these requirements is stated above in section XIV.A.1.) We have determined that the proposed payment suspension provision does not have an economic impact on Medicare payments or other payments to providers. We are proposing to allow the Secretary flexibility in payment suspensions, but we are not altering the final payment determination in any way. With the implementation of the various prospective payment systems, the majority of the payment to providers is based on the PPS methodology and not on the cost report. Suspending all payments because the cost report is not timely filed negatively affects providers. Providing the Secretary with flexibility in payment suspension can lessen the financial impact on providers. For these reasons, we are not preparing analyses for either the RFA or section 1102(b) of the Act because we have determined, and we certify, that this rule would not have a significant economic impact on a substantial number of small entities or a significant impact on the operations of a substantial number of small rural hospitals. Under the requirement for Unfunded Mandates, this proposed rule will not have an economic effect on State, local, or tribal governments, in the aggregate, or on the private sector.
Anticipated Effects
1. Effects on providers that file cost reports. The majority of providers that file cost reports comply with the timeliness provisions and will be unaffected by this proposed regulation. Start Printed Page 52150In FY 2000, collectively 16 percent of hospitals, skilled nursing facilities, and home health agencies filed late cost reports. Of this 16 percent, 65 percent of those were only 1 day late. Currently, when a provider fails to file an acceptable cost report, the provider is placed on a complete payment suspension. Under this provision, for those providers who do not file timely, an immediate payment suspension less than the total suspension currently required might be imposed if the Secretary deemed it appropriate, which would allow the provider to more easily continue operations while completing and submitting the acceptable cost report.
2. Effects on other providers. The payment suspension provision does not affect other providers.
3. Effects on the Medicare Program. The provision would allow the Secretary to more effectively manage the Medicare program by imposing other than complete payment suspension when it is appropriate to do so. The Medicare program benefits because immediate complete payment suspension can be disruptive to providers and may negatively affect the care of Medicare patients. There are no costs to the Medicare program to doing so, because when the cost report is submitted, the suspended payments are returned to the provider.
4. Effects on Beneficiaries. We have determined that this provision has a potentially positive impact on beneficiaries. Under this proposed provision the Secretary will have the discretion to impose less than 100 percent payment suspension when a provider fails to timely file an acceptable cost report. Doing so will lessen the financial burden on the provider and thereby allow it to provide adequate services to its patient population as it works to complete and file an acceptable cost report.
Alternatives Considered
We considered not revising existing § 405.371(c) to provide that payment suspension could be “in whole or in part”. However, we did not choose this option because we believe the Secretary should have the discretion to impose partial payment suspensions when circumstances warrant in order to more effectively manage the Medicare program.
Conclusion
In conclusion, we have determined that the proposed payment suspension provision does not have an economic impact on Medicare payments.
Federalism
Since this regulation does not impose any costs on State or local governments, it will not have an effect on State or local governments. State or local governments will have no roles or responsibilities associated with this provision.
In accordance with the provisions of Executive Order 12866, this regulation was reviewed by the Office of Management and Budget.
Start List of SubjectsList of Subjects
42 CFR Part 405
- Administrative practice and procedure
- Health facilities
- Health professions
- Kidney diseases
- Medicare
- Reporting and recordkeeping requirements
- Rural areas
- X-rays
42 CFR Part 410
- Health facilities
- Health professions
- Kidney diseases
- Laboratories
- Medicare
- Reporting and recordkeeping requirements
- Rural areas
- X-rays
42 CFR Part 419
- Hospitals
- Medicare
- Reporting and recordkeeping requirements
For the reasons set forth in the preamble, the Centers for Medicare & Medicaid Services proposes to amend 42 CFR chapter IV as follows:
Start PartPART 405—FEDERAL HEALTH INSURANCE FOR THE AGED AND DISABLED
Subpart C—Suspension of Payment, Recovery of Overpayments, and Repayment of Scholarships and Loans
1. The authority citation for subpart C continues to read as follows:
2.Section 405.371(c) is revised to read as follows:
Suspension, offset and recoupment of Medicare payments to providers and suppliers of services.* * * * *(c) Suspension of payment in the case of unfiled cost reports. If a provider has failed to timely file an acceptable cost report, payment to the provider is immediately suspended in whole or in part until a cost report is filed and determined by the intermediary to be acceptable. In the case of an unfiled cost report, the provisions of § 405.372 do not apply. (See § 405.372(a)(2) concerning failure to furnish other information.)
PART 410—SUPPLEMENTARY MEDICAL INSURANCE (SMI) BENEFITS
1.The authority citation continues to read as follows:
2. In 410.43 republish the introductory text of paragraph (b), and add a new paragraph (b)(6) to read as follows:
Partial hospitalization services: Conditions and exclusions.* * * * *(b) The following services are separately covered and not paid as partial hospitalization services:
* * * * *(6) Clinical social worker services that meet the requirements of section 1861(hh)(2) of the Act.
PART 419—PROSPECTIVE PAYMENT SYSTEM FOR HOSPITAL OUTPATIENT DEPARTMENT SERVICES
1. The authority citation continues to read as follows:
[Amended]2. In § 419.66, paragraph (c)(1) is amended by adding the phrase “or by any category previously in effect” after “categories” and before “and'.
Catalog of Federal Domestic Assistance Program No. 93.773, Medicare—Hospital Insurance; and Program No. 93.774, Medicare—Supplementary Medical Insurance Program)
Dated: July 31, 2002.
Thomas A. Scully,
Administrator, Centers for Medicare & Medicaid Services.
Approved: August 5, 2002.Tommy G. Thompson,
Secretary.
Addendum A.—List of Ambulatory Payment Classifications (APCs) With Status Indicators, Relative Weights, Payment Rates, and Copayment Amounts Calendar Year 2003
APC Group title Status indicator Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment 0620 Critical Care S 10.25 $533.09 $150.55 $106.62 0656 Transcatheter Placement of Drug-Eluting Coronary Stents T 90.90 $4,927.70 $985.54 0657 Placement of Tissue Clips S 1.38 $71.77 $14.35 0658 Percutaneous Breast Biopsies T 5.57 $289.69 $57.94 —————————— CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All rights reserved. Start Printed Page 52159Addendum A.—List of Ambulatory Payment Classifications (APCs) with Status Indicators, Relative Weights, Payment Rates, and Copayment Amounts Calendar Year 2003
APC Group title Status indicator Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment 0001 Level I Photochemotherapy S 0.43 $22.36 $7.88 $4.47 0002 Fine needle Biopsy/Aspiration T 0.63 $32.77 $8.52 $6.55 0003 Bone Marrow Biopsy/Aspiration T 1.24 $64.49 $27.08 $12.90 0004 Level I Needle Biopsy/Aspiration Except Bone Marrow T 1.63 $84.77 $22.04 $16.95 0005 Level II Needle Biopsy /Aspiration Except Bone Marrow T 3.02 $157.07 $69.11 $31.41 0006 Level I Incision & Drainage T 1.89 $98.30 $25.56 $19.66 0007 Level II Incision & Drainage T 9.44 $490.96 $103.10 $98.19 0008 Level III Incision and Drainage T 16.32 $848.79 $169.76 0009 Nail Procedures T 0.68 $35.37 $8.34 $7.07 0010 Level I Destruction of Lesion T 0.70 $36.41 $10.56 $7.28 0011 Level II Destruction of Lesion T 1.93 $100.38 $27.88 $20.08 0012 Level I Debridement & Destruction T 0.76 $39.53 $10.67 $7.91 0013 Level II Debridement & Destruction T 1.10 $57.21 $14.30 $11.44 0015 Level III Debridement & Destruction T 1.43 $74.37 $18.59 $14.87 0016 Level IV Debridement & Destruction T 2.57 $133.66 $56.14 $26.73 0017 Level VI Debridement & Destruction T 16.46 $856.07 $227.84 $171.21 0018 Biopsy of Skin/Puncture of Lesion T 0.92 $47.85 $15.79 $9.57 0019 Level I Excision/ Biopsy T 3.94 $204.92 $75.82 $40.98 0020 Level II Excision/ Biopsy T 7.36 $382.79 $114.84 $76.56 0021 Level III Excision/ Biopsy T 14.58 $758.29 $227.49 $151.66 0022 Level IV Excision/ Biopsy T 18.10 $941.36 $367.13 $188.27 0023 Exploration Penetrating Wound T 2.38 $123.78 $40.37 $24.76 0024 Level I Skin Repair T 2.00 $104.02 $37.45 $20.80 0025 Level II Skin Repair T 5.89 $306.33 $116.41 $61.27 0027 Level IV Skin Repair T 15.73 $818.10 $343.60 $163.62 0028 Level I Breast Surgery T 17.44 $907.04 $303.74 $181.41 0029 Level II Breast Surgery T 29.89 $1,554.55 $632.64 $310.91 0030 Level III Breast Surgery T 40.23 $2,092.32 $763.55 $418.46 0032 Insertion of Central Venous/Arterial Catheter T 7.14 $371.34 $74.27 0033 Partial Hospitalization P 4.96 $257.96 $51.59 0035 Placement of Arterial or Central Venous Catheter T 0.24 $12.48 $3.74 $2.50 0041 Level I Arthroscopy T 27.58 $1,434.41 $580.06 $286.88 0042 Level II Arthroscopy T 43.24 $2,248.87 $804.74 $449.77 0043 Closed Treatment Fracture Finger/Toe/Trunk T 1.68 $87.38 $17.48 0045 Bone/Joint Manipulation Under Anesthesia T 13.47 $700.56 $280.22 $140.11 0046 Open/Percutaneous Treatment Fracture or Dislocation T 29.03 $1,509.82 $535.76 $301.96 0047 Arthroplasty without Prosthesis T 29.59 $1,538.95 $537.03 $307.79 0048 Arthroplasty with Prosthesis T 36.93 $1,920.69 $633.83 $384.14 0049 Level I Musculoskeletal Procedures Except Hand and Foot T 19.45 $1,011.58 $202.32 0050 Level II Musculoskeletal Procedures Except Hand and Foot T 23.60 $1,227.41 $245.48 0051 Level III Musculoskeletal Procedures Except Hand and Foot T 34.03 $1,769.87 $353.97 0052 Level IV Musculoskeletal Procedures Except Hand and Foot T 42.37 $2,203.62 $440.72 0053 Level I Hand Musculoskeletal Procedures T 14.76 $767.65 $253.49 $153.53 0054 Level II Hand Musculoskeletal Procedures T 23.50 $1,222.21 $472.33 $244.44 0055 Level I Foot Musculoskeletal Procedures T 18.28 $950.72 $355.34 $190.14 0056 Level II Foot Musculoskeletal Procedures T 22.94 $1,193.09 $405.81 $238.62 0057 Bunion Procedures T 23.87 $1,241.45 $496.58 $248.29 0058 Level I Strapping and Cast Application S 1.09 $56.69 $14.74 $11.34 0060 Manipulation Therapy S 0.36 $18.72 $3.74 Start Printed Page 52152 0068 CPAP Initiation S 1.59 $82.69 $45.48 $16.54 0069 Thoracoscopy T 29.51 $1,534.79 $591.64 $306.96 0070 Thoracentesis/Lavage Procedures T 3.30 $171.63 $34.33 0071 Level I Endoscopy Upper Airway T 1.01 $52.53 $14.18 $10.51 0072 Level II Endoscopy Upper Airway T 1.66 $86.33 $37.99 $17.27 0073 Level III Endoscopy Upper Airway T 3.63 $188.79 $74.14 $37.76 0074 Level IV Endoscopy Upper Airway T 12.84 $667.80 $295.70 $133.56 0075 Level V Endoscopy Upper Airway T 20.41 $1,061.50 $445.92 $212.30 0076 Endoscopy Lower Airway T 9.30 $483.68 $189.92 $96.74 0077 Level I Pulmonary Treatment S 0.26 $13.52 $7.44 $2.70 0078 Level II Pulmonary Treatment S 0.68 $35.37 $15.21 $7.07 0079 Ventilation Initiation and Management S 1.63 $84.77 $16.80 $16.95 0080 Diagnostic Cardiac Catheterization T 35.64 $1,853.60 $838.92 $370.72 0081 Non-Coronary Angioplasty or Atherectomy T 22.69 $1,180.08 $236.02 0082 Coronary Atherectomy T 75.42 $3,922.52 $1,137.53 $784.50 0083 Coronary Angioplasty and Percutaneous Valvuloplasty T 47.83 $2,487.59 $497.52 0084 Level I Electrophysiologic Evaluation S 9.60 $499.29 $99.86 0085 Level II Electrophysiologic Evaluation T 31.77 $1,652.33 $363.51 $330.47 0086 Ablate Heart Dysrhythm Focus T 43.70 $2,272.79 $772.75 $454.56 0087 Cardiac Electrophysiologic Recording/Mapping T 5.81 $302.17 $60.43 0088 Thrombectomy T 33.96 $1,766.23 $678.68 $353.25 0089 Insertion/Replacement of Permanent Pacemaker and Electrodes T 108.92 $5,664.82 $1,642.80 $1,132.96 0090 Insertion/Replacement of Pacemaker Pulse Generator T 77.15 $4,012.49 $1,444.50 $802.50 0091 Level II Vascular Ligation T 27.03 $1,405.80 $348.23 $281.16 0092 Level I Vascular Ligation T 24.97 $1,298.66 $505.37 $259.73 0093 Vascular Repair/Fistula Construction T 26.29 $1,367.32 $277.34 $273.46 0094 Level I Resuscitation and Cardioversion S 2.68 $139.38 $47.39 $27.88 0095 Cardiac Rehabilitation S 0.66 $34.33 $16.73 $6.87 0096 Non-Invasive Vascular Studies S 1.82 $94.66 $48.15 $18.93 0097 Cardiac and Ambulatory Blood Pressure Monitoring X 0.84 $43.69 $23.80 $8.74 0098 Injection of Sclerosing Solution T 1.90 $98.82 $20.88 $19.76 0099 Electrocardiograms S 0.38 $19.76 $3.95 0100 Stress Tests and Continuous ECG X 1.34 $69.69 $38.33 $13.94 0101 Tilt Table Evaluation S 4.40 $228.84 $105.27 $45.77 0103 Miscellaneous Vascular Procedures T 11.26 $585.62 $210.82 $117.12 0104 Transcatheter Placement of Intracoronary Stents T 72.72 $3,782.09 $756.42 0105 Revision/Removal of Pacemakers, AICD, or Vascular T 19.14 $995.45 $370.40 $199.09 0106 Insertion/Replacement/Repair of Pacemaker and/or Electrodes T 29.23 $1,520.22 $410.46 $304.04 0107 Insertion of Cardioverter-Defibrillator T 181.51 $9,440.15 $2,076.83 $1,888.03 0108 Insertion/Replacement/Repair of Cardioverter-Defibrillator Leads T 232.69 $12,101.97 $2,420.39 0109 Removal of Implanted Devices T 7.68 $399.43 $131.49 $79.89 0110 Transfusion S 4.04 $210.12 $42.02 0111 Blood Product Exchange S 13.60 $707.32 $198.05 $141.46 0112 Apheresis, Photopheresis, and Plasmapheresis S 39.40 $2,049.15 $612.47 $409.83 0113 Excision Lymphatic System T 19.75 $1,027.18 $205.44 0114 Thyroid/Lymphadenectomy Procedures T 37.55 $1,952.94 $507.76 $390.59 0115 Cannula/Access Device Procedures T 23.48 $1,221.17 $439.62 $244.23 0116 Chemotherapy Administration by Other Technique Except Infusion S 0.85 $44.21 $8.84 0117 Chemotherapy Administration by Infusion Only S 3.87 $201.27 $52.33 $40.25 0118 Chemotherapy Administration by Both Infusion and Other Technique S 5.68 $295.41 $72.03 $59.08 0119 Implantation of Devices T 25.88 $1,345.99 $269.20 0120 Infusion Therapy Except Chemotherapy T 1.81 $94.14 $25.42 $18.83 0121 Level I Tube changes and Repositioning T 2.17 $112.86 $45.14 $22.57 0122 Level II Tube changes and Repositioning T 3.89 $202.32 $46.53 $40.46 0123 Bone Marrow Harvesting and Bone Marrow/Stem Cell Transplant S 4.86 $252.76 $50.55 0124 Revision of Implanted Infusion Pump T 23.47 $1,220.65 $244.13 0125 Refilling of Infusion Pump T 1.73 $89.98 $18.00 0130 Level I Laparoscopy T 31.99 $1,663.77 $659.53 $332.75 0131 Level II Laparoscopy T 42.44 $2,207.26 $1,001.89 $441.45 0132 Level III Laparoscopy T 57.95 $3,013.92 $1,239.22 $602.78 0140 Esophageal Dilation without Endoscopy T 5.84 $303.73 $107.24 $60.75 Start Printed Page 52153 0141 Upper GI Procedures T 7.82 $406.71 $150.48 $81.34 0142 Small Intestine Endoscopy T 8.21 $426.99 $152.78 $85.40 0143 Lower GI Endoscopy T 8.37 $435.32 $186.06 $87.06 0146 Level I Sigmoidoscopy T 3.47 $180.47 $64.40 $36.09 0147 Level II Sigmoidoscopy T 7.30 $379.67 $83.53 $75.93 0148 Level I Anal/Rectal Procedure T 3.61 $187.75 $67.59 $37.55 0149 Level III Anal/Rectal Procedure T 16.91 $879.47 $293.06 $175.89 0150 Level IV Anal/Rectal Procedure T 22.02 $1,145.24 $437.12 $229.05 0151 Endoscopic Retrograde Cholangio-Pancreatography (ERCP) T 18.23 $948.12 $245.46 $189.62 0152 Percutaneous Abdominal and Biliary Procedures T 6.18 $321.42 $80.36 $64.28 0153 Peritoneal and Abdominal Procedures T 25.99 $1,351.71 $540.68 $270.34 0154 Hernia/Hydrocele Procedures T 26.98 $1,403.20 $491.12 $280.64 0155 Level II Anal/Rectal Procedure T 10.05 $522.69 $188.17 $104.54 0156 Level II Urinary and Anal Procedures T 3.10 $161.23 $48.37 $32.25 0157 Colorectal Cancer Screening: Barium Enema S 2.73 $141.98 $22.19 $28.40 0158 Colorectal Cancer Screening: Colonoscopy T 7.56 $393.19 $98.30 0159 Colorectal Cancer Screening: Flexible Sigmoidoscopy S 2.48 $128.98 $32.25 0160 Level I Cystourethroscopy and other Genitourinary Procedures T 6.44 $334.94 $105.06 $66.99 0161 Level II Cystourethroscopy and other Genitourinary Procedures T 16.03 $833.70 $249.36 $166.74 0162 Level III Cystourethroscopy and other Genitourinary Procedures T 21.50 $1,118.19 $223.64 0163 Level IV Cystourethroscopy and other Genitourinary Procedures T 24.77 $1,288.26 $257.65 0164 Level I Urinary and Anal Procedures T 1.18 $61.37 $18.41 $12.27 0165 Level III Urinary and Anal Procedures T 12.62 $656.35 $131.27 0166 Level I Urethral Procedures T 15.63 $812.90 $218.73 $162.58 0167 Level III Urethral Procedures T 27.15 $1,412.04 $555.84 $282.41 0168 Level II Urethral Procedures T 24.10 $1,253.42 $405.60 $250.68 0169 Lithotripsy T 46.44 $2,415.30 $1,115.69 $483.06 0170 Dialysis S 4.79 $249.12 $49.82 0179 Urinary Incontinence Procedures T 81.28 $4,227.29 $1,817.73 $845.46 0180 Circumcision T 18.95 $985.57 $304.87 $197.11 0181 Penile Procedures T 29.88 $1,554.03 $621.82 $310.81 0182 Insertion of Penile Prosthesis T 83.80 $4,358.35 $1,438.26 $871.67 0183 Testes/Epididymis Procedures T 22.19 $1,154.08 $448.94 $230.82 0184 Prostate Biopsy T 3.66 $190.35 $95.18 $38.07 0187 Miscellaneous Placement/Repositioning X 4.19 $217.92 $94.96 $43.58 0188 Level II Female Reproductive Proc T 1.12 $58.25 $11.95 $11.65 0189 Level III Female Reproductive Proc T 1.63 $84.77 $18.60 $16.95 0190 Surgical Hysteroscopy T 20.06 $1,043.30 $424.28 $208.66 0191 Level I Female Reproductive Proc T 0.22 $11.44 $3.32 $2.29 0192 Level IV Female Reproductive Proc T 2.94 $152.91 $42.81 $30.58 0193 Level V Female Reproductive Proc T 14.57 $757.77 $171.13 $151.55 0194 Level VI Female Reproductive Proc T 18.88 $981.93 $397.84 $196.39 0195 Level VII Female Reproductive Proc T 24.37 $1,267.46 $483.80 $253.49 0196 Dilation and Curettage T 16.32 $848.79 $338.23 $169.76 0197 Infertility Procedures T 1.19 $61.89 $24.76 $12.38 0198 Pregnancy and Neonatal Care Procedures T 1.33 $69.17 $32.92 $13.83 0199 Vaginal Delivery T 5.69 $295.93 $72.98 $59.19 0200 Therapeutic Abortion T 14.49 $753.61 $307.83 $150.72 0201 Spontaneous Abortion T 15.84 $823.82 $329.65 $164.76 0202 Level VIII Female Reproductive Proc T 39.09 $2,033.03 $996.18 $406.61 0203 Level IV Nerve Injections T 10.96 $570.02 $256.51 $114.00 0204 Level I Nerve Injections T 2.13 $110.78 $42.10 $22.16 0206 Level II Nerve Injections T 4.89 $254.32 $75.55 $50.86 0207 Level III Nerve Injections T 5.97 $310.49 $123.69 $62.10 0208 Laminotomies and Laminectomies T 39.95 $2,077.76 $415.55 0209 Extended EEG Studies and Sleep Studies, Level II S 12.09 $628.79 $280.58 $125.76 0212 Nervous System Injections T 3.53 $183.59 $84.45 $36.72 0213 Extended EEG Studies and Sleep Studies, Level I S 3.38 $175.79 $70.41 $35.16 0214 Electroencephalogram S 2.37 $123.26 $61.63 $24.65 0215 Level I Nerve and Muscle Tests S 0.60 $31.21 $6.24 0216 Level III Nerve and Muscle Tests S 3.06 $159.15 $71.62 $31.83 0218 Level II Nerve and Muscle Tests S 1.06 $55.13 $11.03 0220 Level I Nerve Procedures T 16.66 $866.47 $173.29 0221 Level II Nerve Procedures T 25.35 $1,318.43 $463.62 $263.69 Start Printed Page 52154 0222 Implantation of Neurological Device T 140.56 $7,310.39 $1,462.08 0223 Implantation of Pain Management Device T 20.30 $1,055.78 $211.16 0224 Implantation of Reservoir/Pump/Shunt T 39.14 $2,035.63 $453.41 $407.13 0225 Implantation of Neurostimulator Electrodes T 44.47 $2,312.84 $462.57 0226 Implantation of Drug Infusion Reservoir T 44.20 $2,298.80 $459.76 0227 Implantation of Drug Infusion Device T 128.03 $6,658.71 $1,331.74 0228 Creation of Lumbar Subarachnoid Shunt T 55.05 $2,863.10 $696.46 $572.62 0229 Transcatherter Placement of Intravascular Shunts T 49.00 $2,548.44 $662.59 $509.69 0230 Level I Eye Tests & Treatments S 0.78 $40.57 $15.82 $8.11 0231 Level III Eye Tests & Treatments S 2.24 $116.50 $52.43 $23.30 0232 Level I Anterior Segment Eye Procedures T 4.91 $255.36 $112.36 $51.07 0233 Level II Anterior Segment Eye Procedures T 13.43 $698.48 $266.33 $139.70 0234 Level III Anterior Segment Eye Procedures T 21.45 $1,115.59 $535.48 $223.12 0235 Level I Posterior Segment Eye Procedures T 5.62 $292.29 $81.84 $58.46 0236 Level II Posterior Segment Eye Procedures T 20.62 $1,072.43 $214.49 0237 Level III Posterior Segment Eye Procedures T 35.09 $1,825.00 $818.54 $365.00 0238 Level I Repair and Plastic Eye Procedures T 3.04 $158.11 $58.96 $31.62 0239 Level II Repair and Plastic Eye Procedures T 6.91 $359.38 $115.94 $71.88 0240 Level III Repair and Plastic Eye Procedures T 16.99 $883.63 $315.31 $176.73 0241 Level IV Repair and Plastic Eye Procedures T 21.89 $1,138.48 $384.47 $227.70 0242 Level V Repair and Plastic Eye Procedures T 28.87 $1,501.50 $597.36 $300.30 0243 Strabismus/Muscle Procedures T 20.94 $1,089.07 $431.39 $217.81 0244 Corneal Transplant T 38.14 $1,983.62 $851.42 $396.72 0245 Level I Cataract Procedures without IOL Insert T 14.39 $748.41 $251.21 $149.68 0246 Cataract Procedures with IOL Insert T 23.59 $1,226.89 $495.96 $245.38 0247 Laser Eye Procedures Except Retinal T 4.97 $258.48 $108.56 $51.70 0248 Laser Retinal Procedures T 4.44 $230.92 $96.99 $46.18 0249 Level II Cataract Procedures without IOL Insert T 27.75 $1,443.25 $524.67 $288.65 0250 Nasal Cauterization/Packing T 1.68 $87.38 $30.58 $17.48 0251 Level I ENT Procedures T 1.92 $99.86 $19.97 0252 Level II ENT Procedures T 6.27 $326.10 $114.24 $65.22 0253 Level III ENT Procedures T 14.79 $769.21 $284.61 $153.84 0254 Level IV ENT Procedures T 21.89 $1,138.48 $352.93 $227.70 0256 Level V ENT Procedures T 35.51 $1,846.84 $369.37 0258 Tonsil and Adenoid Procedures T 21.15 $1,099.99 $437.25 $220.00 0259 Level VI ENT Procedures T 291.05 $15,137.22 $7,417.24 $3,027.44 0260 Level I Plain Film Except Teeth X 0.81 $42.13 $23.17 $8.43 0261 Level II Plain Film Except Teeth Including Bone Density Measurement X 1.37 $71.25 $34.15 $14.25 0262 Plain Film of Teeth X 0.60 $31.21 $10.30 $6.24 0263 Level I Miscellaneous Radiology Procedures X 1.99 $103.50 $45.54 $20.70 0264 Level II Miscellaneous Radiology Procedures X 2.75 $143.02 $77.23 $28.60 0265 Level I Diagnostic Ultrasound Except Vascular S 1.04 $54.09 $29.75 $10.82 0266 Level II Diagnostic Ultrasound Except Vascular S 1.70 $88.42 $48.63 $17.68 0267 Level III Diagnostic Ultrasound Except Vascular S 2.58 $134.18 $65.52 $26.84 0268 Ultrasound Guidance Procedures S 1.48 $76.97 $15.39 0269 Level III Echocardiogram Except Transesophageal S 3.42 $177.87 $92.49 $35.57 0270 Transesophageal Echocardiogram S 5.65 $293.85 $146.79 $58.77 0271 Mammography S 0.69 $35.89 $16.80 $7.18 0272 Level I Fluoroscopy X 1.38 $71.77 $38.64 $14.35 0274 Myelography S 3.21 $166.95 $80.14 $33.39 0275 Arthrography S 3.09 $160.71 $69.09 $32.14 0276 Level I Digestive Radiology S 1.69 $87.90 $41.72 $17.58 0277 Level II Digestive Radiology S 2.50 $130.02 $60.47 $26.00 0278 Diagnostic Urography S 2.65 $137.82 $66.07 $27.56 0279 Level II Angiography and Venography except Extremity S 8.41 $437.40 $174.57 $87.48 0280 Level III Angiography and Venography except Extremity S 15.51 $806.66 $353.85 $161.33 0281 Venography of Extremity S 5.23 $272.01 $115.16 $54.40 0282 Miscellaneous Computerized Axial Tomography S 1.76 $91.54 $44.51 $18.31 0283 Computerized Axial Tomography with Contrast Material S 4.75 $247.04 $49.41 0284 Magnetic Resonance Imaging and Magnetic Resonance Angiography with Contrast Material S 7.74 $402.55 $201.02 $80.51 0285 Myocardial Positron Emission Tomography (PET) S 16.73 $870.11 $374.15 $174.02 0286 Myocardial Scans S 6.94 $360.94 $198.52 $72.19 0287 Complex Venography S 7.13 $370.82 $114.51 $74.16 0288 Bone Density:Axial Skeleton S 1.38 $71.77 $14.35 Start Printed Page 52155 0289 Needle Localization for Breast Biopsy X 1.84 $95.70 $44.80 $19.14 0290 Level I Diagnostic Nuclear Medicine Excluding Myocardial Scans S 2.16 $112.34 $56.17 $22.47 0291 Level II Diagnostic Nuclear Medicine Excluding Myocardial Scans S 4.19 $217.92 $108.96 $43.58 0292 Level III Diagnostic Nuclear Medicine Excluding Myocardial Scans S 4.53 $235.60 $117.80 $47.12 0294 Level II Therapeutic Nuclear Medicine S 4.45 $231.44 $127.29 $46.29 0295 Level I Therapeutic Nuclear Medicine S 3.86 $200.75 $110.41 $40.15 0296 Level I Therapeutic Radiologic Procedures S 2.12 $110.26 $52.92 $22.05 0297 Level II Therapeutic Radiologic Procedures S 7.80 $405.67 $172.51 $81.13 0299 Miscellaneous Radiation Treatment S 6.20 $322.46 $64.49 0300 Level I Radiation Therapy S 1.53 $79.57 $15.91 0301 Level II Radiation Therapy S 2.22 $115.46 $23.09 0302 Level III Radiation Therapy S 10.17 $528.93 $200.99 $105.79 0303 Treatment Device Construction X 2.93 $152.39 $68.58 $30.48 0304 Level I Therapeutic Radiation Treatment Preparation X 1.69 $87.90 $41.52 $17.58 0305 Level II Therapeutic Radiation Treatment Preparation X 3.87 $201.27 $91.38 $40.25 0310 Level III Therapeutic Radiation Treatment Preparation X 14.38 $747.89 $339.05 $149.58 0312 Radioelement Applications S 4.23 $220.00 $44.00 0313 Brachytherapy S 13.80 $717.72 $143.54 0314 Hyperthermic Therapies S 4.24 $220.52 $101.77 $44.10 0320 Electroconvulsive Therapy S 4.46 $231.96 $80.06 $46.39 0321 Biofeedback and Other Training S 1.27 $66.05 $21.78 $13.21 0322 Brief Individual Psychotherapy S 1.44 $74.89 $12.40 $14.98 0323 Extended Individual Psychotherapy S 1.95 $101.42 $21.26 $20.28 0324 Family Psychotherapy S 2.71 $140.94 $28.19 0325 Group Psychotherapy S 1.55 $80.61 $18.27 $16.12 0330 Dental Procedures S 0.64 $33.29 $6.66 0332 Computerized Axial Tomography and Computerized Angiography without Contrast Material S 3.62 $188.27 $91.27 $37.65 0333 Computerized Axial Tomography and Computerized Angio w/o Contrast Material followed by Contrast S 5.69 $295.93 $146.98 $59.19 0335 Magnetic Resonance Imaging, Miscellaneous S 6.46 $335.98 $151.46 $67.20 0336 Magnetic Resonance Imaging and Magnetic Resonance Angiography without Contrast S 7.01 $364.58 $176.94 $72.92 0337 MRI and Magnetic Resonance Angiography without Contrast Material followed by Contrast Material S 9.86 $512.81 $240.77 $102.56 0339 Observation S 7.60 $395.27 $79.05 0340 Minor Ancillary Procedures X 0.66 $34.33 $6.87 0341 Skin Tests and Miscellaneous Red Blood Cell Tests X 0.16 $8.32 $3.08 $1.66 0342 Level I Pathology X 0.23 $11.96 $5.88 $2.39 0343 Level II Pathology X 0.47 $24.44 $13.20 $4.89 0344 Level III Pathology X 0.66 $34.33 $18.54 $6.87 0345 Level I Transfusion Laboratory Procedures X 0.19 $9.88 $3.06 $1.98 0346 Level II Transfusion Laboratory Procedures X 0.42 $21.84 $5.46 $4.37 0347 Level III Transfusion Laboratory Procedures X 0.98 $50.97 $12.74 $10.19 0348 Fertility Laboratory Procedures X 0.83 $43.17 $8.63 0352 Level I Injections X 0.14 $7.28 $1.46 0353 Level II Allergy Injections X 0.43 $22.36 $4.47 0354 Administration of Influenza/Pneumonia Vaccine K 0.09 $4.68 0355 Level I Immunizations K 0.24 $12.48 $2.50 0356 Level II Immunizations K 0.69 $35.89 $7.18 0359 Level II Injections X 0.83 $43.17 $8.63 0360 Level I Alimentary Tests X 1.65 $85.81 $42.91 $17.16 0361 Level II Alimentary Tests X 3.55 $184.63 $83.23 $36.93 0362 Level III Otorhinolaryngologic Function Tests X 2.83 $147.19 $29.44 0363 Level I Otorhinolaryngologic Function Tests X 0.76 $39.53 $14.63 $7.91 0364 Level I Audiometry X 0.45 $23.40 $9.13 $4.68 0365 Level II Audiometry X 1.31 $68.13 $20.16 $13.63 0367 Level I Pulmonary Test X 0.60 $31.21 $15.61 $6.24 0368 Level II Pulmonary Tests X 0.96 $49.93 $24.97 $9.99 0369 Level III Pulmonary Tests X 2.39 $124.30 $41.02 $24.86 0370 Allergy Tests X 0.74 $38.49 $11.16 $7.70 0371 Level I Allergy Injections X 0.50 $26.00 $5.20 0372 Therapeutic Phlebotomy X 0.56 $29.13 $10.09 $5.83 0373 Neuropsychological Testing X 2.37 $123.26 $24.65 0374 Monitoring Psychiatric Drugs X 1.20 $62.41 $12.48 Start Printed Page 52156 0600 Low Level Clinic Visits V 0.91 $47.33 $9.47 0601 Mid Level Clinic Visits V 1.04 $54.09 $10.82 0602 High Level Clinic Visits V 1.57 $81.65 $16.33 0610 Low Level Emergency Visits V 1.49 $77.49 $19.57 $15.50 0611 Mid Level Emergency Visits V 2.66 $138.34 $36.47 $27.67 0612 High Level Emergency Visits V 4.53 $235.60 $54.14 $47.12 0620 Critical Care S 10.25 $533.09 $150.55 $106.62 0656 Transcatheter Placement of Drug-Eluting Coronary Stents T 90.90 $4,927.70 $985.54 0657 Placement of Tissue Clips S 1.38 $71.77 $14.35 0658 Percutaneous Breast Biopsies T 5.57 $289.69 $57.94 0659 Hyperbaric Oxygen S 3.12 $162.27 $32.45 0660 Level II Otorhinolaryngologic Function Tests X 1.65 $85.81 $31.75 $17.16 0661 Level IV Pathology X 3.46 $179.95 $98.97 $35.99 0662 CT Angiography S 5.96 $309.97 $170.48 $61.99 0663 Stereoteactic Radiosurgery S 63.69 $3,312.45 $662.49 0664 Proton Beam Radiation Therapy S 11.03 $573.66 $114.73 0665 Bone Density:AppendicularSkeleton S 0.73 $37.97 $7.59 0666 Myocardial Add-on Scans S 1.59 $82.69 $45.48 $16.54 0667 Nonmyocardial Positron Emission Tomography (PET) S 18.68 $971.53 $194.31 0668 Level I Angiography and Venography except Extremity S 5.36 $278.77 $122.66 $55.75 0669 Digital Mammography S 0.95 $49.41 $9.88 0670 Intravenous and Intracardiac Ultrasound S 14.78 $768.69 $276.73 $153.74 0671 Level II Echocardiogram Except Transesophageal S 1.68 $87.38 $45.44 $17.48 0672 Level IV Posterior Segment Procedures T 39.95 $2,077.76 $1,038.88 $415.55 0673 Level IV Anterior Segment Eye Procedures T 27.47 $1,428.69 $685.77 $285.74 0674 Prostate Cryoablation T 69.25 $3,601.62 $720.32 0675 Prostatic Thermotherapy T 51.57 $2,682.10 $536.42 0676 Level II Transcatheter Thrombolysis T 4.62 $240.28 $64.88 $48.06 0677 Level I Transcatheter Thrombolysis T 2.80 $145.63 $29.13 0678 External Counterpulsation T 2.55 $132.62 $26.52 0679 Level II Resuscitation and Cardioversion S 5.70 $296.45 $100.79 $59.29 0680 Insertion of Patient Activated Event Recorders S 51.95 $2,701.87 $540.37 0681 Knee Arthroplasty T 158.14 $8,224.70 $3,289.88 $1,644.94 0682 Level V Debridement & Destruction T 6.74 $350.54 $161.25 $70.11 0683 Level II Photochemotherapy S 2.11 $109.74 $39.51 $21.95 0684 Prostate Brachytherapy T 103.47 $5,381.37 $1,076.27 0685 Level III Needle Biopsy/Aspiration Except Bone Marrow T 4.47 $232.48 $102.29 $46.50 0686 Level III Skin Repair T 11.30 $587.70 $270.34 $117.54 0687 Revision/Removal of Neurostimulator Electrodes T 19.50 $1,014.18 $466.52 $202.84 0688 Revision/Removal of Neurostimulator Pulse Generator Receiver T 30.58 $1,590.44 $779.32 $318.09 0689 Electronic Analysis of Cardioverter-defibrillators S 0.60 $31.21 $12.03 $6.24 0690 Electronic Analysis of Pacemakers and other Cardiac Devices S 0.45 $23.40 $10.63 $4.68 0691 Electronic Analysis of Programmable Shunts/Pumps S 3.14 $163.31 $89.02 $32.66 0692 Electronic Analysis of Neurostimulator Pulse Generators S 0.85 $44.21 $24.32 $8.84 0693 Level II Breast Reconstruction T 39.30 $2,043.95 $798.17 $408.79 0694 Mohs Surgery T 3.90 $202.84 $81.14 $40.57 0695 Level VII Debridement & Destruction T 19.65 $1,021.98 $266.59 $204.40 0697 Level I Echocardiogram Except Transesophageal S 1.51 $78.53 $40.84 $15.71 0698 Level II Eye Tests & Treatments S 1.01 $52.53 $20.49 $10.51 0699 Level IV Eye Tests & Treatment T 2.37 $123.26 $55.47 $24.65 0701 SR 89 chloride, per mCi K 6.43 $334.42 $66.88 0702 SM 153 lexidronam, 50 mCi K 15.02 $781.18 $156.24 0706 New Technology - Level I ($0 - $50) S $25.00 $5.00 0707 New Technology - Level II ($50 - $100) S $75.00 $15.00 0708 New Technology - Level III ($100 - $200) S $150.00 $30.00 0709 New Technology - Level IV ($200 - $300) S $250.00 $50.00 0710 New Technology - Level V ($300 - $500) S $400.00 $80.00 0711 New Technology - Level VI ($500 - $750) S $625.00 $125.00 0712 New Technology - Level VII ($750 - $1000) S $875.00 $175.00 0713 New Technology - Level VIII ($1000 - $1250) S $1,125.00 $225.00 0714 New Technology - Level IX ($1250 - $1500) S $1,375.00 $275.00 0715 New Technology - Level X ($1500 - $1750) S $1,625.00 $325.00 0716 New Technology - Level XI ($1750 - $2000) S $1,875.00 $375.00 Start Printed Page 52157 0717 New Technology - Level XII ($2000 - $2500) S $2,250.00 $450.00 0718 New Technology - Level XIII ($2500 - $3000) S $2,750.00 $550.00 0719 New Technology-Level XIV ($3000- $3500) S $3,250.00 $650.00 0720 New Technology - Level XV ($3500 - $5000) S $4,250.00 $850.00 0721 New Technology - Level XVI ($5000 - $6000) S $5,500.00 $1,100.00 0726 Dexrazoxane hcl injection, 250 mg K 2.40 $124.82 $24.96 0728 Filgrastim 300 mcg injection K 2.24 $116.50 $23.30 0730 Pamidronate disodium , 30 mg K 3.46 $179.95 $35.99 0732 Mesna injection 200 mg K 0.55 $28.60 $5.72 0733 Non esrd epoetin alpha inj, 1000 u K 0.19 $9.88 $1.98 0734 Darbepoetin alfa, 1 mcg G $4.74 $.68 0800 Leuprolide acetate, 3.75 mg K 4.15 $215.84 $43.17 0802 Etoposide oral 50 mg K 0.54 $28.08 $5.62 0807 Aldesleukin/single use vial K 6.09 $316.73 $63.35 0810 Goserelin acetate implant 3.6 mg K 5.94 $308.93 $61.79 0811 Carboplatin injection 50 mg K 1.58 $82.17 $16.43 0813 Cisplatin 10 mg injection K 0.47 $24.44 $4.89 0820 Daunorubicin 10 mg K 2.27 $118.06 $23.61 0821 Daunorubicin citrate liposom 10 mg K 3.17 $164.87 $32.97 0822 Diethylstilbestrol injection 250 mg K 2.21 $114.94 $22.99 0823 Docetaxel, 20 mg K 4.01 $208.56 $41.71 0827 Floxuridine injection 500 mg K 2.42 $125.86 $25.17 0828 Gemcitabine HCL 200 mg K 1.49 $77.49 $15.50 0830 Irinotecan injection 20 mg K 1.86 $96.74 $19.35 0831 Ifosfomide injection 1 gm K 2.06 $107.14 $21.43 0832 Idarubicin hcl injection 5 mg K 4.57 $237.68 $47.54 0838 Interferon gamma 1-b inj, 3 million u K 2.49 $129.50 $25.90 0840 Melphalan hydrochl 50 mg K 4.09 $212.72 $42.54 0842 Fludarabine phosphate inj 50 mg K 3.30 $171.63 $34.33 0843 Pegaspargase, singl dose vial K 2.38 $123.78 $24.76 0844 Pentostatin injection, 10 mg K 21.32 $1,108.83 $221.77 0849 Rituximab, 100 mg K 5.71 $296.97 $59.39 0852 Topotecan, 4 mg K 7.61 $395.79 $79.16 0855 Vinorelbine tartrate, 10 mg K 1.10 $57.21 $11.44 0856 Porfimer sodium, 75 mg K 26.35 $1,370.44 $274.09 0857 Bleomycin sulfate injection 15 u K 3.10 $161.23 $32.25 0858 Cladribine, 1mg K 0.84 $43.69 $8.74 0861 Leuprolide acetate injection 1 mg K 0.84 $43.69 $8.74 0862 Mitomycin 5 mg inj K 1.18 $61.37 $12.27 0863 Paclitaxel injection, 30 mg K 2.50 $130.02 $26.00 0864 Mitoxantrone hcl, 5 mg K 3.02 $157.07 $31.41 0884 Rho d immune globulin inj, 1 dose pkg K 0.70 $36.41 $7.28 0888 Cyclosporine oral 100 mg K 0.04 $2.08 $.42 0890 Lymphocyte immune globulin 250 mg K 3.64 $189.31 $37.86 0891 Tacrolimus oral per 1 mg K 0.02 $1.04 $.21 0900 Alglucerase injection, per 10 u K 0.53 $27.56 $5.51 0901 Alpha 1 proteinase inhibitor, 10 mg K 0.02 $1.04 $.21 0902 Botulinum toxin a, per unit K 0.05 $2.60 $.52 0903 Cytomegalovirus imm IV/vial K 0.34 $17.68 $3.54 0905 Immune globulin 500 mg K 0.45 $23.40 $4.68 0909 Interferon beta-1a, 33 mcg K 2.77 $144.06 $28.81 0916 Injection imiglucerase /unit K 0.05 $2.60 $.52 0925 Factor viii per iu K 0.01 $.52 $.10 0926 Factor VIII (porcine) per iu K 0.02 $1.04 $.21 0927 Factor viii recombinant per iu K 0.01 $.52 $.10 0928 Factor ix complex per iu K 0.01 $.52 $.10 0929 Anti-inhibitor per iu K 0.01 $.52 $.10 0930 Antithrombin iii injection per iu K 0.01 $.52 $.10 0931 Factor IX non-recombinant, per iu K 0.01 $.52 $.10 0932 Factor IX recombinant, per iu K 0.03 $1.56 $.31 0949 Plasma, Pooled Multiple Donor, Solvent/Detergent T K 1.26 $65.53 $13.11 0950 Blood (Whole) For Transfusion K 1.25 $65.01 $13.00 0952 Cryoprecipitate K 0.53 $27.56 $5.51 0954 RBC leukocytes reduced K 1.59 $82.69 $16.54 0955 Plasma, Fresh Frozen K 0.71 $36.93 $7.39 0956 Plasma Protein Fraction K 1.94 $100.90 $20.18 0957 Platelet Concentrate K 0.67 $34.85 $6.97 0958 Platelet Rich Plasma K 1.12 $58.25 $11.65 0959 Red Blood Cells K 1.12 $58.25 $11.65 Start Printed Page 52158 0960 Washed Red Blood Cells K 1.42 $73.85 $14.77 0961 Infusion, Albumin (Human) 5%, 50 ml K 0.47 $24.44 $4.89 0963 Albumin (human), 5%, 250 ml K 2.37 $123.26 $24.65 0964 Albumin (human), 25%, 20 ml K 0.50 $26.00 $5.20 0965 Albumin (human), 25%, 50ml K 1.25 $65.01 $13.00 0966 Plasmaprotein fract,5%,250ml K 9.71 $505.01 $101.00 0970 New Technology - Level I ($0 - $50) T $25.00 $5.00 0971 New Technology - Level II ($50 - $100) T $75.00 $15.00 0972 New Technology - Level III ($100 - $200) T $150.00 $30.00 0973 New Technology - Level IV ($200 - $300) T $250.00 $50.00 0974 New Technology - Level V ($300 - $500) T $400.00 $80.00 0975 New Technology - Level VI ($500 - $750) T $625.00 $125.00 0976 New Technology - Level VII ($750 - $1000) T $875.00 $175.00 0977 New Technology - Level VIII ($1000 - $1250) T $1,125.00 $225.00 0978 New Technology - Level IX ($1250 - $1500) T $1,375.00 $275.00 0979 New Technology - Level X ($1500 - $1750) T $1,625.00 $325.00 0980 New Technology - Level XI ($1750 - $2000) T $1,875.00 $375.00 0981 New Technology - Level XII ($2000 - $2500) T $2,250.00 $450.00 0982 New Technology - Level XIII ($2500 - $3000) T $2,750.00 $550.00 0983 New Technology-Level XIV ($3000- $3500) T $3,250.00 $650.00 0984 New Technology - Level XV ($3500 - $5000) T $4,250.00 $850.00 0985 New Technology - Level XVI ($5000 - $6000) T $5,500.00 $1,100.00 1009 Cryoprecip reduced plasma K 0.66 $34.33 $6.87 1010 Blood, L/R, CMV-neg K 1.67 $86.86 $17.37 1011 Platelets, HLA-m, L/R, unit K 6.03 $313.61 $62.72 1013 Platelet concentrate, L/R, unit K 0.91 $47.33 $9.47 1016 Blood, L/R, froz/deglycerol/washed K 1.09 $56.69 $11.34 1017 Platelets, aph/pher, L/R, CMV-neg, unit K 4.78 $248.60 $49.72 1018 Blood, L/R, irradiated K 1.90 $98.82 $19.76 1019 Platelets, aph/pher, L/R, irradiated, unit K 6.93 $360.42 $72.08 1058 TC 99M oxidronate, per vial G $36.74 $5.26 1059 Cultured chondrocytes implnt K 43.64 $2,269.67 $453.93 1064 I-131 cap, each add mCi G $5.86 $.75 1065 I-131 sol, each add mCi G $15.81 $2.03 1084 Denileukin diftitox, 300 MCG K 13.94 $725.01 $145.00 1086 Temozolomide,oral 5 mg K 0.05 $2.60 $.52 1091 IN 111 Oxyquinoline, per .5 mCi K 4.36 $226.76 $45.35 1092 IN 111 Pentetate, per 0.5 mCi K 4.78 $248.60 $49.72 1095 Technetium TC 99M Depreotide K 0.25 $13.00 $2.60 1096 TC 99M Exametazime, per dose K 3.35 $174.23 $34.85 1122 TC 99M arcitumomab, per vial K 8.33 $433.23 $86.65 1167 Epirubicin hcl, 2 mg K 0.32 $16.64 $3.33 1178 Busulfan IV, 6 mg K 0.53 $27.56 $5.51 1203 Verteporfin for injection K 16.26 $845.67 $169.13 1207 Octreotide acetate depot 1mg K 1.22 $63.45 $12.69 1305 Apligraf K 12.47 $648.55 $129.71 1348 I-131 sol, per 1-6 mCi K 0.19 $9.88 $1.98 1409 Factor viia recombinant, per 1.2 mg K 13.53 $703.68 $140.74 1604 IN 111 capromab pendetide, per dose K 5.91 $307.37 $61.47 1605 Abciximab injection, 10 mg K 5.82 $302.69 $60.54 1609 Rho(D) immune globulin h, sd, 100 iu K 0.22 $11.44 $2.29 1611 Hylan G-F 20 injection, 16 mg K 2.43 $126.38 $25.28 1612 Daclizumab, parenteral, 25 mg K 3.77 $196.07 $39.21 1613 Trastuzumab, 10 mg K 0.66 $34.33 $6.87 1614 Valrubicin, 200 mg K 2.04 $106.10 $21.22 1615 Basiliximab, 20 mg K 9.64 $501.37 $100.27 1618 Vonwillebrandfactrcmplx, per iu K 0.01 $.52 $.10 1620 Technetium tc99m bicisate K 2.80 $145.63 $29.13 1625 Indium 111-in pentetreotide K 4.57 $237.68 $47.54 1628 Chromic phosphate p32 K 1.35 $70.21 $14.04 1716 Brachytx seed, Gold 198 K 0.35 $18.20 $3.64 1718 Brachytx seed, Iodine 125 K 0.64 $33.29 $6.66 1719 Brachytxseed, Non-HDR Ir-192 K 0.57 $29.65 $5.93 1720 Brachytx seed, Palladium 103 K 0.89 $46.29 $9.26 1765 Adhesion barrier H 1775 FDG, per dose (4-40 mCi/ml) G $475.00 $68.00 1783 Ocular implant, aqueous drainage assist device H 1888 Catheter, ablation, non-cardiac, endovascular (implantable H Start Printed Page 52159 1900 Lead, left ventricular coronary venous system H 2618 Probe, cryoablation H 7000 Amifostine, 500 mg K 4.46 $231.96 $46.39 7001 Amphotericin B lipid complex, 50 mg K 2.05 $106.62 $21.32 7011 Oprelvekin injection, 5 mg K 2.52 $131.06 $26.21 7024 Corticorelin ovine triflutat K 4.62 $240.28 $48.06 7025 Digoxin immune FAB (ovine) K 2.77 $144.06 $28.81 7030 Hemin, per 1 mg K 0.01 $.52 $.10 7031 Octreotide acetate injection K 0.90 $46.81 $9.36 7034 Somatropin injection K 0.78 $40.57 $8.11 7035 Teniposide, 50 mg K 1.24 $64.49 $12.90 7038 Muromonab-CD3, 5 mg K 4.43 $230.40 $46.08 7041 Tirofiban hydrochloride 12.5 mg K 4.82 $250.68 $50.14 7042 Capecitabine, oral, 150 mg K 0.03 $1.56 $.31 7043 Infliximab injection 10 mg K 0.74 $38.49 $7.70 7045 Trimetrexate glucoronate K 1.23 $63.97 $12.79 7046 Doxorubicin hcl liposome inj 10 mg K 4.54 $236.12 $47.22 7049 Filgrastim 480 mcg injection K 3.37 $175.27 $35.05 7051 Leuprolide acetate implant, 65 mg G $5,399.80 $773.02 9002 Tenecteplase, 50mg/vial K 25.46 $1,324.15 $264.83 9003 Palivizumab, per 50mg K 9.34 $485.76 $97.15 9004 Gemtuzumab ozogamicin inj,5mg K 1.05 $54.61 $10.92 9005 Reteplase injection K 10.84 $563.78 $112.76 9009 Baclofen refill kit - per 2000 mcg K 0.79 $41.09 $8.22 9010 Baclofen refill kit - per 4000 mcg K 0.95 $49.41 $9.88 9012 Arsenic Trioxide G $23.75 $3.40 9015 Mycophenolate mofetil oral 250 mg G $2.40 $.34 9016 Echocardiography contrast G $118.75 $17.00 9018 Botulinum tox B, per 100 u G $8.79 $1.26 9019 Caspofungin acetate, 5 mg G $34.20 $4.90 9020 Sirolimus tablet, 1 mg K 0.05 $2.60 $.52 9104 Anti-thymocycte globulin rabbit K 1.97 $102.46 $20.49 9105 Hep B imm glob, per 1 ml K 1.58 $82.17 $16.43 9106 Sirolimus, 1 mg K 0.05 $2.60 $.52 9108 Thyrotropin alfa, per 1.1 mg K 8.79 $457.16 $91.43 9109 Tirofliban hcl, per 6.25 mg K 2.32 $120.66 $24.13 9110 Alemtuzumab, per ml G $486.88 $69.70 9111 Inj, bivalirudin, per 250mg vial G $397.81 $56.95 9112 Perflutren lipid micro, per 2ml G $148.20 $21.22 9113 Inj pantoprazole sodium, vial G $22.80 $3.26 9114 Nesiritide, per 1.5 mg vial G $433.20 $62.02 9115 Inj, zoledronic acid, per 2 mg G $406.78 $58.23 9200 Orcel, per 36 cm2 G $1,135.25 $162.52 9201 Dermagraft, per 37.5 sq cm G $577.60 $82.69 9217 Leuprolide acetate suspnsion, 7.5 mg K 6.30 $327.66 $65.53 9500 Platelets, irradiated K 0.92 $47.85 $9.57 9501 Platelets, pheresis K 5.10 $265.25 $53.05 9502 Platelet pheresis irradiated K 1.99 $103.50 $20.70 9503 Fresh frozen plasma, ea unit K 0.77 $40.05 $8.01 9504 RBC deglycerolized K 1.91 $99.34 $19.87 9505 RBC irradiated K 1.82 $94.66 $18.93 9506 Granulocytes, pheresis K 0.45 $23.40 $4.68 Start Printed Page 52337Addendum B.—Payment Status by HCPCS Code and Related Information Calender Year 2003------
CPT/HCPCS Status indicator Description APC Relative weight Payment rate National unadjusted copayment Minimum unadjusted copayment 0002T C Endovas repr abdo ao aneurys 0003T S Cervicography 0706 $25.00 $5.00 0005T C Perc cath stent/brain cv art 0006T C Perc cath stent/brain cv art Start Printed Page 52160 0007T C Perc cath stent/brain cv art 0008T E Upper gi endoscopy w/suture 0009T T Endometrial cryoablation 0980 $1,875.00 $375.00 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 0012T T Osteochondral knee autograft 0041 27.58 $1,434.41 $580.06 $286.88 0013T T Osteochondral knee allograft 0041 27.58 $1,434.41 $580.06 $286.88 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 0014T T Meniscal transplant, knee 0041 27.58 $1,434.41 $580.06 $286.88 00160 N Anesth, nose/sinus surgery 00162 N Anesth, nose/sinus surgery 00164 N Anesth, biopsy of nose 0016T E Thermotx choroid vasc lesion 00170 N Anesth, procedure on mouth 00172 N Anesth, cleft palate repair 00174 C Anesth, pharyngeal surgery 00176 C Anesth, pharyngeal surgery 0017T E Photocoagulat macular drusen 0018T S Transcranial magnetic stimul 0215 0.60 $31.21 $6.24 00190 N Anesth, face/skull bone surg 00192 C Anesth, facial bone surgery 0019T A Extracorp shock wave tx, ms 0020T A 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 0025T S Ultrasonic pachymetry 0230 0.78 $40.57 $15.82 $8.11 0026T A Measure remnant lipoproteins 00300 N Anesth, head/neck/ptrunk 00320 N Anesth, neck organ surgery 00322 N Anesth, biopsy of thyroid 00350 N Anesth, neck vessel surgery 00352 N Anesth, neck vessel surgery 00400 N Anesth, skin, ext/per/atrunk 00402 N Anesth, surgery of breast 00404 C Anesth, surgery of breast 00406 C Anesth, surgery of breast 00410 N Anesth, correct heart rhythm 00450 N Anesth, surgery of shoulder 00452 C Anesth, surgery of shoulder 00454 N Anesth, collar bone biopsy 00470 N Anesth, removal of rib 00472 N Anesth, chest wall repair 00474 C Anesth, surgery of rib(s) 00500 N Anesth, esophageal surgery 00520 N Anesth, chest procedure 00522 N Anesth, chest lining biopsy Start Printed Page 52161 00524 C Anesth, chest drainage 00528 N Anesth, chest partition view 00530 N Anesth, pacemaker insertion 00532 N Anesth, vascular access 00534 N Anesth, cardioverter/defib 00537 N Anesth, cardiac electrophys 00540 C Anesth, chest surgery 00542 C Anesth, release of lung 00544 C Anesth, chest lining removal 00546 C Anesth, lung,chest wall surg 00548 N Anesth, trachea,bronchi surg 00550 N Anesth, sternal debridement 00560 C Anesth, open heart surgery 00562 C Anesth, open heart surgery 00563 N Anesth, heart proc w/pump 00566 N Anesth, cabg w/o pump 00580 C Anesth heart/lung transplant 00600 N Anesth, spine, cord surgery 00604 C Anesth, sitting procedure 00620 N Anesth, spine, cord surgery 00622 C Anesth, removal of nerves 00630 N Anesth, spine, cord surgery 00632 C Anesth, removal of nerves 00634 C Anesth for chemonucleolysis 00635 N Anesth, lumbar puncture 00670 C Anesth, spine, cord surgery 00700 N Anesth, abdominal wall surg 00702 N Anesth, for liver biopsy 00730 N Anesth, abdominal wall surg 00740 N Anesth, upper gi visualize 00750 N Anesth, repair of hernia 00752 N Anesth, repair of hernia 00754 N Anesth, repair of hernia 00756 N Anesth, repair of hernia 00770 N Anesth, blood vessel repair 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 00800 N Anesth, abdominal wall surg 00802 C Anesth, fat layer removal 00810 N Anesth, low intestine scope 00820 N Anesth, abdominal wall surg 00830 N Anesth, repair of hernia 00832 N Anesth, repair of hernia 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 00851 N Anesth, tubal ligation 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 00869 N Anesth, vasectomy 00870 N Anesth, bladder stone surg 00872 N Anesth kidney stone destruct 00873 N Anesth kidney stone destruct 00880 N Anesth, abdomen vessel surg 00882 C Anesth, major vein ligation 00902 N Anesth, anorectal surgery 00904 C Anesth, perineal surgery Start Printed Page 52162 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 00922 N Anesth, sperm duct surgery 00924 N Anesth, testis exploration 00926 N Anesth, removal of testis 00928 C 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/urethal 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 01180 N Anesth, pelvis nerve removal 01190 C 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, 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 01464 N Anesth, ankle arthroscopy 01470 N Anesth, lower leg surgery Start Printed Page 52163 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 Anesth, 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, 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 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 01951 N Anesth, burn, less 4 percent 01952 N Anesth, burn, 4-9 percent 01953 N Anesth, burn, each 9 percent Start Printed Page 52164 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 01995 N Regional anesthesia limb 01996 N Manage daily drug therapy 01999 N Unlisted anesth procedure 10021 T Fna w/o image 0002 0.63 $32.77 $8.52 $6.55 10022 T Fna w/image 0002 0.63 $32.77 $8.52 $6.55 10040 T Acne surgery 0010 0.70 $36.41 $10.56 $7.28 10060 T Drainage of skin abscess 0006 1.89 $98.30 $25.56 $19.66 10061 T Drainage of skin abscess 0006 1.89 $98.30 $25.56 $19.66 10080 T Drainage of pilonidal cyst 0006 1.89 $98.30 $25.56 $19.66 10081 T Drainage of pilonidal cyst 0007 9.44 $490.96 $103.10 $98.19 10120 T Remove foreign body 0006 1.89 $98.30 $25.56 $19.66 10121 T Remove foreign body 0021 14.58 $758.29 $227.49 $151.66 10140 T Drainage of hematoma/fluid 0007 9.44 $490.96 $103.10 $98.19 10160 T Puncture drainage of lesion 0018 0.92 $47.85 $15.79 $9.57 10180 T Complex drainage, wound 0007 9.44 $490.96 $103.10 $98.19 11000 T Debride infected skin 0015 1.43 $74.37 $18.59 $14.87 11001 T Debride infected skin add-on 0013 1.10 $57.21 $14.30 $11.44 11010 T Debride skin, fx 0022 18.10 $941.36 $367.13 $188.27 11011 T Debride skin/muscle, fx 0022 18.10 $941.36 $367.13 $188.27 11012 T Debride skin/muscle/bone, fx 0022 18.10 $941.36 $367.13 $188.27 11040 T Debride skin, partial 0015 1.43 $74.37 $18.59 $14.87 11041 T Debride skin, full 0015 1.43 $74.37 $18.59 $14.87 11042 T Debride skin/tissue 0016 2.57 $133.66 $56.14 $26.73 11043 T Debride tissue/muscle 0016 2.57 $133.66 $56.14 $26.73 11044 T Debride tissue/muscle/bone 0682 6.74 $350.54 $161.25 $70.11 11055 T Trim skin lesion 0012 0.76 $39.53 $10.67 $7.91 11056 T Trim skin lesions, 2 to 4 0012 0.76 $39.53 $10.67 $7.91 11057 T Trim skin lesions, over 4 0012 0.76 $39.53 $10.67 $7.91 11100 T Biopsy of skin lesion 0018 0.92 $47.85 $15.79 $9.57 11101 T Biopsy, skin add-on 0018 0.92 $47.85 $15.79 $9.57 11200 T Removal of skin tags 0013 1.10 $57.21 $14.30 $11.44 11201 T Remove skin tags add-on 0015 1.43 $74.37 $18.59 $14.87 11300 T Shave skin lesion 0012 0.76 $39.53 $10.67 $7.91 11301 T Shave skin lesion 0012 0.76 $39.53 $10.67 $7.91 11302 T Shave skin lesion 0013 1.10 $57.21 $14.30 $11.44 11303 T Shave skin lesion 0015 1.43 $74.37 $18.59 $14.87 11305 T Shave skin lesion 0013 1.10 $57.21 $14.30 $11.44 11306 T Shave skin lesion 0013 1.10 $57.21 $14.30 $11.44 11307 T Shave skin lesion 0013 1.10 $57.21 $14.30 $11.44 11308 T Shave skin lesion 0013 1.10 $57.21 $14.30 $11.44 11310 T Shave skin lesion 0013 1.10 $57.21 $14.30 $11.44 11311 T Shave skin lesion 0013 1.10 $57.21 $14.30 $11.44 11312 T Shave skin lesion 0013 1.10 $57.21 $14.30 $11.44 11313 T Shave skin lesion 0016 2.57 $133.66 $56.14 $26.73 11400 T Removal of skin lesion 0019 3.94 $204.92 $75.82 $40.98 11401 T Removal of skin lesion 0019 3.94 $204.92 $75.82 $40.98 11402 T Removal of skin lesion 0019 3.94 $204.92 $75.82 $40.98 11403 T Removal of skin lesion 0020 7.36 $382.79 $114.84 $76.56 11404 T Removal of skin lesion 0020 7.36 $382.79 $114.84 $76.56 11406 T Removal of skin lesion 0021 14.58 $758.29 $227.49 $151.66 11420 T Removal of skin lesion 0020 7.36 $382.79 $114.84 $76.56 11421 T Removal of skin lesion 0020 7.36 $382.79 $114.84 $76.56 11422 T Removal of skin lesion 0020 7.36 $382.79 $114.84 $76.56 11423 T Removal of skin lesion 0020 7.36 $382.79 $114.84 $76.56 11424 T Removal of skin lesion 0021 14.58 $758.29 $227.49 $151.66 11426 T Removal of skin lesion 0022 18.10 $941.36 $367.13 $188.27 11440 T Removal of skin lesion 0019 3.94 $204.92 $75.82 $40.98 Start Printed Page 52165 11441 T Removal of skin lesion 0019 3.94 $204.92 $75.82 $40.98 11442 T Removal of skin lesion 0020 7.36 $382.79 $114.84 $76.56 11443 T Removal of skin lesion 0020 7.36 $382.79 $114.84 $76.56 11444 T Removal of skin lesion 0020 7.36 $382.79 $114.84 $76.56 11446 T Removal of skin lesion 0022 18.10 $941.36 $367.13 $188.27 11450 T Removal, sweat gland lesion 0022 18.10 $941.36 $367.13 $188.27 11451 T Removal, sweat gland lesion 0022 18.10 $941.36 $367.13 $188.27 11462 T Removal, sweat gland lesion 0022 18.10 $941.36 $367.13 $188.27 11463 T Removal, sweat gland lesion 0022 18.10 $941.36 $367.13 $188.27 11470 T Removal, sweat gland lesion 0022 18.10 $941.36 $367.13 $188.27 11471 T Removal, sweat gland lesion 0022 18.10 $941.36 $367.13 $188.27 11600 T Removal of skin lesion 0019 3.94 $204.92 $75.82 $40.98 11601 T Removal of skin lesion 0019 3.94 $204.92 $75.82 $40.98 11602 T Removal of skin lesion 0019 3.94 $204.92 $75.82 $40.98 11603 T Removal of skin lesion 0020 7.36 $382.79 $114.84 $76.56 11604 T Removal of skin lesion 0020 7.36 $382.79 $114.84 $76.56 11606 T Removal of skin lesion 0021 14.58 $758.29 $227.49 $151.66 11620 T Removal of skin lesion 0020 7.36 $382.79 $114.84 $76.56 11621 T Removal of skin lesion 0019 3.94 $204.92 $75.82 $40.98 11622 T Removal of skin lesion 0020 7.36 $382.79 $114.84 $76.56 11623 T Removal of skin lesion 0020 7.36 $382.79 $114.84 $76.56 11624 T Removal of skin lesion 0021 14.58 $758.29 $227.49 $151.66 11626 T Removal of skin lesion 0022 18.10 $941.36 $367.13 $188.27 11640 T Removal of skin lesion 0020 7.36 $382.79 $114.84 $76.56 11641 T Removal of skin lesion 0020 7.36 $382.79 $114.84 $76.56 11642 T Removal of skin lesion 0020 7.36 $382.79 $114.84 $76.56 11643 T Removal of skin lesion 0020 7.36 $382.79 $114.84 $76.56 11644 T Removal of skin lesion 0021 14.58 $758.29 $227.49 $151.66 11646 T Removal of skin lesion 0022 18.10 $941.36 $367.13 $188.27 11719 T Trim nail(s) 0009 0.68 $35.37 $8.34 $7.07 11720 T Debride nail, 1-5 0009 0.68 $35.37 $8.34 $7.07 11721 T Debride nail, 6 or more 0009 0.68 $35.37 $8.34 $7.07 11730 T Removal of nail plate 0013 1.10 $57.21 $14.30 $11.44 11732 T Remove nail plate, add-on 0012 0.76 $39.53 $10.67 $7.91 11740 T Drain blood from under nail 0009 0.68 $35.37 $8.34 $7.07 11750 T Removal of nail bed 0019 3.94 $204.92 $75.82 $40.98 11752 T Remove nail bed/finger tip 0022 18.10 $941.36 $367.13 $188.27 11755 T Biopsy, nail unit 0019 3.94 $204.92 $75.82 $40.98 11760 T Repair of nail bed 0024 2.00 $104.02 $37.45 $20.80 11762 T Reconstruction of nail bed 0024 2.00 $104.02 $37.45 $20.80 11765 T Excision of nail fold, toe 0015 1.43 $74.37 $18.59 $14.87 11770 T Removal of pilonidal lesion 0022 18.10 $941.36 $367.13 $188.27 11771 T Removal of pilonidal lesion 0022 18.10 $941.36 $367.13 $188.27 11772 T Removal of pilonidal lesion 0022 18.10 $941.36 $367.13 $188.27 11900 T Injection into skin lesions 0012 0.76 $39.53 $10.67 $7.91 11901 T Added skin lesions injection 0012 0.76 $39.53 $10.67 $7.91 11920 T Correct skin color defects 0024 2.00 $104.02 $37.45 $20.80 11921 T Correct skin color defects 0024 2.00 $104.02 $37.45 $20.80 11922 T Correct skin color defects 0024 2.00 $104.02 $37.45 $20.80 11950 T Therapy for contour defects 0024 2.00 $104.02 $37.45 $20.80 11951 T Therapy for contour defects 0024 2.00 $104.02 $37.45 $20.80 11952 T Therapy for contour defects 0024 2.00 $104.02 $37.45 $20.80 11954 T Therapy for contour defects 0024 2.00 $104.02 $37.45 $20.80 11960 T Insert tissue expander(s) 0027 15.73 $818.10 $343.60 $163.62 11970 T Replace tissue expander 0027 15.73 $818.10 $343.60 $163.62 11971 T Remove tissue expander(s) 0022 18.10 $941.36 $367.13 $188.27 11975 E Insert contraceptive cap 11976 T Removal of contraceptive cap 0019 3.94 $204.92 $75.82 $40.98 11977 E Removal/reinsert contra cap 11980 X Implant hormone pellet(s) 0340 0.66 $34.33 $6.87 11981 X Insert drug implant device 0340 0.66 $34.33 $6.87 11982 X Remove drug implant device 0340 0.66 $34.33 $6.87 11983 X Remove/insert drug implant 0340 0.66 $34.33 $6.87 12001 T Repair superficial wound(s) 0024 2.00 $104.02 $37.45 $20.80 12002 T Repair superficial wound(s) 0024 2.00 $104.02 $37.45 $20.80 12004 T Repair superficial wound(s) 0024 2.00 $104.02 $37.45 $20.80 Start Printed Page 52166 12005 T Repair superficial wound(s) 0024 2.00 $104.02 $37.45 $20.80 12006 T Repair superficial wound(s) 0024 2.00 $104.02 $37.45 $20.80 12007 T Repair superficial wound(s) 0024 2.00 $104.02 $37.45 $20.80 12011 T Repair superficial wound(s) 0024 2.00 $104.02 $37.45 $20.80 12013 T Repair superficial wound(s) 0024 2.00 $104.02 $37.45 $20.80 12014 T Repair superficial wound(s) 0024 2.00 $104.02 $37.45 $20.80 12015 T Repair superficial wound(s) 0024 2.00 $104.02 $37.45 $20.80 12016 T Repair superficial wound(s) 0024 2.00 $104.02 $37.45 $20.80 12017 T Repair superficial wound(s) 0024 2.00 $104.02 $37.45 $20.80 12018 T Repair superficial wound(s) 0024 2.00 $104.02 $37.45 $20.80 12020 T Closure of split wound 0024 2.00 $104.02 $37.45 $20.80 12021 T Closure of split wound 0024 2.00 $104.02 $37.45 $20.80 12031 T Layer closure of wound(s) 0024 2.00 $104.02 $37.45 $20.80 12032 T Layer closure of wound(s) 0024 2.00 $104.02 $37.45 $20.80 12034 T Layer closure of wound(s) 0024 2.00 $104.02 $37.45 $20.80 12035 T Layer closure of wound(s) 0024 2.00 $104.02 $37.45 $20.80 12036 T Layer closure of wound(s) 0024 2.00 $104.02 $37.45 $20.80 12037 T Layer closure of wound(s) 0025 5.89 $306.33 $116.41 $61.27 12041 T Layer closure of wound(s) 0024 2.00 $104.02 $37.45 $20.80 12042 T Layer closure of wound(s) 0024 2.00 $104.02 $37.45 $20.80 12044 T Layer closure of wound(s) 0024 2.00 $104.02 $37.45 $20.80 12045 T Layer closure of wound(s) 0024 2.00 $104.02 $37.45 $20.80 12046 T Layer closure of wound(s) 0024 2.00 $104.02 $37.45 $20.80 12047 T Layer closure of wound(s) 0025 5.89 $306.33 $116.41 $61.27 12051 T Layer closure of wound(s) 0024 2.00 $104.02 $37.45 $20.80 12052 T Layer closure of wound(s) 0024 2.00 $104.02 $37.45 $20.80 12053 T Layer closure of wound(s) 0024 2.00 $104.02 $37.45 $20.80 12054 T Layer closure of wound(s) 0024 2.00 $104.02 $37.45 $20.80 12055 T Layer closure of wound(s) 0024 2.00 $104.02 $37.45 $20.80 12056 T Layer closure of wound(s) 0024 2.00 $104.02 $37.45 $20.80 12057 T Layer closure of wound(s) 0025 5.89 $306.33 $116.41 $61.27 13100 T Repair of wound or lesion 0025 5.89 $306.33 $116.41 $61.27 13101 T Repair of wound or lesion 0025 5.89 $306.33 $116.41 $61.27 13102 T Repair wound/lesion add-on 0024 2.00 $104.02 $37.45 $20.80 13120 T Repair of wound or lesion 0024 2.00 $104.02 $37.45 $20.80 13121 T Repair of wound or lesion 0024 2.00 $104.02 $37.45 $20.80 13122 T Repair wound/lesion add-on 0024 2.00 $104.02 $37.45 $20.80 13131 T Repair of wound or lesion 0024 2.00 $104.02 $37.45 $20.80 13132 T Repair of wound or lesion 0024 2.00 $104.02 $37.45 $20.80 13133 T Repair wound/lesion add-on 0024 2.00 $104.02 $37.45 $20.80 13150 T Repair of wound or lesion 0025 5.89 $306.33 $116.41 $61.27 13151 T Repair of wound or lesion 0024 2.00 $104.02 $37.45 $20.80 13152 T Repair of wound or lesion 0025 5.89 $306.33 $116.41 $61.27 13153 T Repair wound/lesion add-on 0024 2.00 $104.02 $37.45 $20.80 13160 T Late closure of wound 0027 15.73 $818.10 $343.60 $163.62 14000 T Skin tissue rearrangement 0027 15.73 $818.10 $343.60 $163.62 14001 T Skin tissue rearrangement 0027 15.73 $818.10 $343.60 $163.62 14020 T Skin tissue rearrangement 0027 15.73 $818.10 $343.60 $163.62 14021 T Skin tissue rearrangement 0027 15.73 $818.10 $343.60 $163.62 14040 T Skin tissue rearrangement 0027 15.73 $818.10 $343.60 $163.62 14041 T Skin tissue rearrangement 0027 15.73 $818.10 $343.60 $163.62 14060 T Skin tissue rearrangement 0027 15.73 $818.10 $343.60 $163.62 14061 T Skin tissue rearrangement 0027 15.73 $818.10 $343.60 $163.62 14300 T Skin tissue rearrangement 0027 15.73 $818.10 $343.60 $163.62 14350 T Skin tissue rearrangement 0027 15.73 $818.10 $343.60 $163.62 15000 T Skin graft 0025 5.89 $306.33 $116.41 $61.27 15001 T Skin graft add-on 0025 5.89 $306.33 $116.41 $61.27 15050 T Skin pinch graft 0025 5.89 $306.33 $116.41 $61.27 15100 T Skin split graft 0027 15.73 $818.10 $343.60 $163.62 15101 T Skin split graft add-on 0027 15.73 $818.10 $343.60 $163.62 15120 T Skin split graft 0027 15.73 $818.10 $343.60 $163.62 15121 T Skin split graft add-on 0027 15.73 $818.10 $343.60 $163.62 15200 T Skin full graft 0027 15.73 $818.10 $343.60 $163.62 15201 T Skin full graft add-on 0025 5.89 $306.33 $116.41 $61.27 15220 T Skin full graft 0027 15.73 $818.10 $343.60 $163.62 15221 T Skin full graft add-on 0025 5.89 $306.33 $116.41 $61.27 Start Printed Page 52167 15240 T Skin full graft 0027 15.73 $818.10 $343.60 $163.62 15241 T Skin full graft add-on 0025 5.89 $306.33 $116.41 $61.27 15260 T Skin full graft 0027 15.73 $818.10 $343.60 $163.62 15261 T Skin full graft add-on 0025 5.89 $306.33 $116.41 $61.27 15342 T Cultured skin graft, 25 cm 0025 5.89 $306.33 $116.41 $61.27 15343 T Culture skn graft addl 25 cm 0024 2.00 $104.02 $37.45 $20.80 15350 T Skin homograft 0686 11.30 $587.70 $270.34 $117.54 15351 T Skin homograft add-on 0027 15.73 $818.10 $343.60 $163.62 15400 T Skin heterograft 0025 5.89 $306.33 $116.41 $61.27 15401 T Skin heterograft add-on 0025 5.89 $306.33 $116.41 $61.27 15570 T Form skin pedicle flap 0027 15.73 $818.10 $343.60 $163.62 15572 T Form skin pedicle flap 0027 15.73 $818.10 $343.60 $163.62 15574 T Form skin pedicle flap 0027 15.73 $818.10 $343.60 $163.62 15576 T Form skin pedicle flap 0027 15.73 $818.10 $343.60 $163.62 15600 T Skin graft 0027 15.73 $818.10 $343.60 $163.62 15610 T Skin graft 0027 15.73 $818.10 $343.60 $163.62 15620 T Skin graft 0027 15.73 $818.10 $343.60 $163.62 15630 T Skin graft 0027 15.73 $818.10 $343.60 $163.62 15650 T Transfer skin pedicle flap 0027 15.73 $818.10 $343.60 $163.62 15732 T Muscle-skin graft, head/neck 0027 15.73 $818.10 $343.60 $163.62 15734 T Muscle-skin graft, trunk 0027 15.73 $818.10 $343.60 $163.62 15736 T Muscle-skin graft, arm 0027 15.73 $818.10 $343.60 $163.62 15738 T Muscle-skin graft, leg 0027 15.73 $818.10 $343.60 $163.62 15740 T Island pedicle flap graft 0027 15.73 $818.10 $343.60 $163.62 15750 T Neurovascular pedicle graft 0027 15.73 $818.10 $343.60 $163.62 15756 C Free muscle flap, microvasc 15757 C Free skin flap, microvasc 15758 C Free fascial flap, microvasc 15760 T Composite skin graft 0027 15.73 $818.10 $343.60 $163.62 15770 T Derma-fat-fascia graft 0027 15.73 $818.10 $343.60 $163.62 15775 T Hair transplant punch grafts 0025 5.89 $306.33 $116.41 $61.27 15776 T Hair transplant punch grafts 0025 5.89 $306.33 $116.41 $61.27 15780 T Abrasion treatment of skin 0022 18.10 $941.36 $367.13 $188.27 15781 T Abrasion treatment of skin 0022 18.10 $941.36 $367.13 $188.27 15782 T Abrasion treatment of skin 0022 18.10 $941.36 $367.13 $188.27 15783 T Abrasion treatment of skin 0016 2.57 $133.66 $56.14 $26.73 15786 T Abrasion, lesion, single 0013 1.10 $57.21 $14.30 $11.44 15787 T Abrasion, lesions, add-on 0013 1.10 $57.21 $14.30 $11.44 15788 T Chemical peel, face, epiderm 0012 0.76 $39.53 $10.67 $7.91 15789 T Chemical peel, face, dermal 0015 1.43 $74.37 $18.59 $14.87 15792 T Chemical peel, nonfacial 0012 0.76 $39.53 $10.67 $7.91 15793 T Chemical peel, nonfacial 0013 1.10 $57.21 $14.30 $11.44 15810 T Salabrasion 0016 2.57 $133.66 $56.14 $26.73 15811 T Salabrasion 0016 2.57 $133.66 $56.14 $26.73 15819 T Plastic surgery, neck 0025 5.89 $306.33 $116.41 $61.27 15820 T Revision of lower eyelid 0027 15.73 $818.10 $343.60 $163.62 15821 T Revision of lower eyelid 0027 15.73 $818.10 $343.60 $163.62 15822 T Revision of upper eyelid 0027 15.73 $818.10 $343.60 $163.62 15823 T Revision of upper eyelid 0027 15.73 $818.10 $343.60 $163.62 15824 T Removal of forehead wrinkles 0027 15.73 $818.10 $343.60 $163.62 15825 T Removal of neck wrinkles 0027 15.73 $818.10 $343.60 $163.62 15826 T Removal of brow wrinkles 0027 15.73 $818.10 $343.60 $163.62 15828 T Removal of face wrinkles 0027 15.73 $818.10 $343.60 $163.62 15829 T Removal of skin wrinkles 0027 15.73 $818.10 $343.60 $163.62 15831 T Excise excessive skin tissue 0022 18.10 $941.36 $367.13 $188.27 15832 T Excise excessive skin tissue 0022 18.10 $941.36 $367.13 $188.27 15833 T Excise excessive skin tissue 0022 18.10 $941.36 $367.13 $188.27 15834 T Excise excessive skin tissue 0022 18.10 $941.36 $367.13 $188.27 15835 T Excise excessive skin tissue 0025 5.89 $306.33 $116.41 $61.27 15836 T Excise excessive skin tissue 0020 7.36 $382.79 $114.84 $76.56 15837 T Excise excessive skin tissue 0020 7.36 $382.79 $114.84 $76.56 15838 T Excise excessive skin tissue 0020 7.36 $382.79 $114.84 $76.56 15839 T Excise excessive skin tissue 0020 7.36 $382.79 $114.84 $76.56 15840 T Graft for face nerve palsy 0027 15.73 $818.10 $343.60 $163.62 15841 T Graft for face nerve palsy 0027 15.73 $818.10 $343.60 $163.62 15842 T Flap for face nerve palsy 0027 15.73 $818.10 $343.60 $163.62 Start Printed Page 52168 15845 T Skin and muscle repair, face 0027 15.73 $818.10 $343.60 $163.62 15850 T Removal of sutures 0016 2.57 $133.66 $56.14 $26.73 15851 T Removal of sutures 0013 1.10 $57.21 $14.30 $11.44 15852 X Dressing change,not for burn 0340 0.66 $34.33 $6.87 15860 S Test for blood flow in graft 0706 $25.00 $5.00 15876 T Suction assisted lipectomy 0027 15.73 $818.10 $343.60 $163.62 15877 T Suction assisted lipectomy 0027 15.73 $818.10 $343.60 $163.62 15878 T Suction assisted lipectomy 0027 15.73 $818.10 $343.60 $163.62 15879 T Suction assisted lipectomy 0027 15.73 $818.10 $343.60 $163.62 15920 T Removal of tail bone ulcer 0022 18.10 $941.36 $367.13 $188.27 15922 T Removal of tail bone ulcer 0027 15.73 $818.10 $343.60 $163.62 15931 T Remove sacrum pressure sore 0022 18.10 $941.36 $367.13 $188.27 15933 T Remove sacrum pressure sore 0022 18.10 $941.36 $367.13 $188.27 15934 T Remove sacrum pressure sore 0027 15.73 $818.10 $343.60 $163.62 15935 T Remove sacrum pressure sore 0027 15.73 $818.10 $343.60 $163.62 15936 T Remove sacrum pressure sore 0027 15.73 $818.10 $343.60 $163.62 15937 T Remove sacrum pressure sore 0027 15.73 $818.10 $343.60 $163.62 15940 T Remove hip pressure sore 0022 18.10 $941.36 $367.13 $188.27 15941 T Remove hip pressure sore 0022 18.10 $941.36 $367.13 $188.27 15944 T Remove hip pressure sore 0027 15.73 $818.10 $343.60 $163.62 15945 T Remove hip pressure sore 0027 15.73 $818.10 $343.60 $163.62 15946 T Remove hip pressure sore 0027 15.73 $818.10 $343.60 $163.62 15950 T Remove thigh pressure sore 0022 18.10 $941.36 $367.13 $188.27 15951 T Remove thigh pressure sore 0022 18.10 $941.36 $367.13 $188.27 15952 T Remove thigh pressure sore 0027 15.73 $818.10 $343.60 $163.62 15953 T Remove thigh pressure sore 0027 15.73 $818.10 $343.60 $163.62 15956 T Remove thigh pressure sore 0027 15.73 $818.10 $343.60 $163.62 15958 T Remove thigh pressure sore 0027 15.73 $818.10 $343.60 $163.62 15999 T Removal of pressure sore 0022 18.10 $941.36 $367.13 $188.27 16000 T Initial treatment of burn(s) 0013 1.10 $57.21 $14.30 $11.44 16010 T Treatment of burn(s) 0016 2.57 $133.66 $56.14 $26.73 16015 T Treatment of burn(s) 0017 16.46 $856.07 $227.84 $171.21 16020 T Treatment of burn(s) 0013 1.10 $57.21 $14.30 $11.44 16025 T Treatment of burn(s) 0013 1.10 $57.21 $14.30 $11.44 16030 T Treatment of burn(s) 0015 1.43 $74.37 $18.59 $14.87 16035 C Incision of burn scab, initi 16036 C Incise burn scab, addl incis 17000 T Detroy benign/premal lesion 0010 0.70 $36.41 $10.56 $7.28 17003 T Destroy lesions, 2-14 0010 0.70 $36.41 $10.56 $7.28 17004 T Destroy lesions, 15 or more 0011 1.93 $100.38 $27.88 $20.08 17106 T Destruction of skin lesions 0011 1.93 $100.38 $27.88 $20.08 17107 T Destruction of skin lesions 0011 1.93 $100.38 $27.88 $20.08 17108 T Destruction of skin lesions 0011 1.93 $100.38 $27.88 $20.08 17110 T Destruct lesion, 1-14 0010 0.70 $36.41 $10.56 $7.28 17111 T Destruct lesion, 15 or more 0011 1.93 $100.38 $27.88 $20.08 17250 T Chemical cautery, tissue 0013 1.10 $57.21 $14.30 $11.44 17260 T Destruction of skin lesions 0015 1.43 $74.37 $18.59 $14.87 17261 T Destruction of skin lesions 0015 1.43 $74.37 $18.59 $14.87 17262 T Destruction of skin lesions 0015 1.43 $74.37 $18.59 $14.87 17263 T Destruction of skin lesions 0015 1.43 $74.37 $18.59 $14.87 17264 T Destruction of skin lesions 0015 1.43 $74.37 $18.59 $14.87 17266 T Destruction of skin lesions 0016 2.57 $133.66 $56.14 $26.73 17270 T Destruction of skin lesions 0015 1.43 $74.37 $18.59 $14.87 17271 T Destruction of skin lesions 0012 0.76 $39.53 $10.67 $7.91 17272 T Destruction of skin lesions 0015 1.43 $74.37 $18.59 $14.87 17273 T Destruction of skin lesions 0015 1.43 $74.37 $18.59 $14.87 17274 T Destruction of skin lesions 0016 2.57 $133.66 $56.14 $26.73 17276 T Destruction of skin lesions 0016 2.57 $133.66 $56.14 $26.73 17280 T Destruction of skin lesions 0015 1.43 $74.37 $18.59 $14.87 17281 T Destruction of skin lesions 0015 1.43 $74.37 $18.59 $14.87 17282 T Destruction of skin lesions 0015 1.43 $74.37 $18.59 $14.87 17283 T Destruction of skin lesions 0015 1.43 $74.37 $18.59 $14.87 17284 T Destruction of skin lesions 0016 2.57 $133.66 $56.14 $26.73 17286 T Destruction of skin lesions 0015 1.43 $74.37 $18.59 $14.87 17304 T Chemosurgery of skin lesion 0694 3.90 $202.84 $81.14 $40.57 17305 T 2nd stage chemosurgery 0694 3.90 $202.84 $81.14 $40.57 Start Printed Page 52169 17306 T 3rd stage chemosurgery 0694 3.90 $202.84 $81.14 $40.57 17307 T Followup skin lesion therapy 0694 3.90 $202.84 $81.14 $40.57 17310 T Extensive skin chemosurgery 0694 3.90 $202.84 $81.14 $40.57 17340 T Cryotherapy of skin 0012 0.76 $39.53 $10.67 $7.91 17360 T Skin peel therapy 0012 0.76 $39.53 $10.67 $7.91 17380 T Hair removal by electrolysis 0012 0.76 $39.53 $10.67 $7.91 17999 T Skin tissue procedure 0006 1.89 $98.30 $25.56 $19.66 19000 T Drainage of breast lesion 0004 1.63 $84.77 $22.04 $16.95 19001 T Drain breast lesion add-on 0004 1.63 $84.77 $22.04 $16.95 19020 T Incision of breast lesion 0008 16.32 $848.79 $169.76 19030 N Injection for breast x-ray 19100 T Bx breast percut w/o image 0005 3.02 $157.07 $69.11 $31.41 19101 T Biopsy of breast, open 0028 17.44 $907.04 $303.74 $181.41 19102 T Bx breast percut w/image 0005 3.02 $157.07 $69.11 $31.41 19103 T Bx breast percut w/device 0658 5.57 $289.69 $57.94 19110 T Nipple exploration 0028 17.44 $907.04 $303.74 $181.41 19112 T Excise breast duct fistula 0028 17.44 $907.04 $303.74 $181.41 19120 T Removal of breast lesion 0028 17.44 $907.04 $303.74 $181.41 19125 T Excision, breast lesion 0028 17.44 $907.04 $303.74 $181.41 19126 T Excision, addl breast lesion 0028 17.44 $907.04 $303.74 $181.41 19140 T Removal of breast tissue 0028 17.44 $907.04 $303.74 $181.41 19160 T Removal of breast tissue 0028 17.44 $907.04 $303.74 $181.41 19162 T Remove breast tissue, nodes 0693 39.30 $2,043.95 $798.17 $408.79 19180 T Removal of breast 0029 29.89 $1,554.55 $632.64 $310.91 19182 T Removal of breast 0029 29.89 $1,554.55 $632.64 $310.91 19200 C Removal of breast 19220 C Removal of breast 19240 T Removal of breast 0030 40.23 $2,092.32 $763.55 $418.46 19260 T Removal of chest wall lesion 0021 14.58 $758.29 $227.49 $151.66 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 1.38 $71.77 $14.35 19316 T Suspension of breast 0029 29.89 $1,554.55 $632.64 $310.91 19318 T Reduction of large breast 0693 39.30 $2,043.95 $798.17 $408.79 19324 T Enlarge breast 0693 39.30 $2,043.95 $798.17 $408.79 19325 T Enlarge breast with implant 0693 39.30 $2,043.95 $798.17 $408.79 19328 T Removal of breast implant 0029 29.89 $1,554.55 $632.64 $310.91 19330 T Removal of implant material 0029 29.89 $1,554.55 $632.64 $310.91 19340 T Immediate breast prosthesis 0030 40.23 $2,092.32 $763.55 $418.46 19342 T Delayed breast prosthesis 0693 39.30 $2,043.95 $798.17 $408.79 19350 T Breast reconstruction 0029 29.89 $1,554.55 $632.64 $310.91 19355 T Correct inverted nipple(s) 0029 29.89 $1,554.55 $632.64 $310.91 19357 T Breast reconstruction 0693 39.30 $2,043.95 $798.17 $408.79 19361 C Breast reconstruction 19364 C Breast reconstruction 19366 T Breast reconstruction 0029 29.89 $1,554.55 $632.64 $310.91 19367 C Breast reconstruction 19368 C Breast reconstruction 19369 C Breast reconstruction 19370 T Surgery of breast capsule 0029 29.89 $1,554.55 $632.64 $310.91 19371 T Removal of breast capsule 0029 29.89 $1,554.55 $632.64 $310.91 19380 T Revise breast reconstruction 0030 40.23 $2,092.32 $763.55 $418.46 19396 T Design custom breast implant 0029 29.89 $1,554.55 $632.64 $310.91 19499 T Breast surgery procedure 0028 17.44 $907.04 $303.74 $181.41 20000 T Incision of abscess 0006 1.89 $98.30 $25.56 $19.66 20005 T Incision of deep abscess 0049 19.45 $1,011.58 $202.32 20100 T Explore wound, neck 0023 2.38 $123.78 $40.37 $24.76 20101 T Explore wound, chest 0027 15.73 $818.10 $343.60 $163.62 20102 T Explore wound, abdomen 0027 15.73 $818.10 $343.60 $163.62 20103 T Explore wound, extremity 0023 2.38 $123.78 $40.37 $24.76 20150 T Excise epiphyseal bar 0051 34.03 $1,769.87 $353.97 20200 T Muscle biopsy 0021 14.58 $758.29 $227.49 $151.66 20205 T Deep muscle biopsy 0021 14.58 $758.29 $227.49 $151.66 20206 T Needle biopsy, muscle 0005 3.02 $157.07 $69.11 $31.41 Start Printed Page 52170 20220 T Bone biopsy, trocar/needle 0019 3.94 $204.92 $75.82 $40.98 20225 T Bone biopsy, trocar/needle 0019 3.94 $204.92 $75.82 $40.98 20240 T Bone biopsy, excisional 0022 18.10 $941.36 $367.13 $188.27 20245 T Bone biopsy, excisional 0022 18.10 $941.36 $367.13 $188.27 20250 T Open bone biopsy 0049 19.45 $1,011.58 $202.32 20251 T Open bone biopsy 0049 19.45 $1,011.58 $202.32 20500 T Injection of sinus tract 0251 1.92 $99.86 $19.97 20501 N Inject sinus tract for x-ray 20520 T Removal of foreign body 0019 3.94 $204.92 $75.82 $40.98 20525 T Removal of foreign body 0022 18.10 $941.36 $367.13 $188.27 20526 T Ther injection carpal tunnel 0204 2.13 $110.78 $42.10 $22.16 20550 T Inject tendon/ligament/cyst 0204 2.13 $110.78 $42.10 $22.16 20551 T Inject tendon origin/insert 0204 2.13 $110.78 $42.10 $22.16 20552 T Inject trigger point, 1 or 2 0204 2.13 $110.78 $42.10 $22.16 20553 T Inject trigger points, > 3 0204 2.13 $110.78 $42.10 $22.16 20600 T Drain/inject, joint/bursa 0204 2.13 $110.78 $42.10 $22.16 20605 T Drain/inject, joint/bursa 0204 2.13 $110.78 $42.10 $22.16 20610 T Drain/inject, joint/bursa 0204 2.13 $110.78 $42.10 $22.16 20615 T Treatment of bone cyst 0004 1.63 $84.77 $22.04 $16.95 20650 T Insert and remove bone pin 0049 19.45 $1,011.58 $202.32 20660 C Apply,remove fixation device 20661 C Application of head brace 20662 C Application of pelvis brace 20663 C Application of thigh brace 20664 C Halo brace application 20665 X Removal of fixation device 0340 0.66 $34.33 $6.87 20670 T Removal of support implant 0021 14.58 $758.29 $227.49 $151.66 20680 T Removal of support implant 0022 18.10 $941.36 $367.13 $188.27 20690 T Apply bone fixation device 0050 23.60 $1,227.41 $245.48 20692 T Apply bone fixation device 0050 23.60 $1,227.41 $245.48 20693 T Adjust bone fixation device 0049 19.45 $1,011.58 $202.32 20694 T Remove bone fixation device 0049 19.45 $1,011.58 $202.32 20802 C Replantation, arm, complete 20805 C Replant, forearm, complete 20808 C Replantation hand, complete 20816 C Replantation digit, complete 20822 C Replantation digit, complete 20824 C Replantation thumb, complete 20827 C Replantation thumb, complete 20838 C Replantation foot, complete 20900 T Removal of bone for graft 0050 23.60 $1,227.41 $245.48 20902 T Removal of bone for graft 0050 23.60 $1,227.41 $245.48 20910 T Remove cartilage for graft 0027 15.73 $818.10 $343.60 $163.62 20912 T Remove cartilage for graft 0027 15.73 $818.10 $343.60 $163.62 20920 T Removal of fascia for graft 0027 15.73 $818.10 $343.60 $163.62 20922 T Removal of fascia for graft 0027 15.73 $818.10 $343.60 $163.62 20924 T Removal of tendon for graft 0050 23.60 $1,227.41 $245.48 20926 T Removal of tissue for graft 0027 15.73 $818.10 $343.60 $163.62 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 1.89 $98.30 $25.56 $19.66 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 C Bone/skin graft, metatarsal 20973 C Bone/skin graft, great toe 20974 A Electrical bone stimulation 20975 T Electrical bone stimulation 0049 19.45 $1,011.58 $202.32 20979 A Us bone stimulation 20999 T Musculoskeletal surgery 0049 19.45 $1,011.58 $202.32 Start Printed Page 52171 21010 T Incision of jaw joint 0254 21.89 $1,138.48 $352.93 $227.70 21015 T Resection of facial tumor 0253 14.79 $769.21 $284.61 $153.84 21025 T Excision of bone, lower jaw 0256 35.51 $1,846.84 $369.37 21026 T Excision of facial bone(s) 0256 35.51 $1,846.84 $369.37 21029 T Contour of face bone lesion 0256 35.51 $1,846.84 $369.37 21030 T Removal of face bone lesion 0254 21.89 $1,138.48 $352.93 $227.70 21031 T Remove exostosis, mandible 0254 21.89 $1,138.48 $352.93 $227.70 21032 T Remove exostosis, maxilla 0254 21.89 $1,138.48 $352.93 $227.70 21034 T Removal of face bone lesion 0256 35.51 $1,846.84 $369.37 21040 T Removal of jaw bone lesion 0254 21.89 $1,138.48 $352.93 $227.70 21041 T Removal of jaw bone lesion 0256 35.51 $1,846.84 $369.37 21044 T Removal of jaw bone lesion 0256 35.51 $1,846.84 $369.37 21045 C Extensive jaw surgery 21050 T Removal of jaw joint 0256 35.51 $1,846.84 $369.37 21060 T Remove jaw joint cartilage 0256 35.51 $1,846.84 $369.37 21070 T Remove coronoid process 0256 35.51 $1,846.84 $369.37 21076 T Prepare face/oral prosthesis 0254 21.89 $1,138.48 $352.93 $227.70 21077 T Prepare face/oral prosthesis 0256 35.51 $1,846.84 $369.37 21079 T Prepare face/oral prosthesis 0256 35.51 $1,846.84 $369.37 21080 T Prepare face/oral prosthesis 0256 35.51 $1,846.84 $369.37 21081 T Prepare face/oral prosthesis 0256 35.51 $1,846.84 $369.37 21082 T Prepare face/oral prosthesis 0256 35.51 $1,846.84 $369.37 21083 T Prepare face/oral prosthesis 0256 35.51 $1,846.84 $369.37 21084 T Prepare face/oral prosthesis 0256 35.51 $1,846.84 $369.37 21085 T Prepare face/oral prosthesis 0253 14.79 $769.21 $284.61 $153.84 21086 T Prepare face/oral prosthesis 0256 35.51 $1,846.84 $369.37 21087 T Prepare face/oral prosthesis 0256 35.51 $1,846.84 $369.37 21088 T Prepare face/oral prosthesis 0256 35.51 $1,846.84 $369.37 21089 T Prepare face/oral prosthesis 0253 14.79 $769.21 $284.61 $153.84 21100 T Maxillofacial fixation 0256 35.51 $1,846.84 $369.37 21110 T Interdental fixation 0252 6.27 $326.10 $114.24 $65.22 21116 N Injection, jaw joint x-ray 21120 T Reconstruction of chin 0254 21.89 $1,138.48 $352.93 $227.70 21121 T Reconstruction of chin 0254 21.89 $1,138.48 $352.93 $227.70 21122 T Reconstruction of chin 0254 21.89 $1,138.48 $352.93 $227.70 21123 T Reconstruction of chin 0254 21.89 $1,138.48 $352.93 $227.70 21125 T Augmentation, lower jaw bone 0254 21.89 $1,138.48 $352.93 $227.70 21127 T Augmentation, lower jaw bone 0256 35.51 $1,846.84 $369.37 21137 T Reduction of forehead 0254 21.89 $1,138.48 $352.93 $227.70 21138 T Reduction of forehead 0256 35.51 $1,846.84 $369.37 21139 T Reduction of forehead 0256 35.51 $1,846.84 $369.37 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 C Reconstruct midface, lefort 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 C Reconstruct orbit/forehead 21179 C Reconstruct entire forehead 21180 C Reconstruct entire forehead 21181 T Contour cranial bone lesion 0254 21.89 $1,138.48 $352.93 $227.70 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 C Reconst lwr jaw w/o fixation 21196 C Reconst lwr jaw w/fixation Start Printed Page 52172 21198 T Reconstr lwr jaw segment 0256 35.51 $1,846.84 $369.37 21199 T Reconstr lwr jaw w/advance 0256 35.51 $1,846.84 $369.37 21206 T Reconstruct upper jaw bone 0256 35.51 $1,846.84 $369.37 21208 T Augmentation of facial bones 0256 35.51 $1,846.84 $369.37 21209 T Reduction of facial bones 0256 35.51 $1,846.84 $369.37 21210 T Face bone graft 0256 35.51 $1,846.84 $369.37 21215 T Lower jaw bone graft 0256 35.51 $1,846.84 $369.37 21230 T Rib cartilage graft 0256 35.51 $1,846.84 $369.37 21235 T Ear cartilage graft 0254 21.89 $1,138.48 $352.93 $227.70 21240 T Reconstruction of jaw joint 0256 35.51 $1,846.84 $369.37 21242 T Reconstruction of jaw joint 0256 35.51 $1,846.84 $369.37 21243 T Reconstruction of jaw joint 0256 35.51 $1,846.84 $369.37 21244 T Reconstruction of lower jaw 0256 35.51 $1,846.84 $369.37 21245 T Reconstruction of jaw 0256 35.51 $1,846.84 $369.37 21246 T Reconstruction of jaw 0256 35.51 $1,846.84 $369.37 21247 C Reconstruct lower jaw bone 21248 T Reconstruction of jaw 0256 35.51 $1,846.84 $369.37 21249 T Reconstruction of jaw 0256 35.51 $1,846.84 $369.37 21255 C Reconstruct lower jaw bone 21256 C Reconstruction of orbit 21260 T Revise eye sockets 0256 35.51 $1,846.84 $369.37 21261 T Revise eye sockets 0256 35.51 $1,846.84 $369.37 21263 T Revise eye sockets 0256 35.51 $1,846.84 $369.37 21267 T Revise eye sockets 0256 35.51 $1,846.84 $369.37 21268 C Revise eye sockets 21270 T Augmentation, cheek bone 0256 35.51 $1,846.84 $369.37 21275 T Revision, orbitofacial bones 0256 35.51 $1,846.84 $369.37 21280 T Revision of eyelid 0256 35.51 $1,846.84 $369.37 21282 T Revision of eyelid 0253 14.79 $769.21 $284.61 $153.84 21295 T Revision of jaw muscle/bone 0252 6.27 $326.10 $114.24 $65.22 21296 T Revision of jaw muscle/bone 0254 21.89 $1,138.48 $352.93 $227.70 21299 T Cranio/maxillofacial surgery 0253 14.79 $769.21 $284.61 $153.84 21300 T Treatment of skull fracture 0253 14.79 $769.21 $284.61 $153.84 21310 X Treatment of nose fracture 0340 0.66 $34.33 $6.87 21315 X Treatment of nose fracture 0340 0.66 $34.33 $6.87 21320 X Treatment of nose fracture 0340 0.66 $34.33 $6.87 21325 T Treatment of nose fracture 0254 21.89 $1,138.48 $352.93 $227.70 21330 T Treatment of nose fracture 0254 21.89 $1,138.48 $352.93 $227.70 21335 T Treatment of nose fracture 0254 21.89 $1,138.48 $352.93 $227.70 21336 T Treat nasal septal fracture 0046 29.03 $1,509.82 $535.76 $301.96 21337 T Treat nasal septal fracture 0253 14.79 $769.21 $284.61 $153.84 21338 T Treat nasoethmoid fracture 0254 21.89 $1,138.48 $352.93 $227.70 21339 T Treat nasoethmoid fracture 0254 21.89 $1,138.48 $352.93 $227.70 21340 T Treatment of nose fracture 0256 35.51 $1,846.84 $369.37 21343 C Treatment of sinus fracture 21344 C Treatment of sinus fracture 21345 T Treat nose/jaw fracture 0254 21.89 $1,138.48 $352.93 $227.70 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 35.51 $1,846.84 $369.37 21356 C Treat cheek bone fracture 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 35.51 $1,846.84 $369.37 21395 C Treat eye socket fracture 21400 T Treat eye socket fracture 0252 6.27 $326.10 $114.24 $65.22 21401 T Treat eye socket fracture 0253 14.79 $769.21 $284.61 $153.84 21406 T Treat eye socket fracture 0256 35.51 $1,846.84 $369.37 21407 T Treat eye socket fracture 0256 35.51 $1,846.84 $369.37 21408 C Treat eye socket fracture 21421 T Treat mouth roof fracture 0254 21.89 $1,138.48 $352.93 $227.70 Start Printed Page 52173 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 21.89 $1,138.48 $352.93 $227.70 21445 T Treat dental ridge fracture 0254 21.89 $1,138.48 $352.93 $227.70 21450 T Treat lower jaw fracture 0251 1.92 $99.86 $19.97 21451 T Treat lower jaw fracture 0252 6.27 $326.10 $114.24 $65.22 21452 T Treat lower jaw fracture 0253 14.79 $769.21 $284.61 $153.84 21453 T Treat lower jaw fracture 0256 35.51 $1,846.84 $369.37 21454 T Treat lower jaw fracture 0254 21.89 $1,138.48 $352.93 $227.70 21461 T Treat lower jaw fracture 0256 35.51 $1,846.84 $369.37 21462 T Treat lower jaw fracture 0256 35.51 $1,846.84 $369.37 21465 T Treat lower jaw fracture 0256 35.51 $1,846.84 $369.37 21470 T Treat lower jaw fracture 0256 35.51 $1,846.84 $369.37 21480 T Reset dislocated jaw 0251 1.92 $99.86 $19.97 21485 T Reset dislocated jaw 0253 14.79 $769.21 $284.61 $153.84 21490 T Repair dislocated jaw 0256 35.51 $1,846.84 $369.37 21493 T Treat hyoid bone fracture 0252 6.27 $326.10 $114.24 $65.22 21494 T Treat hyoid bone fracture 0252 6.27 $326.10 $114.24 $65.22 21495 C Treat hyoid bone fracture 21497 T Interdental wiring 0253 14.79 $769.21 $284.61 $153.84 21499 T Head surgery procedure 0253 14.79 $769.21 $284.61 $153.84 21501 T Drain neck/chest lesion 0008 16.32 $848.79 $169.76 21502 T Drain chest lesion 0049 19.45 $1,011.58 $202.32 21510 C Drainage of bone lesion 21550 T Biopsy of neck/chest 0021 14.58 $758.29 $227.49 $151.66 21555 T Remove lesion, neck/chest 0022 18.10 $941.36 $367.13 $188.27 21556 T Remove lesion, neck/chest 0022 18.10 $941.36 $367.13 $188.27 21557 C Remove tumor, neck/chest 21600 T Partial removal of rib 0050 23.60 $1,227.41 $245.48 21610 T Partial removal of rib 0050 23.60 $1,227.41 $245.48 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 21632 C Extensive sternum surgery 21700 T Revision of neck muscle 0049 19.45 $1,011.58 $202.32 21705 C Revision of neck muscle/rib 21720 T Revision of neck muscle 0049 19.45 $1,011.58 $202.32 21725 T Revision of neck muscle 0006 1.89 $98.30 $25.56 $19.66 21740 C Reconstruction of sternum 21750 C Repair of sternum separation 21800 T Treatment of rib fracture 0043 1.68 $87.38 $17.48 21805 T Treatment of rib fracture 0046 29.03 $1,509.82 $535.76 $301.96 21810 C Treatment of rib fracture(s) 21820 T Treat sternum fracture 0043 1.68 $87.38 $17.48 21825 C Treat sternum fracture 21899 T Neck/chest surgery procedure 0252 6.27 $326.10 $114.24 $65.22 21920 T Biopsy soft tissue of back 0020 7.36 $382.79 $114.84 $76.56 21925 T Biopsy soft tissue of back 0022 18.10 $941.36 $367.13 $188.27 21930 T Remove lesion, back or flank 0022 18.10 $941.36 $367.13 $188.27 21935 T Remove tumor, back 0022 18.10 $941.36 $367.13 $188.27 22100 T Remove part of neck vertebra 0208 39.95 $2,077.76 $415.55 22101 T Remove part, thorax vertebra 0208 39.95 $2,077.76 $415.55 22102 T Remove part, lumbar vertebra 0208 39.95 $2,077.76 $415.55 22103 T Remove extra spine segment 0208 39.95 $2,077.76 $415.55 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 Start Printed Page 52174 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 C Revision of thorax spine 22224 C Revision of lumbar spine 22226 C Revise, extra spine segment 22305 T Treat spine process fracture 0043 1.68 $87.38 $17.48 22310 T Treat spine fracture 0043 1.68 $87.38 $17.48 22315 T Treat spine fracture 0043 1.68 $87.38 $17.48 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 13.47 $700.56 $280.22 $140.11 22520 T Percut vertebroplasty thor 0050 23.60 $1,227.41 $245.48 22521 T Percut vertebroplasty lumb 0050 23.60 $1,227.41 $245.48 22522 T Percut vertebroplasty addl 0050 23.60 $1,227.41 $245.48 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 C Lumbar spine fusion 22614 C Spine fusion, extra segment 22630 C Lumbar spine fusion 22632 C Spine fusion, extra segment 22800 C Fusion of spine 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 1.68 $87.38 $17.48 22900 T Remove abdominal wall lesion 0022 18.10 $941.36 $367.13 $188.27 22999 T Abdomen surgery procedure 0022 18.10 $941.36 $367.13 $188.27 23000 T Removal of calcium deposits 0021 14.58 $758.29 $227.49 $151.66 23020 T Release shoulder joint 0051 34.03 $1,769.87 $353.97 23030 T Drain shoulder lesion 0008 16.32 $848.79 $169.76 23031 T Drain shoulder bursa 0008 16.32 $848.79 $169.76 23035 T Drain shoulder bone lesion 0049 19.45 $1,011.58 $202.32 23040 T Exploratory shoulder surgery 0050 23.60 $1,227.41 $245.48 23044 T Exploratory shoulder surgery 0050 23.60 $1,227.41 $245.48 Start Printed Page 52175 23065 T Biopsy shoulder tissues 0021 14.58 $758.29 $227.49 $151.66 23066 T Biopsy shoulder tissues 0022 18.10 $941.36 $367.13 $188.27 23075 T Removal of shoulder lesion 0021 14.58 $758.29 $227.49 $151.66 23076 T Removal of shoulder lesion 0022 18.10 $941.36 $367.13 $188.27 23077 T Remove tumor of shoulder 0022 18.10 $941.36 $367.13 $188.27 23100 T Biopsy of shoulder joint 0049 19.45 $1,011.58 $202.32 23101 T Shoulder joint surgery 0050 23.60 $1,227.41 $245.48 23105 T Remove shoulder joint lining 0050 23.60 $1,227.41 $245.48 23106 T Incision of collarbone joint 0050 23.60 $1,227.41 $245.48 23107 T Explore treat shoulder joint 0050 23.60 $1,227.41 $245.48 23120 T Partial removal, collar bone 0051 34.03 $1,769.87 $353.97 23125 T Removal of collar bone 0051 34.03 $1,769.87 $353.97 23130 T Remove shoulder bone, part 0051 34.03 $1,769.87 $353.97 23140 T Removal of bone lesion 0049 19.45 $1,011.58 $202.32 23145 T Removal of bone lesion 0050 23.60 $1,227.41 $245.48 23146 T Removal of bone lesion 0050 23.60 $1,227.41 $245.48 23150 T Removal of humerus lesion 0050 23.60 $1,227.41 $245.48 23155 T Removal of humerus lesion 0050 23.60 $1,227.41 $245.48 23156 T Removal of humerus lesion 0050 23.60 $1,227.41 $245.48 23170 T Remove collar bone lesion 0050 23.60 $1,227.41 $245.48 23172 T Remove shoulder blade lesion 0050 23.60 $1,227.41 $245.48 23174 T Remove humerus lesion 0050 23.60 $1,227.41 $245.48 23180 T Remove collar bone lesion 0050 23.60 $1,227.41 $245.48 23182 T Remove shoulder blade lesion 0050 23.60 $1,227.41 $245.48 23184 T Remove humerus lesion 0050 23.60 $1,227.41 $245.48 23190 T Partial removal of scapula 0050 23.60 $1,227.41 $245.48 23195 T Removal of head of humerus 0050 23.60 $1,227.41 $245.48 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 7.36 $382.79 $114.84 $76.56 23331 T Remove shoulder foreign body 0022 18.10 $941.36 $367.13 $188.27 23332 C Remove shoulder foreign body 23350 N Injection for shoulder x-ray 23395 T Muscle transfer,shoulder/arm 0051 34.03 $1,769.87 $353.97 23397 T Muscle transfers 0052 42.37 $2,203.62 $440.72 23400 T Fixation of shoulder blade 0050 23.60 $1,227.41 $245.48 23405 T Incision of tendon & muscle 0050 23.60 $1,227.41 $245.48 23406 T Incise tendon(s) & muscle(s) 0050 23.60 $1,227.41 $245.48 23410 T Repair of tendon(s) 0052 42.37 $2,203.62 $440.72 23412 T Repair of tendon(s) 0052 42.37 $2,203.62 $440.72 23415 T Release of shoulder ligament 0051 34.03 $1,769.87 $353.97 23420 T Repair of shoulder 0052 42.37 $2,203.62 $440.72 23430 T Repair biceps tendon 0052 42.37 $2,203.62 $440.72 23440 T Remove/transplant tendon 0052 42.37 $2,203.62 $440.72 23450 T Repair shoulder capsule 0052 42.37 $2,203.62 $440.72 23455 T Repair shoulder capsule 0052 42.37 $2,203.62 $440.72 23460 T Repair shoulder capsule 0052 42.37 $2,203.62 $440.72 23462 T Repair shoulder capsule 0052 42.37 $2,203.62 $440.72 23465 T Repair shoulder capsule 0052 42.37 $2,203.62 $440.72 23466 T Repair shoulder capsule 0052 42.37 $2,203.62 $440.72 23470 T Reconstruct shoulder joint 0048 36.93 $1,920.69 $633.83 $384.14 23472 C Reconstruct shoulder joint 23480 T Revision of collar bone 0051 34.03 $1,769.87 $353.97 23485 T Revision of collar bone 0051 34.03 $1,769.87 $353.97 23490 T Reinforce clavicle 0051 34.03 $1,769.87 $353.97 23491 T Reinforce shoulder bones 0051 34.03 $1,769.87 $353.97 23500 T Treat clavicle fracture 0043 1.68 $87.38 $17.48 23505 T Treat clavicle fracture 0043 1.68 $87.38 $17.48 23515 T Treat clavicle fracture 0046 29.03 $1,509.82 $535.76 $301.96 23520 T Treat clavicle dislocation 0043 1.68 $87.38 $17.48 23525 T Treat clavicle dislocation 0043 1.68 $87.38 $17.48 23530 T Treat clavicle dislocation 0046 29.03 $1,509.82 $535.76 $301.96 23532 T Treat clavicle dislocation 0046 29.03 $1,509.82 $535.76 $301.96 Start Printed Page 52176 23540 T Treat clavicle dislocation 0043 1.68 $87.38 $17.48 23545 T Treat clavicle dislocation 0043 1.68 $87.38 $17.48 23550 T Treat clavicle dislocation 0046 29.03 $1,509.82 $535.76 $301.96 23552 T Treat clavicle dislocation 0046 29.03 $1,509.82 $535.76 $301.96 23570 T Treat shoulder blade fx 0043 1.68 $87.38 $17.48 23575 T Treat shoulder blade fx 0043 1.68 $87.38 $17.48 23585 T Treat scapula fracture 0046 29.03 $1,509.82 $535.76 $301.96 23600 T Treat humerus fracture 0043 1.68 $87.38 $17.48 23605 T Treat humerus fracture 0043 1.68 $87.38 $17.48 23615 T Treat humerus fracture 0046 29.03 $1,509.82 $535.76 $301.96 23616 T Treat humerus fracture 0046 29.03 $1,509.82 $535.76 $301.96 23620 T Treat humerus fracture 0043 1.68 $87.38 $17.48 23625 T Treat humerus fracture 0043 1.68 $87.38 $17.48 23630 T Treat humerus fracture 0046 29.03 $1,509.82 $535.76 $301.96 23650 T Treat shoulder dislocation 0043 1.68 $87.38 $17.48 23655 T Treat shoulder dislocation 0045 13.47 $700.56 $280.22 $140.11 23660 T Treat shoulder dislocation 0046 29.03 $1,509.82 $535.76 $301.96 23665 T Treat dislocation/fracture 0043 1.68 $87.38 $17.48 23670 T Treat dislocation/fracture 0046 29.03 $1,509.82 $535.76 $301.96 23675 T Treat dislocation/fracture 0043 1.68 $87.38 $17.48 23680 T Treat dislocation/fracture 0046 29.03 $1,509.82 $535.76 $301.96 23700 T Fixation of shoulder 0045 13.47 $700.56 $280.22 $140.11 23800 T Fusion of shoulder joint 0051 34.03 $1,769.87 $353.97 23802 T Fusion of shoulder joint 0051 34.03 $1,769.87 $353.97 23900 C Amputation of arm & girdle 23920 C Amputation at shoulder joint 23921 T Amputation follow-up surgery 0025 5.89 $306.33 $116.41 $61.27 23929 T Shoulder surgery procedure 0043 1.68 $87.38 $17.48 23930 T Drainage of arm lesion 0008 16.32 $848.79 $169.76 23931 T Drainage of arm bursa 0006 1.89 $98.30 $25.56 $19.66 23935 T Drain arm/elbow bone lesion 0049 19.45 $1,011.58 $202.32 24000 T Exploratory elbow surgery 0050 23.60 $1,227.41 $245.48 24006 T Release elbow joint 0050 23.60 $1,227.41 $245.48 24065 T Biopsy arm/elbow soft tissue 0021 14.58 $758.29 $227.49 $151.66 24066 T Biopsy arm/elbow soft tissue 0021 14.58 $758.29 $227.49 $151.66 24075 T Remove arm/elbow lesion 0021 14.58 $758.29 $227.49 $151.66 24076 T Remove arm/elbow lesion 0022 18.10 $941.36 $367.13 $188.27 24077 T Remove tumor of arm/elbow 0022 18.10 $941.36 $367.13 $188.27 24100 T Biopsy elbow joint lining 0049 19.45 $1,011.58 $202.32 24101 T Explore/treat elbow joint 0050 23.60 $1,227.41 $245.48 24102 T Remove elbow joint lining 0050 23.60 $1,227.41 $245.48 24105 T Removal of elbow bursa 0049 19.45 $1,011.58 $202.32 24110 T Remove humerus lesion 0049 19.45 $1,011.58 $202.32 24115 T Remove/graft bone lesion 0050 23.60 $1,227.41 $245.48 24116 T Remove/graft bone lesion 0050 23.60 $1,227.41 $245.48 24120 T Remove elbow lesion 0049 19.45 $1,011.58 $202.32 24125 T Remove/graft bone lesion 0050 23.60 $1,227.41 $245.48 24126 T Remove/graft bone lesion 0050 23.60 $1,227.41 $245.48 24130 T Removal of head of radius 0050 23.60 $1,227.41 $245.48 24134 T Removal of arm bone lesion 0050 23.60 $1,227.41 $245.48 24136 T Remove radius bone lesion 0050 23.60 $1,227.41 $245.48 24138 T Remove elbow bone lesion 0050 23.60 $1,227.41 $245.48 24140 T Partial removal of arm bone 0050 23.60 $1,227.41 $245.48 24145 T Partial removal of radius 0050 23.60 $1,227.41 $245.48 24147 T Partial removal of elbow 0050 23.60 $1,227.41 $245.48 24149 C Radical resection of elbow 24150 T Extensive humerus surgery 0052 42.37 $2,203.62 $440.72 24151 T Extensive humerus surgery 0052 42.37 $2,203.62 $440.72 24152 T Extensive radius surgery 0052 42.37 $2,203.62 $440.72 24153 T Extensive radius surgery 0052 42.37 $2,203.62 $440.72 24155 T Removal of elbow joint 0051 34.03 $1,769.87 $353.97 24160 T Remove elbow joint implant 0050 23.60 $1,227.41 $245.48 24164 T Remove radius head implant 0050 23.60 $1,227.41 $245.48 24200 T Removal of arm foreign body 0019 3.94 $204.92 $75.82 $40.98 24201 T Removal of arm foreign body 0021 14.58 $758.29 $227.49 $151.66 24220 N Injection for elbow x-ray Start Printed Page 52177 24300 T Manipulate elbow w/anesth 0045 13.47 $700.56 $280.22 $140.11 24301 T Muscle/tendon transfer 0050 23.60 $1,227.41 $245.48 24305 T Arm tendon lengthening 0050 23.60 $1,227.41 $245.48 24310 T Revision of arm tendon 0049 19.45 $1,011.58 $202.32 24320 T Repair of arm tendon 0051 34.03 $1,769.87 $353.97 24330 T Revision of arm muscles 0051 34.03 $1,769.87 $353.97 24331 T Revision of arm muscles 0051 34.03 $1,769.87 $353.97 24332 T Tenolysis, triceps 0049 19.45 $1,011.58 $202.32 24340 T Repair of biceps tendon 0051 34.03 $1,769.87 $353.97 24341 T Repair arm tendon/muscle 0051 34.03 $1,769.87 $353.97 24342 T Repair of ruptured tendon 0051 34.03 $1,769.87 $353.97 24343 T Repr elbow lat ligmnt w/tiss 0050 23.60 $1,227.41 $245.48 24344 T Reconstruct elbow lat ligmnt 0051 34.03 $1,769.87 $353.97 24345 T Repr elbw med ligmnt w/tiss 0050 23.60 $1,227.41 $245.48 24346 T Reconstruct elbow med ligmnt 0051 34.03 $1,769.87 $353.97 24350 T Repair of tennis elbow 0050 23.60 $1,227.41 $245.48 24351 T Repair of tennis elbow 0050 23.60 $1,227.41 $245.48 24352 T Repair of tennis elbow 0050 23.60 $1,227.41 $245.48 24354 T Repair of tennis elbow 0050 23.60 $1,227.41 $245.48 24356 T Revision of tennis elbow 0050 23.60 $1,227.41 $245.48 24360 T Reconstruct elbow joint 0047 29.59 $1,538.95 $537.03 $307.79 24361 T Reconstruct elbow joint 0048 36.93 $1,920.69 $633.83 $384.14 24362 T Reconstruct elbow joint 0048 36.93 $1,920.69 $633.83 $384.14 24363 T Replace elbow joint 0048 36.93 $1,920.69 $633.83 $384.14 24365 T Reconstruct head of radius 0047 29.59 $1,538.95 $537.03 $307.79 24366 T Reconstruct head of radius 0048 36.93 $1,920.69 $633.83 $384.14 24400 T Revision of humerus 0050 23.60 $1,227.41 $245.48 24410 T Revision of humerus 0050 23.60 $1,227.41 $245.48 24420 T Revision of humerus 0051 34.03 $1,769.87 $353.97 24430 T Repair of humerus 0051 34.03 $1,769.87 $353.97 24435 T Repair humerus with graft 0051 34.03 $1,769.87 $353.97 24470 T Revision of elbow joint 0051 34.03 $1,769.87 $353.97 24495 T Decompression of forearm 0050 23.60 $1,227.41 $245.48 24498 T Reinforce humerus 0051 34.03 $1,769.87 $353.97 24500 T Treat humerus fracture 0043 1.68 $87.38 $17.48 24505 T Treat humerus fracture 0043 1.68 $87.38 $17.48 24515 T Treat humerus fracture 0046 29.03 $1,509.82 $535.76 $301.96 24516 T Treat humerus fracture 0046 29.03 $1,509.82 $535.76 $301.96 24530 T Treat humerus fracture 0043 1.68 $87.38 $17.48 24535 T Treat humerus fracture 0043 1.68 $87.38 $17.48 24538 T Treat humerus fracture 0046 29.03 $1,509.82 $535.76 $301.96 24545 T Treat humerus fracture 0046 29.03 $1,509.82 $535.76 $301.96 24546 T Treat humerus fracture 0046 29.03 $1,509.82 $535.76 $301.96 24560 T Treat humerus fracture 0043 1.68 $87.38 $17.48 24565 T Treat humerus fracture 0043 1.68 $87.38 $17.48 24566 T Treat humerus fracture 0046 29.03 $1,509.82 $535.76 $301.96 24575 T Treat humerus fracture 0046 29.03 $1,509.82 $535.76 $301.96 24576 T Treat humerus fracture 0043 1.68 $87.38 $17.48 24577 T Treat humerus fracture 0043 1.68 $87.38 $17.48 24579 T Treat humerus fracture 0046 29.03 $1,509.82 $535.76 $301.96 24582 T Treat humerus fracture 0046 29.03 $1,509.82 $535.76 $301.96 24586 T Treat elbow fracture 0046 29.03 $1,509.82 $535.76 $301.96 24587 T Treat elbow fracture 0046 29.03 $1,509.82 $535.76 $301.96 24600 T Treat elbow dislocation 0043 1.68 $87.38 $17.48 24605 T Treat elbow dislocation 0045 13.47 $700.56 $280.22 $140.11 24615 T Treat elbow dislocation 0046 29.03 $1,509.82 $535.76 $301.96 24620 T Treat elbow fracture 0043 1.68 $87.38 $17.48 24635 T Treat elbow fracture 0046 29.03 $1,509.82 $535.76 $301.96 24640 T Treat elbow dislocation 0043 1.68 $87.38 $17.48 24650 T Treat radius fracture 0043 1.68 $87.38 $17.48 24655 T Treat radius fracture 0043 1.68 $87.38 $17.48 24665 T Treat radius fracture 0046 29.03 $1,509.82 $535.76 $301.96 24666 T Treat radius fracture 0046 29.03 $1,509.82 $535.76 $301.96 24670 T Treat ulnar fracture 0043 1.68 $87.38 $17.48 24675 T Treat ulnar fracture 0043 1.68 $87.38 $17.48 24685 T Treat ulnar fracture 0046 29.03 $1,509.82 $535.76 $301.96 Start Printed Page 52178 24800 T Fusion of elbow joint 0051 34.03 $1,769.87 $353.97 24802 T Fusion/graft of elbow joint 0051 34.03 $1,769.87 $353.97 24900 C Amputation of upper arm 24920 C Amputation of upper arm 24925 T Amputation follow-up surgery 0049 19.45 $1,011.58 $202.32 24930 C Amputation follow-up surgery 24931 C Amputate upper arm & implant 24935 T Revision of amputation 0052 42.37 $2,203.62 $440.72 24940 C Revision of upper arm 24999 T Upper arm/elbow surgery 0043 1.68 $87.38 $17.48 25000 T Incision of tendon sheath 0049 19.45 $1,011.58 $202.32 25001 T Incise flexor carpi radialis 0049 19.45 $1,011.58 $202.32 25020 T Decompress forearm 1 space 0049 19.45 $1,011.58 $202.32 25023 T Decompress forearm 1 space 0050 23.60 $1,227.41 $245.48 25024 T Decompress forearm 2 spaces 0050 23.60 $1,227.41 $245.48 25025 T Decompress forarm 2 spaces 0050 23.60 $1,227.41 $245.48 25028 T Drainage of forearm lesion 0049 19.45 $1,011.58 $202.32 25031 T Drainage of forearm bursa 0049 19.45 $1,011.58 $202.32 25035 T Treat forearm bone lesion 0049 19.45 $1,011.58 $202.32 25040 T Explore/treat wrist joint 0050 23.60 $1,227.41 $245.48 25065 T Biopsy forearm soft tissues 0021 14.58 $758.29 $227.49 $151.66 25066 T Biopsy forearm soft tissues 0022 18.10 $941.36 $367.13 $188.27 25075 T Remove forearm lesion subcut 0021 14.58 $758.29 $227.49 $151.66 25076 T Remove forearm lesion deep 0022 18.10 $941.36 $367.13 $188.27 25077 T Remove tumor, forearm/wrist 0022 18.10 $941.36 $367.13 $188.27 25085 T Incision of wrist capsule 0049 19.45 $1,011.58 $202.32 25100 T Biopsy of wrist joint 0049 19.45 $1,011.58 $202.32 25101 T Explore/treat wrist joint 0050 23.60 $1,227.41 $245.48 25105 T Remove wrist joint lining 0050 23.60 $1,227.41 $245.48 25107 T Remove wrist joint cartilage 0050 23.60 $1,227.41 $245.48 25110 T Remove wrist tendon lesion 0049 19.45 $1,011.58 $202.32 25111 T Remove wrist tendon lesion 0053 14.76 $767.65 $253.49 $153.53 25112 T Reremove wrist tendon lesion 0053 14.76 $767.65 $253.49 $153.53 25115 T Remove wrist/forearm lesion 0049 19.45 $1,011.58 $202.32 25116 T Remove wrist/forearm lesion 0049 19.45 $1,011.58 $202.32 25118 T Excise wrist tendon sheath 0050 23.60 $1,227.41 $245.48 25119 T Partial removal of ulna 0050 23.60 $1,227.41 $245.48 25120 T Removal of forearm lesion 0050 23.60 $1,227.41 $245.48 25125 T Remove/graft forearm lesion 0050 23.60 $1,227.41 $245.48 25126 T Remove/graft forearm lesion 0050 23.60 $1,227.41 $245.48 25130 T Removal of wrist lesion 0050 23.60 $1,227.41 $245.48 25135 T Remove & graft wrist lesion 0050 23.60 $1,227.41 $245.48 25136 T Remove & graft wrist lesion 0050 23.60 $1,227.41 $245.48 25145 T Remove forearm bone lesion 0050 23.60 $1,227.41 $245.48 25150 T Partial removal of ulna 0050 23.60 $1,227.41 $245.48 25151 T Partial removal of radius 0050 23.60 $1,227.41 $245.48 25170 T Extensive forearm surgery 0052 42.37 $2,203.62 $440.72 25210 T Removal of wrist bone 0054 23.50 $1,222.21 $472.33 $244.44 25215 T Removal of wrist bones 0054 23.50 $1,222.21 $472.33 $244.44 25230 T Partial removal of radius 0050 23.60 $1,227.41 $245.48 25240 T Partial removal of ulna 0050 23.60 $1,227.41 $245.48 25246 N Injection for wrist x-ray 25248 T Remove forearm foreign body 0049 19.45 $1,011.58 $202.32 25250 T Removal of wrist prosthesis 0050 23.60 $1,227.41 $245.48 25251 T Removal of wrist prosthesis 0050 23.60 $1,227.41 $245.48 25259 T Manipulate wrist w/anesthes 0043 1.68 $87.38 $17.48 25260 T Repair forearm tendon/muscle 0050 23.60 $1,227.41 $245.48 25263 T Repair forearm tendon/muscle 0050 23.60 $1,227.41 $245.48 25265 T Repair forearm tendon/muscle 0050 23.60 $1,227.41 $245.48 25270 T Repair forearm tendon/muscle 0050 23.60 $1,227.41 $245.48 25272 T Repair forearm tendon/muscle 0050 23.60 $1,227.41 $245.48 25274 T Repair forearm tendon/muscle 0050 23.60 $1,227.41 $245.48 25275 T Repair forearm tendon sheath 0050 23.60 $1,227.41 $245.48 25280 T Revise wrist/forearm tendon 0050 23.60 $1,227.41 $245.48 25290 T Incise wrist/forearm tendon 0050 23.60 $1,227.41 $245.48 25295 T Release wrist/forearm tendon 0049 19.45 $1,011.58 $202.32 Start Printed Page 52179 25300 T Fusion of tendons at wrist 0050 23.60 $1,227.41 $245.48 25301 T Fusion of tendons at wrist 0050 23.60 $1,227.41 $245.48 25310 T Transplant forearm tendon 0051 34.03 $1,769.87 $353.97 25312 T Transplant forearm tendon 0051 34.03 $1,769.87 $353.97 25315 T Revise palsy hand tendon(s) 0051 34.03 $1,769.87 $353.97 25316 T Revise palsy hand tendon(s) 0051 34.03 $1,769.87 $353.97 25320 T Repair/revise wrist joint 0051 34.03 $1,769.87 $353.97 25332 T Revise wrist joint 0047 29.59 $1,538.95 $537.03 $307.79 25335 T Realignment of hand 0051 34.03 $1,769.87 $353.97 25337 T Reconstruct ulna/radioulnar 0051 34.03 $1,769.87 $353.97 25350 T Revision of radius 0051 34.03 $1,769.87 $353.97 25355 T Revision of radius 0051 34.03 $1,769.87 $353.97 25360 T Revision of ulna 0050 23.60 $1,227.41 $245.48 25365 T Revise radius & ulna 0050 23.60 $1,227.41 $245.48 25370 T Revise radius or ulna 0051 34.03 $1,769.87 $353.97 25375 T Revise radius & ulna 0051 34.03 $1,769.87 $353.97 25390 T Shorten radius or ulna 0050 23.60 $1,227.41 $245.48 25391 T Lengthen radius or ulna 0051 34.03 $1,769.87 $353.97 25392 T Shorten radius & ulna 0050 23.60 $1,227.41 $245.48 25393 T Lengthen radius & ulna 0051 34.03 $1,769.87 $353.97 25394 T Repair carpal bone, shorten 0053 14.76 $767.65 $253.49 $153.53 25400 T Repair radius or ulna 0050 23.60 $1,227.41 $245.48 25405 T Repair/graft radius or ulna 0050 23.60 $1,227.41 $245.48 25415 T Repair radius & ulna 0050 23.60 $1,227.41 $245.48 25420 T Repair/graft radius & ulna 0051 34.03 $1,769.87 $353.97 25425 T Repair/graft radius or ulna 0051 34.03 $1,769.87 $353.97 25426 T Repair/graft radius & ulna 0051 34.03 $1,769.87 $353.97 25430 T Vasc graft into carpal bone 0054 23.50 $1,222.21 $472.33 $244.44 25431 T Repair nonunion carpal bone 0054 23.50 $1,222.21 $472.33 $244.44 25440 T Repair/graft wrist bone 0051 34.03 $1,769.87 $353.97 25441 T Reconstruct wrist joint 0048 36.93 $1,920.69 $633.83 $384.14 25442 T Reconstruct wrist joint 0048 36.93 $1,920.69 $633.83 $384.14 25443 T Reconstruct wrist joint 0048 36.93 $1,920.69 $633.83 $384.14 25444 T Reconstruct wrist joint 0048 36.93 $1,920.69 $633.83 $384.14 25445 T Reconstruct wrist joint 0048 36.93 $1,920.69 $633.83 $384.14 25446 T Wrist replacement 0048 36.93 $1,920.69 $633.83 $384.14 25447 T Repair wrist joint(s) 0047 29.59 $1,538.95 $537.03 $307.79 25449 T Remove wrist joint implant 0047 29.59 $1,538.95 $537.03 $307.79 25450 T Revision of wrist joint 0051 34.03 $1,769.87 $353.97 25455 T Revision of wrist joint 0051 34.03 $1,769.87 $353.97 25490 T Reinforce radius 0051 34.03 $1,769.87 $353.97 25491 T Reinforce ulna 0051 34.03 $1,769.87 $353.97 25492 T Reinforce radius and ulna 0051 34.03 $1,769.87 $353.97 25500 T Treat fracture of radius 0043 1.68 $87.38 $17.48 25505 T Treat fracture of radius 0043 1.68 $87.38 $17.48 25515 T Treat fracture of radius 0046 29.03 $1,509.82 $535.76 $301.96 25520 T Treat fracture of radius 0043 1.68 $87.38 $17.48 25525 T Treat fracture of radius 0046 29.03 $1,509.82 $535.76 $301.96 25526 T Treat fracture of radius 0046 29.03 $1,509.82 $535.76 $301.96 25530 T Treat fracture of ulna 0043 1.68 $87.38 $17.48 25535 T Treat fracture of ulna 0043 1.68 $87.38 $17.48 25545 T Treat fracture of ulna 0046 29.03 $1,509.82 $535.76 $301.96 25560 T Treat fracture radius & ulna 0043 1.68 $87.38 $17.48 25565 T Treat fracture radius & ulna 0043 1.68 $87.38 $17.48 25574 T Treat fracture radius & ulna 0046 29.03 $1,509.82 $535.76 $301.96 25575 T Treat fracture radius/ulna 0046 29.03 $1,509.82 $535.76 $301.96 25600 T Treat fracture radius/ulna 0043 1.68 $87.38 $17.48 25605 T Treat fracture radius/ulna 0043 1.68 $87.38 $17.48 25611 T Treat fracture radius/ulna 0046 29.03 $1,509.82 $535.76 $301.96 25620 T Treat fracture radius/ulna 0046 29.03 $1,509.82 $535.76 $301.96 25622 T Treat wrist bone fracture 0043 1.68 $87.38 $17.48 25624 T Treat wrist bone fracture 0043 1.68 $87.38 $17.48 25628 T Treat wrist bone fracture 0046 29.03 $1,509.82 $535.76 $301.96 25630 T Treat wrist bone fracture 0043 1.68 $87.38 $17.48 25635 T Treat wrist bone fracture 0043 1.68 $87.38 $17.48 25645 T Treat wrist bone fracture 0046 29.03 $1,509.82 $535.76 $301.96 Start Printed Page 52180 25650 T Treat wrist bone fracture 0043 1.68 $87.38 $17.48 25651 T Pin ulnar styloid fracture 0046 29.03 $1,509.82 $535.76 $301.96 25652 T Treat fracture ulnar styloid 0046 29.03 $1,509.82 $535.76 $301.96 25660 T Treat wrist dislocation 0043 1.68 $87.38 $17.48 25670 T Treat wrist dislocation 0046 29.03 $1,509.82 $535.76 $301.96 25671 T Pin radioulnar dislocation 0046 29.03 $1,509.82 $535.76 $301.96 25675 T Treat wrist dislocation 0043 1.68 $87.38 $17.48 25676 T Treat wrist dislocation 0046 29.03 $1,509.82 $535.76 $301.96 25680 T Treat wrist fracture 0043 1.68 $87.38 $17.48 25685 T Treat wrist fracture 0046 29.03 $1,509.82 $535.76 $301.96 25690 T Treat wrist dislocation 0043 1.68 $87.38 $17.48 25695 T Treat wrist dislocation 0046 29.03 $1,509.82 $535.76 $301.96 25800 T Fusion of wrist joint 0051 34.03 $1,769.87 $353.97 25805 T Fusion/graft of wrist joint 0051 34.03 $1,769.87 $353.97 25810 T Fusion/graft of wrist joint 0051 34.03 $1,769.87 $353.97 25820 T Fusion of hand bones 0053 14.76 $767.65 $253.49 $153.53 25825 T Fuse hand bones with graft 0054 23.50 $1,222.21 $472.33 $244.44 25830 T Fusion, radioulnar jnt/ulna 0051 34.03 $1,769.87 $353.97 25900 C Amputation of forearm 25905 C Amputation of forearm 25907 T Amputation follow-up surgery 0049 19.45 $1,011.58 $202.32 25909 C Amputation follow-up surgery 25915 C Amputation of forearm 25920 C Amputate hand at wrist 25922 T Amputate hand at wrist 0049 19.45 $1,011.58 $202.32 25924 C Amputation follow-up surgery 25927 C Amputation of hand 25929 T Amputation follow-up surgery 0027 15.73 $818.10 $343.60 $163.62 25931 C Amputation follow-up surgery 25999 T Forearm or wrist surgery 0043 1.68 $87.38 $17.48 26010 T Drainage of finger abscess 0006 1.89 $98.30 $25.56 $19.66 26011 T Drainage of finger abscess 0007 9.44 $490.96 $103.10 $98.19 26020 T Drain hand tendon sheath 0053 14.76 $767.65 $253.49 $153.53 26025 T Drainage of palm bursa 0053 14.76 $767.65 $253.49 $153.53 26030 T Drainage of palm bursa(s) 0053 14.76 $767.65 $253.49 $153.53 26034 T Treat hand bone lesion 0053 14.76 $767.65 $253.49 $153.53 26035 T Decompress fingers/hand 0053 14.76 $767.65 $253.49 $153.53 26037 T Decompress fingers/hand 0053 14.76 $767.65 $253.49 $153.53 26040 T Release palm contracture 0054 23.50 $1,222.21 $472.33 $244.44 26045 T Release palm contracture 0054 23.50 $1,222.21 $472.33 $244.44 26055 T Incise finger tendon sheath 0053 14.76 $767.65 $253.49 $153.53 26060 T Incision of finger tendon 0053 14.76 $767.65 $253.49 $153.53 26070 T Explore/treat hand joint 0053 14.76 $767.65 $253.49 $153.53 26075 T Explore/treat finger joint 0053 14.76 $767.65 $253.49 $153.53 26080 T Explore/treat finger joint 0053 14.76 $767.65 $253.49 $153.53 26100 T Biopsy hand joint lining 0053 14.76 $767.65 $253.49 $153.53 26105 T Biopsy finger joint lining 0053 14.76 $767.65 $253.49 $153.53 26110 T Biopsy finger joint lining 0053 14.76 $767.65 $253.49 $153.53 26115 T Remove hand lesion subcut 0022 18.10 $941.36 $367.13 $188.27 26116 T Remove hand lesion, deep 0022 18.10 $941.36 $367.13 $188.27 26117 T Remove tumor, hand/finger 0022 18.10 $941.36 $367.13 $188.27 26121 T Release palm contracture 0054 23.50 $1,222.21 $472.33 $244.44 26123 T Release palm contracture 0054 23.50 $1,222.21 $472.33 $244.44 26125 T Release palm contracture 0054 23.50 $1,222.21 $472.33 $244.44 26130 T Remove wrist joint lining 0053 14.76 $767.65 $253.49 $153.53 26135 T Revise finger joint, each 0054 23.50 $1,222.21 $472.33 $244.44 26140 T Revise finger joint, each 0053 14.76 $767.65 $253.49 $153.53 26145 T Tendon excision, palm/finger 0053 14.76 $767.65 $253.49 $153.53 26160 T Remove tendon sheath lesion 0053 14.76 $767.65 $253.49 $153.53 26170 T Removal of palm tendon, each 0053 14.76 $767.65 $253.49 $153.53 26180 T Removal of finger tendon 0053 14.76 $767.65 $253.49 $153.53 26185 T Remove finger bone 0053 14.76 $767.65 $253.49 $153.53 26200 T Remove hand bone lesion 0053 14.76 $767.65 $253.49 $153.53 26205 T Remove/graft bone lesion 0054 23.50 $1,222.21 $472.33 $244.44 26210 T Removal of finger lesion 0053 14.76 $767.65 $253.49 $153.53 26215 T Remove/graft finger lesion 0053 14.76 $767.65 $253.49 $153.53 Start Printed Page 52181 26230 T Partial removal of hand bone 0053 14.76 $767.65 $253.49 $153.53 26235 T Partial removal, finger bone 0053 14.76 $767.65 $253.49 $153.53 26236 T Partial removal, finger bone 0053 14.76 $767.65 $253.49 $153.53 26250 T Extensive hand surgery 0053 14.76 $767.65 $253.49 $153.53 26255 T Extensive hand surgery 0054 23.50 $1,222.21 $472.33 $244.44 26260 T Extensive finger surgery 0053 14.76 $767.65 $253.49 $153.53 26261 T Extensive finger surgery 0053 14.76 $767.65 $253.49 $153.53 26262 T Partial removal of finger 0053 14.76 $767.65 $253.49 $153.53 26320 T Removal of implant from hand 0021 14.58 $758.29 $227.49 $151.66 26340 T Manipulate finger w/anesth 0043 1.68 $87.38 $17.48 26350 T Repair finger/hand tendon 0054 23.50 $1,222.21 $472.33 $244.44 26352 T Repair/graft hand tendon 0054 23.50 $1,222.21 $472.33 $244.44 26356 T Repair finger/hand tendon 0054 23.50 $1,222.21 $472.33 $244.44 26357 T Repair finger/hand tendon 0054 23.50 $1,222.21 $472.33 $244.44 26358 T Repair/graft hand tendon 0054 23.50 $1,222.21 $472.33 $244.44 26370 T Repair finger/hand tendon 0054 23.50 $1,222.21 $472.33 $244.44 26372 T Repair/graft hand tendon 0054 23.50 $1,222.21 $472.33 $244.44 26373 T Repair finger/hand tendon 0054 23.50 $1,222.21 $472.33 $244.44 26390 T Revise hand/finger tendon 0054 23.50 $1,222.21 $472.33 $244.44 26392 T Repair/graft hand tendon 0054 23.50 $1,222.21 $472.33 $244.44 26410 T Repair hand tendon 0053 14.76 $767.65 $253.49 $153.53 26412 T Repair/graft hand tendon 0054 23.50 $1,222.21 $472.33 $244.44 26415 T Excision, hand/finger tendon 0054 23.50 $1,222.21 $472.33 $244.44 26416 T Graft hand or finger tendon 0054 23.50 $1,222.21 $472.33 $244.44 26418 T Repair finger tendon 0053 14.76 $767.65 $253.49 $153.53 26420 T Repair/graft finger tendon 0054 23.50 $1,222.21 $472.33 $244.44 26426 T Repair finger/hand tendon 0054 23.50 $1,222.21 $472.33 $244.44 26428 T Repair/graft finger tendon 0054 23.50 $1,222.21 $472.33 $244.44 26432 T Repair finger tendon 0053 14.76 $767.65 $253.49 $153.53 26433 T Repair finger tendon 0053 14.76 $767.65 $253.49 $153.53 26434 T Repair/graft finger tendon 0054 23.50 $1,222.21 $472.33 $244.44 26437 T Realignment of tendons 0053 14.76 $767.65 $253.49 $153.53 26440 T Release palm/finger tendon 0053 14.76 $767.65 $253.49 $153.53 26442 T Release palm & finger tendon 0054 23.50 $1,222.21 $472.33 $244.44 26445 T Release hand/finger tendon 0053 14.76 $767.65 $253.49 $153.53 26449 T Release forearm/hand tendon 0054 23.50 $1,222.21 $472.33 $244.44 26450 T Incision of palm tendon 0053 14.76 $767.65 $253.49 $153.53 26455 T Incision of finger tendon 0053 14.76 $767.65 $253.49 $153.53 26460 T Incise hand/finger tendon 0053 14.76 $767.65 $253.49 $153.53 26471 T Fusion of finger tendons 0053 14.76 $767.65 $253.49 $153.53 26474 T Fusion of finger tendons 0053 14.76 $767.65 $253.49 $153.53 26476 T Tendon lengthening 0053 14.76 $767.65 $253.49 $153.53 26477 T Tendon shortening 0053 14.76 $767.65 $253.49 $153.53 26478 T Lengthening of hand tendon 0053 14.76 $767.65 $253.49 $153.53 26479 T Shortening of hand tendon 0053 14.76 $767.65 $253.49 $153.53 26480 T Transplant hand tendon 0054 23.50 $1,222.21 $472.33 $244.44 26483 T Transplant/graft hand tendon 0054 23.50 $1,222.21 $472.33 $244.44 26485 T Transplant palm tendon 0054 23.50 $1,222.21 $472.33 $244.44 26489 T Transplant/graft palm tendon 0054 23.50 $1,222.21 $472.33 $244.44 26490 T Revise thumb tendon 0054 23.50 $1,222.21 $472.33 $244.44 26492 T Tendon transfer with graft 0054 23.50 $1,222.21 $472.33 $244.44 26494 T Hand tendon/muscle transfer 0054 23.50 $1,222.21 $472.33 $244.44 26496 T Revise thumb tendon 0054 23.50 $1,222.21 $472.33 $244.44 26497 T Finger tendon transfer 0054 23.50 $1,222.21 $472.33 $244.44 26498 T Finger tendon transfer 0054 23.50 $1,222.21 $472.33 $244.44 26499 T Revision of finger 0054 23.50 $1,222.21 $472.33 $244.44 26500 T Hand tendon reconstruction 0053 14.76 $767.65 $253.49 $153.53 26502 T Hand tendon reconstruction 0054 23.50 $1,222.21 $472.33 $244.44 26504 T Hand tendon reconstruction 0054 23.50 $1,222.21 $472.33 $244.44 26508 T Release thumb contracture 0053 14.76 $767.65 $253.49 $153.53 26510 T Thumb tendon transfer 0054 23.50 $1,222.21 $472.33 $244.44 26516 T Fusion of knuckle joint 0054 23.50 $1,222.21 $472.33 $244.44 26517 T Fusion of knuckle joints 0054 23.50 $1,222.21 $472.33 $244.44 26518 T Fusion of knuckle joints 0054 23.50 $1,222.21 $472.33 $244.44 26520 T Release knuckle contracture 0053 14.76 $767.65 $253.49 $153.53 26525 T Release finger contracture 0053 14.76 $767.65 $253.49 $153.53 Start Printed Page 52182 26530 T Revise knuckle joint 0047 29.59 $1,538.95 $537.03 $307.79 26531 T Revise knuckle with implant 0048 36.93 $1,920.69 $633.83 $384.14 26535 T Revise finger joint 0047 29.59 $1,538.95 $537.03 $307.79 26536 T Revise/implant finger joint 0048 36.93 $1,920.69 $633.83 $384.14 26540 T Repair hand joint 0053 14.76 $767.65 $253.49 $153.53 26541 T Repair hand joint with graft 0054 23.50 $1,222.21 $472.33 $244.44 26542 T Repair hand joint with graft 0053 14.76 $767.65 $253.49 $153.53 26545 T Reconstruct finger joint 0054 23.50 $1,222.21 $472.33 $244.44 26546 T Repair nonunion hand 0054 23.50 $1,222.21 $472.33 $244.44 26548 T Reconstruct finger joint 0054 23.50 $1,222.21 $472.33 $244.44 26550 T Construct thumb replacement 0054 23.50 $1,222.21 $472.33 $244.44 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 23.50 $1,222.21 $472.33 $244.44 26556 C Toe joint transfer 26560 T Repair of web finger 0053 14.76 $767.65 $253.49 $153.53 26561 T Repair of web finger 0054 23.50 $1,222.21 $472.33 $244.44 26562 T Repair of web finger 0054 23.50 $1,222.21 $472.33 $244.44 26565 T Correct metacarpal flaw 0054 23.50 $1,222.21 $472.33 $244.44 26567 T Correct finger deformity 0054 23.50 $1,222.21 $472.33 $244.44 26568 T Lengthen metacarpal/finger 0054 23.50 $1,222.21 $472.33 $244.44 26580 T Repair hand deformity 0054 23.50 $1,222.21 $472.33 $244.44 26587 T Reconstruct extra finger 0053 14.76 $767.65 $253.49 $153.53 26590 T Repair finger deformity 0054 23.50 $1,222.21 $472.33 $244.44 26591 T Repair muscles of hand 0054 23.50 $1,222.21 $472.33 $244.44 26593 T Release muscles of hand 0053 14.76 $767.65 $253.49 $153.53 26596 T Excision constricting tissue 0054 23.50 $1,222.21 $472.33 $244.44 26600 T Treat metacarpal fracture 0043 1.68 $87.38 $17.48 26605 T Treat metacarpal fracture 0043 1.68 $87.38 $17.48 26607 T Treat metacarpal fracture 0043 1.68 $87.38 $17.48 26608 T Treat metacarpal fracture 0046 29.03 $1,509.82 $535.76 $301.96 26615 T Treat metacarpal fracture 0046 29.03 $1,509.82 $535.76 $301.96 26641 T Treat thumb dislocation 0043 1.68 $87.38 $17.48 26645 T Treat thumb fracture 0043 1.68 $87.38 $17.48 26650 T Treat thumb fracture 0046 29.03 $1,509.82 $535.76 $301.96 26665 T Treat thumb fracture 0046 29.03 $1,509.82 $535.76 $301.96 26670 T Treat hand dislocation 0043 1.68 $87.38 $17.48 26675 T Treat hand dislocation 0043 1.68 $87.38 $17.48 26676 T Pin hand dislocation 0046 29.03 $1,509.82 $535.76 $301.96 26685 T Treat hand dislocation 0046 29.03 $1,509.82 $535.76 $301.96 26686 T Treat hand dislocation 0046 29.03 $1,509.82 $535.76 $301.96 26700 T Treat knuckle dislocation 0043 1.68 $87.38 $17.48 26705 T Treat knuckle dislocation 0043 1.68 $87.38 $17.48 26706 T Pin knuckle dislocation 0043 1.68 $87.38 $17.48 26715 T Treat knuckle dislocation 0046 29.03 $1,509.82 $535.76 $301.96 26720 T Treat finger fracture, each 0043 1.68 $87.38 $17.48 26725 T Treat finger fracture, each 0043 1.68 $87.38 $17.48 26727 T Treat finger fracture, each 0046 29.03 $1,509.82 $535.76 $301.96 26735 T Treat finger fracture, each 0046 29.03 $1,509.82 $535.76 $301.96 26740 T Treat finger fracture, each 0043 1.68 $87.38 $17.48 26742 T Treat finger fracture, each 0043 1.68 $87.38 $17.48 26746 T Treat finger fracture, each 0046 29.03 $1,509.82 $535.76 $301.96 26750 T Treat finger fracture, each 0043 1.68 $87.38 $17.48 26755 T Treat finger fracture, each 0043 1.68 $87.38 $17.48 26756 T Pin finger fracture, each 0046 29.03 $1,509.82 $535.76 $301.96 26765 T Treat finger fracture, each 0046 29.03 $1,509.82 $535.76 $301.96 26770 T Treat finger dislocation 0043 1.68 $87.38 $17.48 26775 T Treat finger dislocation 0045 13.47 $700.56 $280.22 $140.11 26776 T Pin finger dislocation 0046 29.03 $1,509.82 $535.76 $301.96 26785 T Treat finger dislocation 0046 29.03 $1,509.82 $535.76 $301.96 26820 T Thumb fusion with graft 0054 23.50 $1,222.21 $472.33 $244.44 26841 T Fusion of thumb 0054 23.50 $1,222.21 $472.33 $244.44 26842 T Thumb fusion with graft 0054 23.50 $1,222.21 $472.33 $244.44 26843 T Fusion of hand joint 0054 23.50 $1,222.21 $472.33 $244.44 26844 T Fusion/graft of hand joint 0054 23.50 $1,222.21 $472.33 $244.44 Start Printed Page 52183 26850 T Fusion of knuckle 0054 23.50 $1,222.21 $472.33 $244.44 26852 T Fusion of knuckle with graft 0054 23.50 $1,222.21 $472.33 $244.44 26860 T Fusion of finger joint 0054 23.50 $1,222.21 $472.33 $244.44 26861 T Fusion of finger jnt, add-on 0054 23.50 $1,222.21 $472.33 $244.44 26862 T Fusion/graft of finger joint 0054 23.50 $1,222.21 $472.33 $244.44 26863 T Fuse/graft added joint 0054 23.50 $1,222.21 $472.33 $244.44 26910 T Amputate metacarpal bone 0054 23.50 $1,222.21 $472.33 $244.44 26951 T Amputation of finger/thumb 0053 14.76 $767.65 $253.49 $153.53 26952 T Amputation of finger/thumb 0053 14.76 $767.65 $253.49 $153.53 26989 T Hand/finger surgery 0043 1.68 $87.38 $17.48 26990 T Drainage of pelvis lesion 0049 19.45 $1,011.58 $202.32 26991 T Drainage of pelvis bursa 0049 19.45 $1,011.58 $202.32 26992 C Drainage of bone lesion 27000 T Incision of hip tendon 0049 19.45 $1,011.58 $202.32 27001 T Incision of hip tendon 0050 23.60 $1,227.41 $245.48 27003 T Incision of hip tendon 0050 23.60 $1,227.41 $245.48 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 34.03 $1,769.87 $353.97 27035 T Denervation of hip joint 0052 42.37 $2,203.62 $440.72 27036 C Excision of hip joint/muscle 27040 T Biopsy of soft tissues 0021 14.58 $758.29 $227.49 $151.66 27041 T Biopsy of soft tissues 0022 18.10 $941.36 $367.13 $188.27 27047 T Remove hip/pelvis lesion 0022 18.10 $941.36 $367.13 $188.27 27048 T Remove hip/pelvis lesion 0022 18.10 $941.36 $367.13 $188.27 27049 T Remove tumor, hip/pelvis 0022 18.10 $941.36 $367.13 $188.27 27050 T Biopsy of sacroiliac joint 0049 19.45 $1,011.58 $202.32 27052 T Biopsy of hip joint 0049 19.45 $1,011.58 $202.32 27054 C Removal of hip joint lining 27060 T Removal of ischial bursa 0049 19.45 $1,011.58 $202.32 27062 T Remove femur lesion/bursa 0049 19.45 $1,011.58 $202.32 27065 T Removal of hip bone lesion 0049 19.45 $1,011.58 $202.32 27066 T Removal of hip bone lesion 0050 23.60 $1,227.41 $245.48 27067 T Remove/graft hip bone lesion 0050 23.60 $1,227.41 $245.48 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 23.60 $1,227.41 $245.48 27086 T Remove hip foreign body 0020 7.36 $382.79 $114.84 $76.56 27087 T Remove hip foreign body 0049 19.45 $1,011.58 $202.32 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 N Inject sacroiliac joint 27097 T Revision of hip tendon 0050 23.60 $1,227.41 $245.48 27098 T Transfer tendon to pelvis 0050 23.60 $1,227.41 $245.48 27100 T Transfer of abdominal muscle 0051 34.03 $1,769.87 $353.97 27105 T Transfer of spinal muscle 0051 34.03 $1,769.87 $353.97 27110 T Transfer of iliopsoas muscle 0051 34.03 $1,769.87 $353.97 27111 T Transfer of iliopsoas muscle 0051 34.03 $1,769.87 $353.97 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 Start Printed Page 52184 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 1.68 $87.38 $17.48 27194 T Treat pelvic ring fracture 0045 13.47 $700.56 $280.22 $140.11 27200 T Treat tail bone fracture 0043 1.68 $87.38 $17.48 27202 T Treat tail bone fracture 0046 29.03 $1,509.82 $535.76 $301.96 27215 C Treat pelvic fracture(s) 27216 T Treat pelvic ring fracture 0050 23.60 $1,227.41 $245.48 27217 C Treat pelvic ring fracture 27218 C Treat pelvic ring fracture 27220 T Treat hip socket fracture 0043 1.68 $87.38 $17.48 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 1.68 $87.38 $17.48 27232 C Treat thigh fracture 27235 T Treat thigh fracture 0050 23.60 $1,227.41 $245.48 27236 C Treat thigh fracture 27238 T Treat thigh fracture 0043 1.68 $87.38 $17.48 27240 C Treat thigh fracture 27244 C Treat thigh fracture 27245 C Treat thigh fracture 27246 T Treat thigh fracture 0043 1.68 $87.38 $17.48 27248 C Treat thigh fracture 27250 T Treat hip dislocation 0043 1.68 $87.38 $17.48 27252 T Treat hip dislocation 0045 13.47 $700.56 $280.22 $140.11 27253 C Treat hip dislocation 27254 C Treat hip dislocation 27256 T Treat hip dislocation 0043 1.68 $87.38 $17.48 27257 T Treat hip dislocation 0045 13.47 $700.56 $280.22 $140.11 27258 C Treat hip dislocation 27259 C Treat hip dislocation 27265 T Treat hip dislocation 0043 1.68 $87.38 $17.48 27266 T Treat hip dislocation 0045 13.47 $700.56 $280.22 $140.11 27275 T Manipulation of hip joint 0045 13.47 $700.56 $280.22 $140.11 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 1.68 $87.38 $17.48 27301 T Drain thigh/knee lesion 0008 16.32 $848.79 $169.76 27303 C Drainage of bone lesion 27305 T Incise thigh tendon & fascia 0049 19.45 $1,011.58 $202.32 27306 T Incision of thigh tendon 0049 19.45 $1,011.58 $202.32 27307 T Incision of thigh tendons 0049 19.45 $1,011.58 $202.32 27310 T Exploration of knee joint 0050 23.60 $1,227.41 $245.48 27315 T Partial removal, thigh nerve 0220 16.66 $866.47 $173.29 27320 T Partial removal, thigh nerve 0220 16.66 $866.47 $173.29 27323 T Biopsy, thigh soft tissues 0021 14.58 $758.29 $227.49 $151.66 Start Printed Page 52185 27324 T Biopsy, thigh soft tissues 0022 18.10 $941.36 $367.13 $188.27 27327 T Removal of thigh lesion 0022 18.10 $941.36 $367.13 $188.27 27328 T Removal of thigh lesion 0022 18.10 $941.36 $367.13 $188.27 27329 T Remove tumor, thigh/knee 0022 18.10 $941.36 $367.13 $188.27 27330 T Biopsy, knee joint lining 0050 23.60 $1,227.41 $245.48 27331 T Explore/treat knee joint 0050 23.60 $1,227.41 $245.48 27332 T Removal of knee cartilage 0050 23.60 $1,227.41 $245.48 27333 T Removal of knee cartilage 0050 23.60 $1,227.41 $245.48 27334 T Remove knee joint lining 0050 23.60 $1,227.41 $245.48 27335 T Remove knee joint lining 0050 23.60 $1,227.41 $245.48 27340 T Removal of kneecap bursa 0049 19.45 $1,011.58 $202.32 27345 T Removal of knee cyst 0049 19.45 $1,011.58 $202.32 27347 T Remove knee cyst 0049 19.45 $1,011.58 $202.32 27350 T Removal of kneecap 0050 23.60 $1,227.41 $245.48 27355 T Remove femur lesion 0050 23.60 $1,227.41 $245.48 27356 T Remove femur lesion/graft 0050 23.60 $1,227.41 $245.48 27357 T Remove femur lesion/graft 0050 23.60 $1,227.41 $245.48 27358 T Remove femur lesion/fixation 0050 23.60 $1,227.41 $245.48 27360 T Partial removal, leg bone(s) 0050 23.60 $1,227.41 $245.48 27365 C Extensive leg surgery 27370 N Injection for knee x-ray 27372 T Removal of foreign body 0022 18.10 $941.36 $367.13 $188.27 27380 T Repair of kneecap tendon 0049 19.45 $1,011.58 $202.32 27381 T Repair/graft kneecap tendon 0049 19.45 $1,011.58 $202.32 27385 T Repair of thigh muscle 0049 19.45 $1,011.58 $202.32 27386 T Repair/graft of thigh muscle 0049 19.45 $1,011.58 $202.32 27390 T Incision of thigh tendon 0049 19.45 $1,011.58 $202.32 27391 T Incision of thigh tendons 0049 19.45 $1,011.58 $202.32 27392 T Incision of thigh tendons 0049 19.45 $1,011.58 $202.32 27393 T Lengthening of thigh tendon 0050 23.60 $1,227.41 $245.48 27394 T Lengthening of thigh tendons 0050 23.60 $1,227.41 $245.48 27395 T Lengthening of thigh tendons 0051 34.03 $1,769.87 $353.97 27396 T Transplant of thigh tendon 0050 23.60 $1,227.41 $245.48 27397 T Transplants of thigh tendons 0051 34.03 $1,769.87 $353.97 27400 T Revise thigh muscles/tendons 0051 34.03 $1,769.87 $353.97 27403 T Repair of knee cartilage 0050 23.60 $1,227.41 $245.48 27405 T Repair of knee ligament 0051 34.03 $1,769.87 $353.97 27407 T Repair of knee ligament 0051 34.03 $1,769.87 $353.97 27409 T Repair of knee ligaments 0051 34.03 $1,769.87 $353.97 27418 T Repair degenerated kneecap 0051 34.03 $1,769.87 $353.97 27420 T Revision of unstable kneecap 0051 34.03 $1,769.87 $353.97 27422 T Revision of unstable kneecap 0051 34.03 $1,769.87 $353.97 27424 T Revision/removal of kneecap 0051 34.03 $1,769.87 $353.97 27425 T Lateral retinacular release 0050 23.60 $1,227.41 $245.48 27427 T Reconstruction, knee 0052 42.37 $2,203.62 $440.72 27428 T Reconstruction, knee 0052 42.37 $2,203.62 $440.72 27429 T Reconstruction, knee 0052 42.37 $2,203.62 $440.72 27430 T Revision of thigh muscles 0051 34.03 $1,769.87 $353.97 27435 T Incision of knee joint 0051 34.03 $1,769.87 $353.97 27437 T Revise kneecap 0047 29.59 $1,538.95 $537.03 $307.79 27438 T Revise kneecap with implant 0048 36.93 $1,920.69 $633.83 $384.14 27440 T Revision of knee joint 0047 29.59 $1,538.95 $537.03 $307.79 27441 T Revision of knee joint 0047 29.59 $1,538.95 $537.03 $307.79 27442 T Revision of knee joint 0047 29.59 $1,538.95 $537.03 $307.79 27443 T Revision of knee joint 0047 29.59 $1,538.95 $537.03 $307.79 27445 C Revision of knee joint 27446 T Revision of knee joint 0681 158.14 $8,224.70 $3,289.88 $1,644.94 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 Start Printed Page 52186 27470 C Repair of thigh 27472 C Repair/graft of thigh 27475 C Surgery to stop leg growth 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 19.45 $1,011.58 $202.32 27497 T Decompression of thigh/knee 0049 19.45 $1,011.58 $202.32 27498 T Decompression of thigh/knee 0049 19.45 $1,011.58 $202.32 27499 T Decompression of thigh/knee 0049 19.45 $1,011.58 $202.32 27500 T Treatment of thigh fracture 0043 1.68 $87.38 $17.48 27501 T Treatment of thigh fracture 0043 1.68 $87.38 $17.48 27502 T Treatment of thigh fracture 0043 1.68 $87.38 $17.48 27503 T Treatment of thigh fracture 0043 1.68 $87.38 $17.48 27506 C Treatment of thigh fracture 27507 C Treatment of thigh fracture 27508 T Treatment of thigh fracture 0043 1.68 $87.38 $17.48 27509 T Treatment of thigh fracture 0046 29.03 $1,509.82 $535.76 $301.96 27510 T Treatment of thigh fracture 0043 1.68 $87.38 $17.48 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 1.68 $87.38 $17.48 27517 T Treat thigh fx growth plate 0043 1.68 $87.38 $17.48 27519 C Treat thigh fx growth plate 27520 T Treat kneecap fracture 0043 1.68 $87.38 $17.48 27524 T Treat kneecap fracture 0046 29.03 $1,509.82 $535.76 $301.96 27530 T Treat knee fracture 0043 1.68 $87.38 $17.48 27532 T Treat knee fracture 0043 1.68 $87.38 $17.48 27535 C Treat knee fracture 27536 C Treat knee fracture 27538 T Treat knee fracture(s) 0043 1.68 $87.38 $17.48 27540 C Treat knee fracture 27550 T Treat knee dislocation 0043 1.68 $87.38 $17.48 27552 T Treat knee dislocation 0045 13.47 $700.56 $280.22 $140.11 27556 C Treat knee dislocation 27557 C Treat knee dislocation 27558 C Treat knee dislocation 27560 T Treat kneecap dislocation 0043 1.68 $87.38 $17.48 27562 T Treat kneecap dislocation 0045 13.47 $700.56 $280.22 $140.11 27566 T Treat kneecap dislocation 0046 29.03 $1,509.82 $535.76 $301.96 27570 T Fixation of knee joint 0045 13.47 $700.56 $280.22 $140.11 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 19.45 $1,011.58 $202.32 27596 C Amputation follow-up surgery 27598 C Amputate lower leg at knee 27599 T Leg surgery procedure 0043 1.68 $87.38 $17.48 27600 T Decompression of lower leg 0049 19.45 $1,011.58 $202.32 27601 T Decompression of lower leg 0049 19.45 $1,011.58 $202.32 27602 T Decompression of lower leg 0049 19.45 $1,011.58 $202.32 27603 T Drain lower leg lesion 0008 16.32 $848.79 $169.76 27604 T Drain lower leg bursa 0049 19.45 $1,011.58 $202.32 27605 T Incision of achilles tendon 0055 18.28 $950.72 $355.34 $190.14 27606 T Incision of achilles tendon 0049 19.45 $1,011.58 $202.32 27607 T Treat lower leg bone lesion 0049 19.45 $1,011.58 $202.32 27610 T Explore/treat ankle joint 0050 23.60 $1,227.41 $245.48 27612 T Exploration of ankle joint 0050 23.60 $1,227.41 $245.48 27613 T Biopsy lower leg soft tissue 0020 7.36 $382.79 $114.84 $76.56 27614 T Biopsy lower leg soft tissue 0022 18.10 $941.36 $367.13 $188.27 Start Printed Page 52187 27615 T Remove tumor, lower leg 0046 29.03 $1,509.82 $535.76 $301.96 27618 T Remove lower leg lesion 0021 14.58 $758.29 $227.49 $151.66 27619 T Remove lower leg lesion 0022 18.10 $941.36 $367.13 $188.27 27620 T Explore/treat ankle joint 0050 23.60 $1,227.41 $245.48 27625 T Remove ankle joint lining 0050 23.60 $1,227.41 $245.48 27626 T Remove ankle joint lining 0050 23.60 $1,227.41 $245.48 27630 T Removal of tendon lesion 0049 19.45 $1,011.58 $202.32 27635 T Remove lower leg bone lesion 0050 23.60 $1,227.41 $245.48 27637 T Remove/graft leg bone lesion 0050 23.60 $1,227.41 $245.48 27638 T Remove/graft leg bone lesion 0050 23.60 $1,227.41 $245.48 27640 T Partial removal of tibia 0051 34.03 $1,769.87 $353.97 27641 T Partial removal of fibula 0050 23.60 $1,227.41 $245.48 27645 C Extensive lower leg surgery 27646 C Extensive lower leg surgery 27647 T Extensive ankle/heel surgery 0051 34.03 $1,769.87 $353.97 27648 N Injection for ankle x-ray 27650 T Repair achilles tendon 0051 34.03 $1,769.87 $353.97 27652 T Repair/graft achilles tendon 0051 34.03 $1,769.87 $353.97 27654 T Repair of achilles tendon 0051 34.03 $1,769.87 $353.97 27656 T Repair leg fascia defect 0049 19.45 $1,011.58 $202.32 27658 T Repair of leg tendon, each 0049 19.45 $1,011.58 $202.32 27659 T Repair of leg tendon, each 0049 19.45 $1,011.58 $202.32 27664 T Repair of leg tendon, each 0049 19.45 $1,011.58 $202.32 27665 T Repair of leg tendon, each 0050 23.60 $1,227.41 $245.48 27675 T Repair lower leg tendons 0049 19.45 $1,011.58 $202.32 27676 T Repair lower leg tendons 0050 23.60 $1,227.41 $245.48 27680 T Release of lower leg tendon 0050 23.60 $1,227.41 $245.48 27681 T Release of lower leg tendons 0050 23.60 $1,227.41 $245.48 27685 T Revision of lower leg tendon 0050 23.60 $1,227.41 $245.48 27686 T Revise lower leg tendons 0050 23.60 $1,227.41 $245.48 27687 T Revision of calf tendon 0050 23.60 $1,227.41 $245.48 27690 T Revise lower leg tendon 0051 34.03 $1,769.87 $353.97 27691 T Revise lower leg tendon 0051 34.03 $1,769.87 $353.97 27692 T Revise additional leg tendon 0051 34.03 $1,769.87 $353.97 27695 T Repair of ankle ligament 0050 23.60 $1,227.41 $245.48 27696 T Repair of ankle ligaments 0050 23.60 $1,227.41 $245.48 27698 T Repair of ankle ligament 0050 23.60 $1,227.41 $245.48 27700 T Revision of ankle joint 0047 29.59 $1,538.95 $537.03 $307.79 27702 C Reconstruct ankle joint 27703 C Reconstruction, ankle joint 27704 T Removal of ankle implant 0049 19.45 $1,011.58 $202.32 27705 T Incision of tibia 0051 34.03 $1,769.87 $353.97 27707 T Incision of fibula 0049 19.45 $1,011.58 $202.32 27709 T Incision of tibia & fibula 0050 23.60 $1,227.41 $245.48 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 23.60 $1,227.41 $245.48 27732 T Repair of fibula epiphysis 0050 23.60 $1,227.41 $245.48 27734 T Repair lower leg epiphyses 0050 23.60 $1,227.41 $245.48 27740 T Repair of leg epiphyses 0050 23.60 $1,227.41 $245.48 27742 T Repair of leg epiphyses 0051 34.03 $1,769.87 $353.97 27745 T Reinforce tibia 0051 34.03 $1,769.87 $353.97 27750 T Treatment of tibia fracture 0043 1.68 $87.38 $17.48 27752 T Treatment of tibia fracture 0043 1.68 $87.38 $17.48 27756 T Treatment of tibia fracture 0046 29.03 $1,509.82 $535.76 $301.96 27758 T Treatment of tibia fracture 0046 29.03 $1,509.82 $535.76 $301.96 27759 T Treatment of tibia fracture 0046 29.03 $1,509.82 $535.76 $301.96 27760 T Treatment of ankle fracture 0043 1.68 $87.38 $17.48 27762 T Treatment of ankle fracture 0043 1.68 $87.38 $17.48 27766 T Treatment of ankle fracture 0046 29.03 $1,509.82 $535.76 $301.96 27780 T Treatment of fibula fracture 0043 1.68 $87.38 $17.48 Start Printed Page 52188 27781 T Treatment of fibula fracture 0043 1.68 $87.38 $17.48 27784 T Treatment of fibula fracture 0046 29.03 $1,509.82 $535.76 $301.96 27786 T Treatment of ankle fracture 0043 1.68 $87.38 $17.48 27788 T Treatment of ankle fracture 0043 1.68 $87.38 $17.48 27792 T Treatment of ankle fracture 0046 29.03 $1,509.82 $535.76 $301.96 27808 T Treatment of ankle fracture 0043 1.68 $87.38 $17.48 27810 T Treatment of ankle fracture 0043 1.68 $87.38 $17.48 27814 T Treatment of ankle fracture 0046 29.03 $1,509.82 $535.76 $301.96 27816 T Treatment of ankle fracture 0043 1.68 $87.38 $17.48 27818 T Treatment of ankle fracture 0043 1.68 $87.38 $17.48 27822 T Treatment of ankle fracture 0046 29.03 $1,509.82 $535.76 $301.96 27823 T Treatment of ankle fracture 0046 29.03 $1,509.82 $535.76 $301.96 27824 T Treat lower leg fracture 0043 1.68 $87.38 $17.48 27825 T Treat lower leg fracture 0043 1.68 $87.38 $17.48 27826 T Treat lower leg fracture 0046 29.03 $1,509.82 $535.76 $301.96 27827 T Treat lower leg fracture 0046 29.03 $1,509.82 $535.76 $301.96 27828 T Treat lower leg fracture 0046 29.03 $1,509.82 $535.76 $301.96 27829 T Treat lower leg joint 0046 29.03 $1,509.82 $535.76 $301.96 27830 T Treat lower leg dislocation 0043 1.68 $87.38 $17.48 27831 T Treat lower leg dislocation 0043 1.68 $87.38 $17.48 27832 T Treat lower leg dislocation 0046 29.03 $1,509.82 $535.76 $301.96 27840 T Treat ankle dislocation 0043 1.68 $87.38 $17.48 27842 T Treat ankle dislocation 0045 13.47 $700.56 $280.22 $140.11 27846 T Treat ankle dislocation 0046 29.03 $1,509.82 $535.76 $301.96 27848 T Treat ankle dislocation 0046 29.03 $1,509.82 $535.76 $301.96 27860 T Fixation of ankle joint 0045 13.47 $700.56 $280.22 $140.11 27870 T Fusion of ankle joint 0051 34.03 $1,769.87 $353.97 27871 T Fusion of tibiofibular joint 0051 34.03 $1,769.87 $353.97 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 19.45 $1,011.58 $202.32 27886 C Amputation follow-up surgery 27888 C Amputation of foot at ankle 27889 T Amputation of foot at ankle 0050 23.60 $1,227.41 $245.48 27892 T Decompression of leg 0049 19.45 $1,011.58 $202.32 27893 T Decompression of leg 0049 19.45 $1,011.58 $202.32 27894 T Decompression of leg 0049 19.45 $1,011.58 $202.32 27899 T Leg/ankle surgery procedure 0043 1.68 $87.38 $17.48 28001 T Drainage of bursa of foot 0008 16.32 $848.79 $169.76 28002 T Treatment of foot infection 0049 19.45 $1,011.58 $202.32 28003 T Treatment of foot infection 0049 19.45 $1,011.58 $202.32 28005 T Treat foot bone lesion 0055 18.28 $950.72 $355.34 $190.14 28008 T Incision of foot fascia 0055 18.28 $950.72 $355.34 $190.14 28010 T Incision of toe tendon 0055 18.28 $950.72 $355.34 $190.14 28011 T Incision of toe tendons 0055 18.28 $950.72 $355.34 $190.14 28020 T Exploration of foot joint 0055 18.28 $950.72 $355.34 $190.14 28022 T Exploration of foot joint 0055 18.28 $950.72 $355.34 $190.14 28024 T Exploration of toe joint 0055 18.28 $950.72 $355.34 $190.14 28030 T Removal of foot nerve 0220 16.66 $866.47 $173.29 28035 T Decompression of tibia nerve 0220 16.66 $866.47 $173.29 28043 T Excision of foot lesion 0021 14.58 $758.29 $227.49 $151.66 28045 T Excision of foot lesion 0055 18.28 $950.72 $355.34 $190.14 28046 T Resection of tumor, foot 0055 18.28 $950.72 $355.34 $190.14 28050 T Biopsy of foot joint lining 0055 18.28 $950.72 $355.34 $190.14 28052 T Biopsy of foot joint lining 0055 18.28 $950.72 $355.34 $190.14 28054 T Biopsy of toe joint lining 0055 18.28 $950.72 $355.34 $190.14 28060 T Partial removal, foot fascia 0056 22.94 $1,193.09 $405.81 $238.62 28062 T Removal of foot fascia 0056 22.94 $1,193.09 $405.81 $238.62 28070 T Removal of foot joint lining 0056 22.94 $1,193.09 $405.81 $238.62 28072 T Removal of foot joint lining 0056 22.94 $1,193.09 $405.81 $238.62 28080 T Removal of foot lesion 0055 18.28 $950.72 $355.34 $190.14 28086 T Excise foot tendon sheath 0055 18.28 $950.72 $355.34 $190.14 28088 T Excise foot tendon sheath 0055 18.28 $950.72 $355.34 $190.14 28090 T Removal of foot lesion 0055 18.28 $950.72 $355.34 $190.14 28092 T Removal of toe lesions 0055 18.28 $950.72 $355.34 $190.14 Start Printed Page 52189 28100 T Removal of ankle/heel lesion 0055 18.28 $950.72 $355.34 $190.14 28102 T Remove/graft foot lesion 0056 22.94 $1,193.09 $405.81 $238.62 28103 T Remove/graft foot lesion 0056 22.94 $1,193.09 $405.81 $238.62 28104 T Removal of foot lesion 0055 18.28 $950.72 $355.34 $190.14 28106 T Remove/graft foot lesion 0056 22.94 $1,193.09 $405.81 $238.62 28107 T Remove/graft foot lesion 0056 22.94 $1,193.09 $405.81 $238.62 28108 T Removal of toe lesions 0055 18.28 $950.72 $355.34 $190.14 28110 T Part removal of metatarsal 0056 22.94 $1,193.09 $405.81 $238.62 28111 T Part removal of metatarsal 0055 18.28 $950.72 $355.34 $190.14 28112 T Part removal of metatarsal 0055 18.28 $950.72 $355.34 $190.14 28113 T Part removal of metatarsal 0055 18.28 $950.72 $355.34 $190.14 28114 T Removal of metatarsal heads 0055 18.28 $950.72 $355.34 $190.14 28116 T Revision of foot 0055 18.28 $950.72 $355.34 $190.14 28118 T Removal of heel bone 0055 18.28 $950.72 $355.34 $190.14 28119 T Removal of heel spur 0055 18.28 $950.72 $355.34 $190.14 28120 T Part removal of ankle/heel 0055 18.28 $950.72 $355.34 $190.14 28122 T Partial removal of foot bone 0055 18.28 $950.72 $355.34 $190.14 28124 T Partial removal of toe 0055 18.28 $950.72 $355.34 $190.14 28126 T Partial removal of toe 0055 18.28 $950.72 $355.34 $190.14 28130 T Removal of ankle bone 0055 18.28 $950.72 $355.34 $190.14 28140 T Removal of metatarsal 0055 18.28 $950.72 $355.34 $190.14 28150 T Removal of toe 0055 18.28 $950.72 $355.34 $190.14 28153 T Partial removal of toe 0055 18.28 $950.72 $355.34 $190.14 28160 T Partial removal of toe 0055 18.28 $950.72 $355.34 $190.14 28171 T Extensive foot surgery 0055 18.28 $950.72 $355.34 $190.14 28173 T Extensive foot surgery 0055 18.28 $950.72 $355.34 $190.14 28175 T Extensive foot surgery 0055 18.28 $950.72 $355.34 $190.14 28190 T Removal of foot foreign body 0019 3.94 $204.92 $75.82 $40.98 28192 T Removal of foot foreign body 0021 14.58 $758.29 $227.49 $151.66 28193 T Removal of foot foreign body 0021 14.58 $758.29 $227.49 $151.66 28200 T Repair of foot tendon 0055 18.28 $950.72 $355.34 $190.14 28202 T Repair/graft of foot tendon 0056 22.94 $1,193.09 $405.81 $238.62 28208 T Repair of foot tendon 0055 18.28 $950.72 $355.34 $190.14 28210 T Repair/graft of foot tendon 0055 18.28 $950.72 $355.34 $190.14 28220 T Release of foot tendon 0055 18.28 $950.72 $355.34 $190.14 28222 T Release of foot tendons 0055 18.28 $950.72 $355.34 $190.14 28225 T Release of foot tendon 0055 18.28 $950.72 $355.34 $190.14 28226 T Release of foot tendons 0055 18.28 $950.72 $355.34 $190.14 28230 T Incision of foot tendon(s) 0055 18.28 $950.72 $355.34 $190.14 28232 T Incision of toe tendon 0055 18.28 $950.72 $355.34 $190.14 28234 T Incision of foot tendon 0055 18.28 $950.72 $355.34 $190.14 28238 T Revision of foot tendon 0056 22.94 $1,193.09 $405.81 $238.62 28240 T Release of big toe 0055 18.28 $950.72 $355.34 $190.14 28250 T Revision of foot fascia 0056 22.94 $1,193.09 $405.81 $238.62 28260 T Release of midfoot joint 0056 22.94 $1,193.09 $405.81 $238.62 28261 T Revision of foot tendon 0056 22.94 $1,193.09 $405.81 $238.62 28262 T Revision of foot and ankle 0056 22.94 $1,193.09 $405.81 $238.62 28264 T Release of midfoot joint 0056 22.94 $1,193.09 $405.81 $238.62 28270 T Release of foot contracture 0055 18.28 $950.72 $355.34 $190.14 28272 T Release of toe joint, each 0055 18.28 $950.72 $355.34 $190.14 28280 T Fusion of toes 0055 18.28 $950.72 $355.34 $190.14 28285 T Repair of hammertoe 0055 18.28 $950.72 $355.34 $190.14 28286 T Repair of hammertoe 0055 18.28 $950.72 $355.34 $190.14 28288 T Partial removal of foot bone 0056 22.94 $1,193.09 $405.81 $238.62 28289 T Repair hallux rigidus 0056 22.94 $1,193.09 $405.81 $238.62 28290 T Correction of bunion 0056 22.94 $1,193.09 $405.81 $238.62 28292 T Correction of bunion 0057 23.87 $1,241.45 $496.58 $248.29 28293 T Correction of bunion 0057 23.87 $1,241.45 $496.58 $248.29 28294 T Correction of bunion 0056 22.94 $1,193.09 $405.81 $238.62 28296 T Correction of bunion 0056 22.94 $1,193.09 $405.81 $238.62 28297 T Correction of bunion 0057 23.87 $1,241.45 $496.58 $248.29 28298 T Correction of bunion 0056 22.94 $1,193.09 $405.81 $238.62 28299 T Correction of bunion 0057 23.87 $1,241.45 $496.58 $248.29 28300 T Incision of heel bone 0056 22.94 $1,193.09 $405.81 $238.62 28302 T Incision of ankle bone 0056 22.94 $1,193.09 $405.81 $238.62 28304 T Incision of midfoot bones 0056 22.94 $1,193.09 $405.81 $238.62 Start Printed Page 52190 28305 T Incise/graft midfoot bones 0056 22.94 $1,193.09 $405.81 $238.62 28306 T Incision of metatarsal 0056 22.94 $1,193.09 $405.81 $238.62 28307 T Incision of metatarsal 0056 22.94 $1,193.09 $405.81 $238.62 28308 T Incision of metatarsal 0056 22.94 $1,193.09 $405.81 $238.62 28309 T Incision of metatarsals 0056 22.94 $1,193.09 $405.81 $238.62 28310 T Revision of big toe 0055 18.28 $950.72 $355.34 $190.14 28312 T Revision of toe 0055 18.28 $950.72 $355.34 $190.14 28313 T Repair deformity of toe 0055 18.28 $950.72 $355.34 $190.14 28315 T Removal of sesamoid bone 0055 18.28 $950.72 $355.34 $190.14 28320 T Repair of foot bones 0056 22.94 $1,193.09 $405.81 $238.62 28322 T Repair of metatarsals 0056 22.94 $1,193.09 $405.81 $238.62 28340 T Resect enlarged toe tissue 0055 18.28 $950.72 $355.34 $190.14 28341 T Resect enlarged toe 0055 18.28 $950.72 $355.34 $190.14 28344 T Repair extra toe(s) 0056 22.94 $1,193.09 $405.81 $238.62 28345 T Repair webbed toe(s) 0056 22.94 $1,193.09 $405.81 $238.62 28360 T Reconstruct cleft foot 0056 22.94 $1,193.09 $405.81 $238.62 28400 T Treatment of heel fracture 0043 1.68 $87.38 $17.48 28405 T Treatment of heel fracture 0043 1.68 $87.38 $17.48 28406 T Treatment of heel fracture 0046 29.03 $1,509.82 $535.76 $301.96 28415 T Treat heel fracture 0046 29.03 $1,509.82 $535.76 $301.96 28420 T Treat/graft heel fracture 0046 29.03 $1,509.82 $535.76 $301.96 28430 T Treatment of ankle fracture 0043 1.68 $87.38 $17.48 28435 T Treatment of ankle fracture 0043 1.68 $87.38 $17.48 28436 T Treatment of ankle fracture 0046 29.03 $1,509.82 $535.76 $301.96 28445 T Treat ankle fracture 0046 29.03 $1,509.82 $535.76 $301.96 28450 T Treat midfoot fracture, each 0043 1.68 $87.38 $17.48 28455 T Treat midfoot fracture, each 0043 1.68 $87.38 $17.48 28456 T Treat midfoot fracture 0046 29.03 $1,509.82 $535.76 $301.96 28465 T Treat midfoot fracture, each 0046 29.03 $1,509.82 $535.76 $301.96 28470 T Treat metatarsal fracture 0043 1.68 $87.38 $17.48 28475 T Treat metatarsal fracture 0043 1.68 $87.38 $17.48 28476 T Treat metatarsal fracture 0046 29.03 $1,509.82 $535.76 $301.96 28485 T Treat metatarsal fracture 0046 29.03 $1,509.82 $535.76 $301.96 28490 T Treat big toe fracture 0043 1.68 $87.38 $17.48 28495 T Treat big toe fracture 0043 1.68 $87.38 $17.48 28496 T Treat big toe fracture 0046 29.03 $1,509.82 $535.76 $301.96 28505 T Treat big toe fracture 0046 29.03 $1,509.82 $535.76 $301.96 28510 T Treatment of toe fracture 0043 1.68 $87.38 $17.48 28515 T Treatment of toe fracture 0043 1.68 $87.38 $17.48 28525 T Treat toe fracture 0046 29.03 $1,509.82 $535.76 $301.96 28530 T Treat sesamoid bone fracture 0043 1.68 $87.38 $17.48 28531 T Treat sesamoid bone fracture 0046 29.03 $1,509.82 $535.76 $301.96 28540 T Treat foot dislocation 0043 1.68 $87.38 $17.48 28545 T Treat foot dislocation 0045 13.47 $700.56 $280.22 $140.11 28546 T Treat foot dislocation 0046 29.03 $1,509.82 $535.76 $301.96 28555 T Repair foot dislocation 0046 29.03 $1,509.82 $535.76 $301.96 28570 T Treat foot dislocation 0043 1.68 $87.38 $17.48 28575 T Treat foot dislocation 0043 1.68 $87.38 $17.48 28576 T Treat foot dislocation 0046 29.03 $1,509.82 $535.76 $301.96 28585 T Repair foot dislocation 0046 29.03 $1,509.82 $535.76 $301.96 28600 T Treat foot dislocation 0043 1.68 $87.38 $17.48 28605 T Treat foot dislocation 0043 1.68 $87.38 $17.48 28606 T Treat foot dislocation 0046 29.03 $1,509.82 $535.76 $301.96 28615 T Repair foot dislocation 0046 29.03 $1,509.82 $535.76 $301.96 28630 T Treat toe dislocation 0043 1.68 $87.38 $17.48 28635 T Treat toe dislocation 0045 13.47 $700.56 $280.22 $140.11 28636 T Treat toe dislocation 0046 29.03 $1,509.82 $535.76 $301.96 28645 T Repair toe dislocation 0046 29.03 $1,509.82 $535.76 $301.96 28660 T Treat toe dislocation 0043 1.68 $87.38 $17.48 28665 T Treat toe dislocation 0045 13.47 $700.56 $280.22 $140.11 28666 T Treat toe dislocation 0046 29.03 $1,509.82 $535.76 $301.96 28675 T Repair of toe dislocation 0046 29.03 $1,509.82 $535.76 $301.96 28705 T Fusion of foot bones 0056 22.94 $1,193.09 $405.81 $238.62 28715 T Fusion of foot bones 0056 22.94 $1,193.09 $405.81 $238.62 28725 T Fusion of foot bones 0056 22.94 $1,193.09 $405.81 $238.62 28730 T Fusion of foot bones 0056 22.94 $1,193.09 $405.81 $238.62 Start Printed Page 52191 28735 T Fusion of foot bones 0056 22.94 $1,193.09 $405.81 $238.62 28737 T Revision of foot bones 0055 18.28 $950.72 $355.34 $190.14 28740 T Fusion of foot bones 0056 22.94 $1,193.09 $405.81 $238.62 28750 T Fusion of big toe joint 0055 18.28 $950.72 $355.34 $190.14 28755 T Fusion of big toe joint 0055 18.28 $950.72 $355.34 $190.14 28760 T Fusion of big toe joint 0056 22.94 $1,193.09 $405.81 $238.62 28800 C Amputation of midfoot 28805 C Amputation thru metatarsal 28810 T Amputation toe & metatarsal 0055 18.28 $950.72 $355.34 $190.14 28820 T Amputation of toe 0055 18.28 $950.72 $355.34 $190.14 28825 T Partial amputation of toe 0055 18.28 $950.72 $355.34 $190.14 28899 T Foot/toes surgery procedure 0043 1.68 $87.38 $17.48 29000 S Application of body cast 0058 1.09 $56.69 $14.74 $11.34 29010 S Application of body cast 0058 1.09 $56.69 $14.74 $11.34 29015 S Application of body cast 0058 1.09 $56.69 $14.74 $11.34 29020 S Application of body cast 0058 1.09 $56.69 $14.74 $11.34 29025 S Application of body cast 0058 1.09 $56.69 $14.74 $11.34 29035 S Application of body cast 0058 1.09 $56.69 $14.74 $11.34 29040 S Application of body cast 0058 1.09 $56.69 $14.74 $11.34 29044 S Application of body cast 0058 1.09 $56.69 $14.74 $11.34 29046 S Application of body cast 0058 1.09 $56.69 $14.74 $11.34 29049 S Application of figure eight 0058 1.09 $56.69 $14.74 $11.34 29055 S Application of shoulder cast 0058 1.09 $56.69 $14.74 $11.34 29058 S Application of shoulder cast 0058 1.09 $56.69 $14.74 $11.34 29065 S Application of long arm cast 0058 1.09 $56.69 $14.74 $11.34 29075 S Application of forearm cast 0058 1.09 $56.69 $14.74 $11.34 29085 S Apply hand/wrist cast 0058 1.09 $56.69 $14.74 $11.34 29086 S Apply finger cast 0058 1.09 $56.69 $14.74 $11.34 29105 S Apply long arm splint 0058 1.09 $56.69 $14.74 $11.34 29125 S Apply forearm splint 0058 1.09 $56.69 $14.74 $11.34 29126 S Apply forearm splint 0058 1.09 $56.69 $14.74 $11.34 29130 S Application of finger splint 0058 1.09 $56.69 $14.74 $11.34 29131 S Application of finger splint 0058 1.09 $56.69 $14.74 $11.34 29200 S Strapping of chest 0058 1.09 $56.69 $14.74 $11.34 29220 S Strapping of low back 0058 1.09 $56.69 $14.74 $11.34 29240 S Strapping of shoulder 0058 1.09 $56.69 $14.74 $11.34 29260 S Strapping of elbow or wrist 0058 1.09 $56.69 $14.74 $11.34 29280 S Strapping of hand or finger 0058 1.09 $56.69 $14.74 $11.34 29305 S Application of hip cast 0058 1.09 $56.69 $14.74 $11.34 29325 S Application of hip casts 0058 1.09 $56.69 $14.74 $11.34 29345 S Application of long leg cast 0058 1.09 $56.69 $14.74 $11.34 29355 S Application of long leg cast 0058 1.09 $56.69 $14.74 $11.34 29358 S Apply long leg cast brace 0058 1.09 $56.69 $14.74 $11.34 29365 S Application of long leg cast 0058 1.09 $56.69 $14.74 $11.34 29405 S Apply short leg cast 0058 1.09 $56.69 $14.74 $11.34 29425 S Apply short leg cast 0058 1.09 $56.69 $14.74 $11.34 29435 S Apply short leg cast 0058 1.09 $56.69 $14.74 $11.34 29440 S Addition of walker to cast 0058 1.09 $56.69 $14.74 $11.34 29445 S Apply rigid leg cast 0058 1.09 $56.69 $14.74 $11.34 29450 S Application of leg cast 0058 1.09 $56.69 $14.74 $11.34 29505 S Application, long leg splint 0058 1.09 $56.69 $14.74 $11.34 29515 S Application lower leg splint 0058 1.09 $56.69 $14.74 $11.34 29520 S Strapping of hip 0058 1.09 $56.69 $14.74 $11.34 29530 S Strapping of knee 0058 1.09 $56.69 $14.74 $11.34 29540 S Strapping of ankle 0058 1.09 $56.69 $14.74 $11.34 29550 S Strapping of toes 0058 1.09 $56.69 $14.74 $11.34 29580 S Application of paste boot 0058 1.09 $56.69 $14.74 $11.34 29590 S Application of foot splint 0058 1.09 $56.69 $14.74 $11.34 29700 S Removal/revision of cast 0058 1.09 $56.69 $14.74 $11.34 29705 S Removal/revision of cast 0058 1.09 $56.69 $14.74 $11.34 29710 S Removal/revision of cast 0058 1.09 $56.69 $14.74 $11.34 29715 S Removal/revision of cast 0058 1.09 $56.69 $14.74 $11.34 29720 S Repair of body cast 0058 1.09 $56.69 $14.74 $11.34 29730 S Windowing of cast 0058 1.09 $56.69 $14.74 $11.34 29740 S Wedging of cast 0058 1.09 $56.69 $14.74 $11.34 29750 S Wedging of clubfoot cast 0058 1.09 $56.69 $14.74 $11.34 Start Printed Page 52192 29799 S Casting/strapping procedure 0058 1.09 $56.69 $14.74 $11.34 29800 T Jaw arthroscopy/surgery 0041 27.58 $1,434.41 $580.06 $286.88 29804 T Jaw arthroscopy/surgery 0041 27.58 $1,434.41 $580.06 $286.88 29805 T Shoulder arthroscopy, dx 0041 27.58 $1,434.41 $580.06 $286.88 29806 T Shoulder arthroscopy/surgery 0041 27.58 $1,434.41 $580.06 $286.88 29807 T Shoulder arthroscopy/surgery 0041 27.58 $1,434.41 $580.06 $286.88 29819 T Shoulder arthroscopy/surgery 0041 27.58 $1,434.41 $580.06 $286.88 29820 T Shoulder arthroscopy/surgery 0041 27.58 $1,434.41 $580.06 $286.88 29821 T Shoulder arthroscopy/surgery 0041 27.58 $1,434.41 $580.06 $286.88 29822 T Shoulder arthroscopy/surgery 0041 27.58 $1,434.41 $580.06 $286.88 29823 T Shoulder arthroscopy/surgery 0041 27.58 $1,434.41 $580.06 $286.88 29824 T Shoulder arthroscopy/surgery 0041 27.58 $1,434.41 $580.06 $286.88 29825 T Shoulder arthroscopy/surgery 0041 27.58 $1,434.41 $580.06 $286.88 29826 T Shoulder arthroscopy/surgery 0042 43.24 $2,248.87 $804.74 $449.77 29830 T Elbow arthroscopy 0041 27.58 $1,434.41 $580.06 $286.88 29834 T Elbow arthroscopy/surgery 0041 27.58 $1,434.41 $580.06 $286.88 29835 T Elbow arthroscopy/surgery 0042 43.24 $2,248.87 $804.74 $449.77 29836 T Elbow arthroscopy/surgery 0042 43.24 $2,248.87 $804.74 $449.77 29837 T Elbow arthroscopy/surgery 0041 27.58 $1,434.41 $580.06 $286.88 29838 T Elbow arthroscopy/surgery 0041 27.58 $1,434.41 $580.06 $286.88 29840 T Wrist arthroscopy 0041 27.58 $1,434.41 $580.06 $286.88 29843 T Wrist arthroscopy/surgery 0041 27.58 $1,434.41 $580.06 $286.88 29844 T Wrist arthroscopy/surgery 0041 27.58 $1,434.41 $580.06 $286.88 29845 T Wrist arthroscopy/surgery 0041 27.58 $1,434.41 $580.06 $286.88 29846 T Wrist arthroscopy/surgery 0041 27.58 $1,434.41 $580.06 $286.88 29847 T Wrist arthroscopy/surgery 0041 27.58 $1,434.41 $580.06 $286.88 29848 T Wrist endoscopy/surgery 0041 27.58 $1,434.41 $580.06 $286.88 29850 T Knee arthroscopy/surgery 0041 27.58 $1,434.41 $580.06 $286.88 29851 T Knee arthroscopy/surgery 0041 27.58 $1,434.41 $580.06 $286.88 29855 T Tibial arthroscopy/surgery 0042 43.24 $2,248.87 $804.74 $449.77 29856 T Tibial arthroscopy/surgery 0041 27.58 $1,434.41 $580.06 $286.88 29860 T Hip arthroscopy, dx 0041 27.58 $1,434.41 $580.06 $286.88 29861 T Hip arthroscopy/surgery 0041 27.58 $1,434.41 $580.06 $286.88 29862 T Hip arthroscopy/surgery 0042 43.24 $2,248.87 $804.74 $449.77 29863 T Hip arthroscopy/surgery 0042 43.24 $2,248.87 $804.74 $449.77 29870 T Knee arthroscopy, dx 0041 27.58 $1,434.41 $580.06 $286.88 29871 T Knee arthroscopy/drainage 0041 27.58 $1,434.41 $580.06 $286.88 29874 T Knee arthroscopy/surgery 0041 27.58 $1,434.41 $580.06 $286.88 29875 T Knee arthroscopy/surgery 0041 27.58 $1,434.41 $580.06 $286.88 29876 T Knee arthroscopy/surgery 0041 27.58 $1,434.41 $580.06 $286.88 29877 T Knee arthroscopy/surgery 0041 27.58 $1,434.41 $580.06 $286.88 29879 T Knee arthroscopy/surgery 0041 27.58 $1,434.41 $580.06 $286.88 29880 T Knee arthroscopy/surgery 0041 27.58 $1,434.41 $580.06 $286.88 29881 T Knee arthroscopy/surgery 0041 27.58 $1,434.41 $580.06 $286.88 29882 T Knee arthroscopy/surgery 0041 27.58 $1,434.41 $580.06 $286.88 29883 T Knee arthroscopy/surgery 0041 27.58 $1,434.41 $580.06 $286.88 29884 T Knee arthroscopy/surgery 0041 27.58 $1,434.41 $580.06 $286.88 29885 T Knee arthroscopy/surgery 0041 27.58 $1,434.41 $580.06 $286.88 29886 T Knee arthroscopy/surgery 0041 27.58 $1,434.41 $580.06 $286.88 29887 T Knee arthroscopy/surgery 0041 27.58 $1,434.41 $580.06 $286.88 29888 T Knee arthroscopy/surgery 0042 43.24 $2,248.87 $804.74 $449.77 29889 T Knee arthroscopy/surgery 0042 43.24 $2,248.87 $804.74 $449.77 29891 T Ankle arthroscopy/surgery 0041 27.58 $1,434.41 $580.06 $286.88 29892 T Ankle arthroscopy/surgery 0041 27.58 $1,434.41 $580.06 $286.88 29893 T Scope, plantar fasciotomy 0055 18.28 $950.72 $355.34 $190.14 29894 T Ankle arthroscopy/surgery 0041 27.58 $1,434.41 $580.06 $286.88 29895 T Ankle arthroscopy/surgery 0041 27.58 $1,434.41 $580.06 $286.88 29897 T Ankle arthroscopy/surgery 0041 27.58 $1,434.41 $580.06 $286.88 29898 T Ankle arthroscopy/surgery 0041 27.58 $1,434.41 $580.06 $286.88 29900 T Mcp joint arthroscopy, dx 0053 14.76 $767.65 $253.49 $153.53 29901 T Mcp joint arthroscopy, surg 0053 14.76 $767.65 $253.49 $153.53 29902 T Mcp joint arthroscopy, surg 0053 14.76 $767.65 $253.49 $153.53 29999 T Arthroscopy of joint 0041 27.58 $1,434.41 $580.06 $286.88 30000 T Drainage of nose lesion 0251 1.92 $99.86 $19.97 30020 T Drainage of nose lesion 0251 1.92 $99.86 $19.97 30100 T Intranasal biopsy 0252 6.27 $326.10 $114.24 $65.22 Start Printed Page 52193 30110 T Removal of nose polyp(s) 0253 14.79 $769.21 $284.61 $153.84 30115 T Removal of nose polyp(s) 0253 14.79 $769.21 $284.61 $153.84 30117 T Removal of intranasal lesion 0253 14.79 $769.21 $284.61 $153.84 30118 T Removal of intranasal lesion 0254 21.89 $1,138.48 $352.93 $227.70 30120 T Revision of nose 0253 14.79 $769.21 $284.61 $153.84 30124 T Removal of nose lesion 0252 6.27 $326.10 $114.24 $65.22 30125 T Removal of nose lesion 0256 35.51 $1,846.84 $369.37 30130 T Removal of turbinate bones 0253 14.79 $769.21 $284.61 $153.84 30140 T Removal of turbinate bones 0254 21.89 $1,138.48 $352.93 $227.70 30150 T Partial removal of nose 0256 35.51 $1,846.84 $369.37 30160 T Removal of nose 0256 35.51 $1,846.84 $369.37 30200 T Injection treatment of nose 0253 14.79 $769.21 $284.61 $153.84 30210 T Nasal sinus therapy 0252 6.27 $326.10 $114.24 $65.22 30220 T Insert nasal septal button 0252 6.27 $326.10 $114.24 $65.22 30300 X Remove nasal foreign body 0340 0.66 $34.33 $6.87 30310 T Remove nasal foreign body 0253 14.79 $769.21 $284.61 $153.84 30320 T Remove nasal foreign body 0253 14.79 $769.21 $284.61 $153.84 30400 T Reconstruction of nose 0256 35.51 $1,846.84 $369.37 30410 T Reconstruction of nose 0256 35.51 $1,846.84 $369.37 30420 T Reconstruction of nose 0256 35.51 $1,846.84 $369.37 30430 T Revision of nose 0254 21.89 $1,138.48 $352.93 $227.70 30435 T Revision of nose 0256 35.51 $1,846.84 $369.37 30450 T Revision of nose 0256 35.51 $1,846.84 $369.37 30460 T Revision of nose 0256 35.51 $1,846.84 $369.37 30462 T Revision of nose 0256 35.51 $1,846.84 $369.37 30465 T Repair nasal stenosis 0256 35.51 $1,846.84 $369.37 30520 T Repair of nasal septum 0254 21.89 $1,138.48 $352.93 $227.70 30540 T Repair nasal defect 0256 35.51 $1,846.84 $369.37 30545 T Repair nasal defect 0256 35.51 $1,846.84 $369.37 30560 T Release of nasal adhesions 0251 1.92 $99.86 $19.97 30580 T Repair upper jaw fistula 0256 35.51 $1,846.84 $369.37 30600 T Repair mouth/nose fistula 0256 35.51 $1,846.84 $369.37 30620 T Intranasal reconstruction 0256 35.51 $1,846.84 $369.37 30630 T Repair nasal septum defect 0254 21.89 $1,138.48 $352.93 $227.70 30801 T Cauterization, inner nose 0252 6.27 $326.10 $114.24 $65.22 30802 T Cauterization, inner nose 0253 14.79 $769.21 $284.61 $153.84 30901 T Control of nosebleed 0250 1.68 $87.38 $30.58 $17.48 30903 T Control of nosebleed 0250 1.68 $87.38 $30.58 $17.48 30905 T Control of nosebleed 0250 1.68 $87.38 $30.58 $17.48 30906 T Repeat control of nosebleed 0250 1.68 $87.38 $30.58 $17.48 30915 T Ligation, nasal sinus artery 0091 27.03 $1,405.80 $348.23 $281.16 30920 T Ligation, upper jaw artery 0092 24.97 $1,298.66 $505.37 $259.73 30930 T Therapy, fracture of nose 0253 14.79 $769.21 $284.61 $153.84 30999 T Nasal surgery procedure 0251 1.92 $99.86 $19.97 31000 T Irrigation, maxillary sinus 0251 1.92 $99.86 $19.97 31002 T Irrigation, sphenoid sinus 0252 6.27 $326.10 $114.24 $65.22 31020 T Exploration, maxillary sinus 0254 21.89 $1,138.48 $352.93 $227.70 31030 T Exploration, maxillary sinus 0256 35.51 $1,846.84 $369.37 31032 T Explore sinus,remove polyps 0256 35.51 $1,846.84 $369.37 31040 T Exploration behind upper jaw 0254 21.89 $1,138.48 $352.93 $227.70 31050 T Exploration, sphenoid sinus 0256 35.51 $1,846.84 $369.37 31051 T Sphenoid sinus surgery 0256 35.51 $1,846.84 $369.37 31070 T Exploration of frontal sinus 0254 21.89 $1,138.48 $352.93 $227.70 31075 T Exploration of frontal sinus 0256 35.51 $1,846.84 $369.37 31080 T Removal of frontal sinus 0256 35.51 $1,846.84 $369.37 31081 T Removal of frontal sinus 0256 35.51 $1,846.84 $369.37 31084 T Removal of frontal sinus 0256 35.51 $1,846.84 $369.37 31085 T Removal of frontal sinus 0256 35.51 $1,846.84 $369.37 31086 T Removal of frontal sinus 0256 35.51 $1,846.84 $369.37 31087 T Removal of frontal sinus 0256 35.51 $1,846.84 $369.37 31090 T Exploration of sinuses 0256 35.51 $1,846.84 $369.37 31200 T Removal of ethmoid sinus 0256 35.51 $1,846.84 $369.37 31201 T Removal of ethmoid sinus 0256 35.51 $1,846.84 $369.37 31205 T Removal of ethmoid sinus 0256 35.51 $1,846.84 $369.37 31225 C Removal of upper jaw 31230 C Removal of upper jaw Start Printed Page 52194 31231 T Nasal endoscopy, dx 0071 1.01 $52.53 $14.18 $10.51 31233 T Nasal/sinus endoscopy, dx 0072 1.66 $86.33 $37.99 $17.27 31235 T Nasal/sinus endoscopy, dx 0074 12.84 $667.80 $295.70 $133.56 31237 T Nasal/sinus endoscopy, surg 0075 20.41 $1,061.50 $445.92 $212.30 31238 T Nasal/sinus endoscopy, surg 0074 12.84 $667.80 $295.70 $133.56 31239 T Nasal/sinus endoscopy, surg 0075 20.41 $1,061.50 $445.92 $212.30 31240 T Nasal/sinus endoscopy, surg 0074 12.84 $667.80 $295.70 $133.56 31254 T Revision of ethmoid sinus 0075 20.41 $1,061.50 $445.92 $212.30 31255 T Removal of ethmoid sinus 0075 20.41 $1,061.50 $445.92 $212.30 31256 T Exploration maxillary sinus 0075 20.41 $1,061.50 $445.92 $212.30 31267 T Endoscopy, maxillary sinus 0075 20.41 $1,061.50 $445.92 $212.30 31276 T Sinus endoscopy, surgical 0075 20.41 $1,061.50 $445.92 $212.30 31287 T Nasal/sinus endoscopy, surg 0075 20.41 $1,061.50 $445.92 $212.30 31288 T Nasal/sinus endoscopy, surg 0075 20.41 $1,061.50 $445.92 $212.30 31290 C Nasal/sinus endoscopy, surg 31291 C Nasal/sinus endoscopy, surg 31292 C Nasal/sinus endoscopy, surg 31293 C Nasal/sinus endoscopy, surg 31294 C Nasal/sinus endoscopy, surg 31299 T Sinus surgery procedure 0252 6.27 $326.10 $114.24 $65.22 31300 T Removal of larynx lesion 0256 35.51 $1,846.84 $369.37 31320 T Diagnostic incision, larynx 0256 35.51 $1,846.84 $369.37 31360 C Removal of larynx 31365 C Removal of larynx 31367 C Partial removal of larynx 31368 C Partial removal of larynx 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 35.51 $1,846.84 $369.37 31420 T Removal of epiglottis 0256 35.51 $1,846.84 $369.37 31500 S Insert emergency airway 0094 2.68 $139.38 $47.39 $27.88 31502 T Change of windpipe airway 0121 2.17 $112.86 $45.14 $22.57 31505 T Diagnostic laryngoscopy 0072 1.66 $86.33 $37.99 $17.27 31510 T Laryngoscopy with biopsy 0074 12.84 $667.80 $295.70 $133.56 31511 T Remove foreign body, larynx 0072 1.66 $86.33 $37.99 $17.27 31512 T Removal of larynx lesion 0074 12.84 $667.80 $295.70 $133.56 31513 T Injection into vocal cord 0072 1.66 $86.33 $37.99 $17.27 31515 T Laryngoscopy for aspiration 0074 12.84 $667.80 $295.70 $133.56 31520 T Diagnostic laryngoscopy 0072 1.66 $86.33 $37.99 $17.27 31525 T Diagnostic laryngoscopy 0074 12.84 $667.80 $295.70 $133.56 31526 T Diagnostic laryngoscopy 0075 20.41 $1,061.50 $445.92 $212.30 31527 T Laryngoscopy for treatment 0075 20.41 $1,061.50 $445.92 $212.30 31528 T Laryngoscopy and dilation 0074 12.84 $667.80 $295.70 $133.56 31529 T Laryngoscopy and dilation 0074 12.84 $667.80 $295.70 $133.56 31530 T Operative laryngoscopy 0075 20.41 $1,061.50 $445.92 $212.30 31531 T Operative laryngoscopy 0075 20.41 $1,061.50 $445.92 $212.30 31535 T Operative laryngoscopy 0075 20.41 $1,061.50 $445.92 $212.30 31536 T Operative laryngoscopy 0075 20.41 $1,061.50 $445.92 $212.30 31540 T Operative laryngoscopy 0075 20.41 $1,061.50 $445.92 $212.30 31541 T Operative laryngoscopy 0075 20.41 $1,061.50 $445.92 $212.30 31560 T Operative laryngoscopy 0075 20.41 $1,061.50 $445.92 $212.30 31561 T Operative laryngoscopy 0075 20.41 $1,061.50 $445.92 $212.30 31570 T Laryngoscopy with injection 0074 12.84 $667.80 $295.70 $133.56 31571 T Laryngoscopy with injection 0075 20.41 $1,061.50 $445.92 $212.30 31575 T Diagnostic laryngoscopy 0071 1.01 $52.53 $14.18 $10.51 31576 T Laryngoscopy with biopsy 0075 20.41 $1,061.50 $445.92 $212.30 31577 T Remove foreign body, larynx 0073 3.63 $188.79 $74.14 $37.76 31578 T Removal of larynx lesion 0075 20.41 $1,061.50 $445.92 $212.30 31579 T Diagnostic laryngoscopy 0073 3.63 $188.79 $74.14 $37.76 31580 T Revision of larynx 0256 35.51 $1,846.84 $369.37 31582 T Revision of larynx 0256 35.51 $1,846.84 $369.37 31584 C Treat larynx fracture Start Printed Page 52195 31585 T Treat larynx fracture 0253 14.79 $769.21 $284.61 $153.84 31586 T Treat larynx fracture 0256 35.51 $1,846.84 $369.37 31587 C Revision of larynx 31588 T Revision of larynx 0256 35.51 $1,846.84 $369.37 31590 T Reinnervate larynx 0256 35.51 $1,846.84 $369.37 31595 T Larynx nerve surgery 0256 35.51 $1,846.84 $369.37 31599 T Larynx surgery procedure 0254 21.89 $1,138.48 $352.93 $227.70 31600 T Incision of windpipe 0254 21.89 $1,138.48 $352.93 $227.70 31601 T Incision of windpipe 0254 21.89 $1,138.48 $352.93 $227.70 31603 T Incision of windpipe 0252 6.27 $326.10 $114.24 $65.22 31605 T Incision of windpipe 0253 14.79 $769.21 $284.61 $153.84 31610 T Incision of windpipe 0254 21.89 $1,138.48 $352.93 $227.70 31611 T Surgery/speech prosthesis 0254 21.89 $1,138.48 $352.93 $227.70 31612 T Puncture/clear windpipe 0254 21.89 $1,138.48 $352.93 $227.70 31613 T Repair windpipe opening 0254 21.89 $1,138.48 $352.93 $227.70 31614 T Repair windpipe opening 0256 35.51 $1,846.84 $369.37 31615 T Visualization of windpipe 0076 9.30 $483.68 $189.92 $96.74 31622 T Dx bronchoscope/wash 0076 9.30 $483.68 $189.92 $96.74 31623 T Dx bronchoscope/brush 0076 9.30 $483.68 $189.92 $96.74 31624 T Dx bronchoscope/lavage 0076 9.30 $483.68 $189.92 $96.74 31625 T Bronchoscopy with biopsy 0076 9.30 $483.68 $189.92 $96.74 31628 T Bronchoscopy with biopsy 0076 9.30 $483.68 $189.92 $96.74 31629 T Bronchoscopy with biopsy 0076 9.30 $483.68 $189.92 $96.74 31630 T Bronchoscopy with repair 0076 9.30 $483.68 $189.92 $96.74 31631 T Bronchoscopy with dilation 0076 9.30 $483.68 $189.92 $96.74 31635 T Remove foreign body, airway 0076 9.30 $483.68 $189.92 $96.74 31640 T Bronchoscopy & remove lesion 0076 9.30 $483.68 $189.92 $96.74 31641 T Bronchoscopy, treat blockage 0076 9.30 $483.68 $189.92 $96.74 31643 T Diag bronchoscope/catheter 0076 9.30 $483.68 $189.92 $96.74 31645 T Bronchoscopy, clear airways 0076 9.30 $483.68 $189.92 $96.74 31646 T Bronchoscopy, reclear airway 0076 9.30 $483.68 $189.92 $96.74 31656 T Bronchoscopy, inj for xray 0076 9.30 $483.68 $189.92 $96.74 31700 T Insertion of airway catheter 0072 1.66 $86.33 $37.99 $17.27 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 3.63 $188.79 $74.14 $37.76 31720 T Clearance of airways 0072 1.66 $86.33 $37.99 $17.27 31725 C Clearance of airways 31730 T Intro, windpipe wire/tube 0073 3.63 $188.79 $74.14 $37.76 31750 T Repair of windpipe 0256 35.51 $1,846.84 $369.37 31755 T Repair of windpipe 0256 35.51 $1,846.84 $369.37 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 21.89 $1,138.48 $352.93 $227.70 31786 C Remove windpipe lesion 31800 C Repair of windpipe injury 31805 C Repair of windpipe injury 31820 T Closure of windpipe lesion 0253 14.79 $769.21 $284.61 $153.84 31825 T Repair of windpipe defect 0254 21.89 $1,138.48 $352.93 $227.70 31830 T Revise windpipe scar 0254 21.89 $1,138.48 $352.93 $227.70 31899 T Airways surgical procedure 0076 9.30 $483.68 $189.92 $96.74 32000 T Drainage of chest 0070 3.30 $171.63 $34.33 32002 T Treatment of collapsed lung 0070 3.30 $171.63 $34.33 32005 T Treat lung lining chemically 0070 3.30 $171.63 $34.33 32020 T Insertion of chest tube 0070 3.30 $171.63 $34.33 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 Start Printed Page 52196 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 3.30 $171.63 $34.33 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 0005 3.02 $157.07 $69.11 $31.41 32402 C Open biopsy chest lining 32405 T Biopsy, lung or mediastinum 0685 4.47 $232.48 $102.29 $46.50 32420 T Puncture/clear lung 0070 3.30 $171.63 $34.33 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 29.51 $1,534.79 $591.64 $306.96 32602 T Thoracoscopy, diagnostic 0069 29.51 $1,534.79 $591.64 $306.96 32603 T Thoracoscopy, diagnostic 0069 29.51 $1,534.79 $591.64 $306.96 32604 T Thoracoscopy, diagnostic 0069 29.51 $1,534.79 $591.64 $306.96 32605 T Thoracoscopy, diagnostic 0069 29.51 $1,534.79 $591.64 $306.96 32606 T Thoracoscopy, diagnostic 0069 29.51 $1,534.79 $591.64 $306.96 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 32900 C Removal of rib(s) 32905 C Revise & repair chest wall 32906 C Revise & repair chest wall Start Printed Page 52197 32940 C Revision of lung 32960 T Therapeutic pneumothorax 0070 3.30 $171.63 $34.33 32997 C Total lung lavage 32999 T Chest surgery procedure 0070 3.30 $171.63 $34.33 33010 T Drainage of heart sac 0070 3.30 $171.63 $34.33 33011 T Repeat drainage of heart sac 0070 3.30 $171.63 $34.33 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) 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 108.92 $5,664.82 $1,642.80 $1,132.96 33207 T Insertion of heart pacemaker 0089 108.92 $5,664.82 $1,642.80 $1,132.96 33208 T Insertion of heart pacemaker 0089 108.92 $5,664.82 $1,642.80 $1,132.96 33210 T Insertion of heart electrode 0106 29.23 $1,520.22 $410.46 $304.04 33211 T Insertion of heart electrode 0106 29.23 $1,520.22 $410.46 $304.04 33212 T Insertion of pulse generator 0090 77.15 $4,012.49 $1,444.50 $802.50 33213 T Insertion of pulse generator 0090 77.15 $4,012.49 $1,444.50 $802.50 33214 T Upgrade of pacemaker system 0089 108.92 $5,664.82 $1,642.80 $1,132.96 33216 T Revise eltrd pacing-defib 0106 29.23 $1,520.22 $410.46 $304.04 33217 T Revise eltrd pacing-defib 0106 29.23 $1,520.22 $410.46 $304.04 33218 T Revise eltrd pacing-defib 0106 29.23 $1,520.22 $410.46 $304.04 33220 T Revise eltrd pacing-defib 0106 29.23 $1,520.22 $410.46 $304.04 33222 T Revise pocket, pacemaker 0027 15.73 $818.10 $343.60 $163.62 33223 T Revise pocket, pacing-defib 0027 15.73 $818.10 $343.60 $163.62 33233 T Removal of pacemaker system 0105 19.14 $995.45 $370.40 $199.09 33234 T Removal of pacemaker system 0105 19.14 $995.45 $370.40 $199.09 33235 T Removal pacemaker electrode 0105 19.14 $995.45 $370.40 $199.09 33236 C Remove electrode/thoracotomy 33237 C Remove electrode/thoracotomy 33238 C Remove electrode/thoracotomy 33240 T Insert pulse generator 0107 181.51 $9,440.15 $2,076.83 $1,888.03 33241 T Remove pulse generator 0105 19.14 $995.45 $370.40 $199.09 33243 C Remove eltrd/thoracotomy 33244 T Remove eltrd, transven 0105 19.14 $995.45 $370.40 $199.09 33245 C Insert epic eltrd pace-defib 33246 C Insert epic eltrd/generator 33249 T Eltrd/insert pace-defib 0108 232.69 $12,101.97 $2,420.39 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 51.95 $2,701.87 $540.37 33284 T Remove pat-active ht record 0109 7.68 $399.43 $131.49 $79.89 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 Start Printed Page 52198 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 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 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 Start Printed Page 52199 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 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 Start Printed Page 52200 33924 C Remove pulmonary shunt 33930 C Removal of donor heart/lung 33935 C Transplantation, heart/lung 33940 C Removal of donor heart 33945 C Transplantation of heart 33960 C External circulation assist 33961 C External circulation assist 33967 C Insert ia percut device 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 3.30 $171.63 $34.33 34001 C Removal of artery clot 34051 C Removal of artery clot 34101 T Removal of artery clot 0088 33.96 $1,766.23 $678.68 $353.25 34111 T Removal of arm artery clot 0088 33.96 $1,766.23 $678.68 $353.25 34151 C Removal of artery clot 34201 T Removal of artery clot 0088 33.96 $1,766.23 $678.68 $353.25 34203 T Removal of leg artery clot 0088 33.96 $1,766.23 $678.68 $353.25 34401 C Removal of vein clot 34421 T Removal of vein clot 0088 33.96 $1,766.23 $678.68 $353.25 34451 C Removal of vein clot 34471 T Removal of vein clot 0088 33.96 $1,766.23 $678.68 $353.25 34490 T Removal of vein clot 0088 33.96 $1,766.23 $678.68 $353.25 34501 T Repair valve, femoral vein 0088 33.96 $1,766.23 $678.68 $353.25 34502 C Reconstruct vena cava 34510 T Transposition of vein valve 0088 33.96 $1,766.23 $678.68 $353.25 34520 T Cross-over vein graft 0088 33.96 $1,766.23 $678.68 $353.25 34530 T Leg vein fusion 0088 33.96 $1,766.23 $678.68 $353.25 34800 C Endovasc abdo repair w/tube 34802 C Endovasc abdo repr w/device 34804 C Endovasc abdo repr w/device 34808 C Endovasc abdo occlud device 34812 C Xpose for endoprosth, aortic 34813 C Xpose for endoprosth, femorl 34820 C Xpose for endoprosth, iliac 34825 C Endovasc extend prosth, init 34826 C Endovasc exten prosth, addl 34830 C Open aortic tube prosth repr 34831 C Open aortoiliac prosth repr 34832 C Open aortofemor prosth repr 35001 C Repair defect of artery 35002 C Repair artery rupture, neck 35005 C Repair defect of artery 35011 T Repair defect of artery 0093 26.29 $1,367.32 $277.34 $273.46 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 Start Printed Page 52201 35122 C Repair artery rupture, belly 35131 C Repair defect of artery 35132 C Repair artery rupture, groin 35141 C Repair defect of artery 35142 C Repair artery rupture, thigh 35151 C Repair defect of artery 35152 C Repair artery rupture, knee 35161 C Repair defect of artery 35162 C Repair artery rupture 35180 T Repair blood vessel lesion 0093 26.29 $1,367.32 $277.34 $273.46 35182 C Repair blood vessel lesion 35184 T Repair blood vessel lesion 0093 26.29 $1,367.32 $277.34 $273.46 35188 T Repair blood vessel lesion 0088 33.96 $1,766.23 $678.68 $353.25 35189 C Repair blood vessel lesion 35190 T Repair blood vessel lesion 0093 26.29 $1,367.32 $277.34 $273.46 35201 T Repair blood vessel lesion 0093 26.29 $1,367.32 $277.34 $273.46 35206 T Repair blood vessel lesion 0093 26.29 $1,367.32 $277.34 $273.46 35207 T Repair blood vessel lesion 0088 33.96 $1,766.23 $678.68 $353.25 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 26.29 $1,367.32 $277.34 $273.46 35231 T Repair blood vessel lesion 0093 26.29 $1,367.32 $277.34 $273.46 35236 T Repair blood vessel lesion 0093 26.29 $1,367.32 $277.34 $273.46 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 26.29 $1,367.32 $277.34 $273.46 35261 T Repair blood vessel lesion 0093 26.29 $1,367.32 $277.34 $273.46 35266 T Repair blood vessel lesion 0093 26.29 $1,367.32 $277.34 $273.46 35271 C Repair blood vessel lesion 35276 C Repair blood vessel lesion 35281 C Repair blood vessel lesion 35286 T Repair blood vessel lesion 0093 26.29 $1,367.32 $277.34 $273.46 35301 C Rechanneling of artery 35311 C Rechanneling of artery 35321 T Rechanneling of artery 0093 26.29 $1,367.32 $277.34 $273.46 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 22.69 $1,180.08 $236.02 35459 T Repair arterial blockage 0081 22.69 $1,180.08 $236.02 35460 T Repair venous blockage 0081 22.69 $1,180.08 $236.02 35470 T Repair arterial blockage 0081 22.69 $1,180.08 $236.02 35471 T Repair arterial blockage 0081 22.69 $1,180.08 $236.02 35472 T Repair arterial blockage 0081 22.69 $1,180.08 $236.02 35473 T Repair arterial blockage 0081 22.69 $1,180.08 $236.02 35474 T Repair arterial blockage 0081 22.69 $1,180.08 $236.02 35475 T Repair arterial blockage 0081 22.69 $1,180.08 $236.02 35476 T Repair venous blockage 0081 22.69 $1,180.08 $236.02 35480 C Atherectomy, open 35481 C Atherectomy, open 35482 C Atherectomy, open 35483 C Atherectomy, open Start Printed Page 52202 35484 T Atherectomy, open 0081 22.69 $1,180.08 $236.02 35485 T Atherectomy, open 0081 22.69 $1,180.08 $236.02 35490 T Atherectomy, percutaneous 0081 22.69 $1,180.08 $236.02 35491 T Atherectomy, percutaneous 0081 22.69 $1,180.08 $236.02 35492 T Atherectomy, percutaneous 0081 22.69 $1,180.08 $236.02 35493 T Atherectomy, percutaneous 0081 22.69 $1,180.08 $236.02 35494 T Atherectomy, percutaneous 0081 22.69 $1,180.08 $236.02 35495 T Atherectomy, percutaneous 0081 22.69 $1,180.08 $236.02 35500 T Harvest vein for bypass 0081 22.69 $1,180.08 $236.02 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 35511 C Artery bypass graft 35515 C Artery bypass graft 35516 C Artery bypass graft 35518 C Artery bypass graft 35521 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 35582 C Vein bypass graft 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 Start Printed Page 52203 35685 T Bypass graft patency/patch 0093 26.29 $1,367.32 $277.34 $273.46 35686 T Bypass graft/av fist patency 0093 26.29 $1,367.32 $277.34 $273.46 35691 C Arterial transposition 35693 C Arterial transposition 35694 C Arterial transposition 35695 C Arterial transposition 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 23.48 $1,221.17 $439.62 $244.23 35800 C Explore neck vessels 35820 C Explore chest vessels 35840 C Explore abdominal vessels 35860 T Explore limb vessels 0093 26.29 $1,367.32 $277.34 $273.46 35870 C Repair vessel graft defect 35875 T Removal of clot in graft 0088 33.96 $1,766.23 $678.68 $353.25 35876 T Removal of clot in graft 0088 33.96 $1,766.23 $678.68 $353.25 35879 T Revise graft w/vein 0088 33.96 $1,766.23 $678.68 $353.25 35881 T Revise graft w/vein 0088 33.96 $1,766.23 $678.68 $353.25 35901 C Excision, graft, neck 35903 T Excision, graft, extremity 0115 23.48 $1,221.17 $439.62 $244.23 35905 C Excision, graft, thorax 35907 C Excision, graft, abdomen 36000 N Place needle in vein 36002 S Pseudoaneurysm injection trt 0267 2.58 $134.18 $65.52 $26.84 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 0119 25.88 $1,345.99 $269.20 36261 T Revision of infusion pump 0124 23.47 $1,220.65 $244.13 36262 T Removal of infusion pump 0109 7.68 $399.43 $131.49 $79.89 36299 N Vessel injection procedure 36400 N Drawing blood 36405 N Drawing blood 36406 N Drawing blood 36410 N Drawing blood 36415 E Drawing blood 36420 T Establish access to vein 0035 0.24 $12.48 $3.74 $2.50 36425 T Establish access to vein 0035 0.24 $12.48 $3.74 $2.50 36430 S Blood transfusion service 0110 4.04 $210.12 $42.02 36440 S Blood transfusion service 0110 4.04 $210.12 $42.02 36450 S Exchange transfusion service 0110 4.04 $210.12 $42.02 36455 S Exchange transfusion service 0110 4.04 $210.12 $42.02 36460 S Transfusion service, fetal 0110 4.04 $210.12 $42.02 36468 T Injection(s), spider veins 0098 1.90 $98.82 $20.88 $19.76 36469 T Injection(s), spider veins 0098 1.90 $98.82 $20.88 $19.76 36470 T Injection therapy of vein 0098 1.90 $98.82 $20.88 $19.76 Start Printed Page 52204 36471 T Injection therapy of veins 0098 1.90 $98.82 $20.88 $19.76 36481 N Insertion of catheter, vein 36488 T Insertion of catheter, vein 0032 7.14 $371.34 $74.27 36489 T Insertion of catheter, vein 0032 7.14 $371.34 $74.27 36490 T Insertion of catheter, vein 0032 7.14 $371.34 $74.27 36491 T Insertion of catheter, vein 0032 7.14 $371.34 $74.27 36493 X Repositioning of cvc 0187 4.19 $217.92 $94.96 $43.58 36500 N Insertion of catheter, vein 36510 C Insertion of catheter, vein 36520 S Plasma and/or cell exchange 0111 13.60 $707.32 $198.05 $141.46 36521 S Apheresis w/ adsorp/reinfuse 0112 39.40 $2,049.15 $612.47 $409.83 36522 S Photopheresis 0112 39.40 $2,049.15 $612.47 $409.83 36530 T Insertion of infusion pump 0119 25.88 $1,345.99 $269.20 36531 T Revision of infusion pump 0124 23.47 $1,220.65 $244.13 36532 T Removal of infusion pump 0109 7.68 $399.43 $131.49 $79.89 36533 T Insertion of access device 0115 23.48 $1,221.17 $439.62 $244.23 36534 T Revision of access device 0109 7.68 $399.43 $131.49 $79.89 36535 T Removal of access device 0109 7.68 $399.43 $131.49 $79.89 36540 N Collect blood venous device 36550 T Declot vascular device 0677 2.80 $145.63 $29.13 36600 N Withdrawal of arterial blood 36620 N Insertion catheter, artery 36625 N Insertion catheter, artery 36640 T Insertion catheter, artery 0032 7.14 $371.34 $74.27 36660 C Insertion catheter, artery 36680 T Insert needle, bone cavity 0120 1.81 $94.14 $25.42 $18.83 36800 T Insertion of cannula 0115 23.48 $1,221.17 $439.62 $244.23 36810 T Insertion of cannula 0115 23.48 $1,221.17 $439.62 $244.23 36815 T Insertion of cannula 0115 23.48 $1,221.17 $439.62 $244.23 36819 T Av fusion/uppr arm vein 0088 33.96 $1,766.23 $678.68 $353.25 36820 T Av fusion/forearm vein 0088 33.96 $1,766.23 $678.68 $353.25 36821 T Av fusion direct any site 0088 33.96 $1,766.23 $678.68 $353.25 36822 C Insertion of cannula(s) 36823 C Insertion of cannula(s) 36825 T Artery-vein graft 0088 33.96 $1,766.23 $678.68 $353.25 36830 T Artery-vein graft 0088 33.96 $1,766.23 $678.68 $353.25 36831 T Open thrombect av fistula 0088 33.96 $1,766.23 $678.68 $353.25 36832 T Av fistula revision, open 0088 33.96 $1,766.23 $678.68 $353.25 36833 T Av fistula revision 0088 33.96 $1,766.23 $678.68 $353.25 36834 T Repair A-V aneurysm 0088 33.96 $1,766.23 $678.68 $353.25 36835 T Artery to vein shunt 0115 23.48 $1,221.17 $439.62 $244.23 36860 T External cannula declotting 0103 11.26 $585.62 $210.82 $117.12 36861 T Cannula declotting 0115 23.48 $1,221.17 $439.62 $244.23 36870 T Percut thrombect av fistula 0093 26.29 $1,367.32 $277.34 $273.46 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 37195 C Thrombolytic therapy, stroke 37200 T Transcatheter biopsy 0685 4.47 $232.48 $102.29 $46.50 37201 T Transcatheter therapy infuse 0676 4.62 $240.28 $64.88 $48.06 37202 T Transcatheter therapy infuse 0677 2.80 $145.63 $29.13 37203 T Transcatheter retrieval 0103 11.26 $585.62 $210.82 $117.12 37204 T Transcatheter occlusion 0115 23.48 $1,221.17 $439.62 $244.23 37205 T Transcatheter stent 0229 49.00 $2,548.44 $662.59 $509.69 37206 T Transcatheter stent add-on 0229 49.00 $2,548.44 $662.59 $509.69 37207 T Transcatheter stent 0229 49.00 $2,548.44 $662.59 $509.69 37208 T Transcatheter stent add-on 0229 49.00 $2,548.44 $662.59 $509.69 37209 T Exchange arterial catheter 0103 11.26 $585.62 $210.82 $117.12 37250 S Iv us first vessel add-on 0670 14.78 $768.69 $276.73 $153.74 37251 S Iv us each add vessel add-on 0670 14.78 $768.69 $276.73 $153.74 37565 T Ligation of neck vein 0093 26.29 $1,367.32 $277.34 $273.46 37600 T Ligation of neck artery 0093 26.29 $1,367.32 $277.34 $273.46 37605 T Ligation of neck artery 0091 27.03 $1,405.80 $348.23 $281.16 37606 T Ligation of neck artery 0091 27.03 $1,405.80 $348.23 $281.16 Start Printed Page 52205 37607 T Ligation of a-v fistula 0092 24.97 $1,298.66 $505.37 $259.73 37609 T Temporal artery procedure 0021 14.58 $758.29 $227.49 $151.66 37615 T Ligation of neck artery 0091 27.03 $1,405.80 $348.23 $281.16 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 27.03 $1,405.80 $348.23 $281.16 37650 T Revision of major vein 0091 27.03 $1,405.80 $348.23 $281.16 37660 C Revision of major vein 37700 T Revise leg vein 0091 27.03 $1,405.80 $348.23 $281.16 37720 T Removal of leg vein 0092 24.97 $1,298.66 $505.37 $259.73 37730 T Removal of leg veins 0092 24.97 $1,298.66 $505.37 $259.73 37735 T Removal of leg veins/lesion 0092 24.97 $1,298.66 $505.37 $259.73 37760 T Revision of leg veins 0091 27.03 $1,405.80 $348.23 $281.16 37780 T Revision of leg vein 0091 27.03 $1,405.80 $348.23 $281.16 37785 T Revise secondary varicosity 0091 27.03 $1,405.80 $348.23 $281.16 37788 C Revascularization, penis 37790 T Penile venous occlusion 0181 29.88 $1,554.03 $621.82 $310.81 37799 T Vascular surgery procedure 0035 0.24 $12.48 $3.74 $2.50 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 42.44 $2,207.26 $1,001.89 $441.45 38129 T Laparoscope proc, spleen 0130 31.99 $1,663.77 $659.53 $332.75 38200 N Injection for spleen x-ray 38220 T Bone marrow aspiration 0003 1.24 $64.49 $27.08 $12.90 38221 T Bone marrow biopsy 0003 1.24 $64.49 $27.08 $12.90 38230 S Bone marrow collection 0123 4.86 $252.76 $50.55 38231 S Stem cell collection 0111 13.60 $707.32 $198.05 $141.46 38240 S Bone marrow/stem transplant 0123 4.86 $252.76 $50.55 38241 S Bone marrow/stem transplant 0123 4.86 $252.76 $50.55 38300 T Drainage, lymph node lesion 0008 16.32 $848.79 $169.76 38305 T Drainage, lymph node lesion 0008 16.32 $848.79 $169.76 38308 T Incision of lymph channels 0113 19.75 $1,027.18 $205.44 38380 C Thoracic duct procedure 38381 C Thoracic duct procedure 38382 C Thoracic duct procedure 38500 T Biopsy/removal, lymph nodes 0113 19.75 $1,027.18 $205.44 38505 T Needle biopsy, lymph nodes 0005 3.02 $157.07 $69.11 $31.41 38510 T Biopsy/removal, lymph nodes 0113 19.75 $1,027.18 $205.44 38520 T Biopsy/removal, lymph nodes 0113 19.75 $1,027.18 $205.44 38525 T Biopsy/removal, lymph nodes 0113 19.75 $1,027.18 $205.44 38530 T Biopsy/removal, lymph nodes 0113 19.75 $1,027.18 $205.44 38542 T Explore deep node(s), neck 0114 37.55 $1,952.94 $507.76 $390.59 38550 T Removal, neck/armpit lesion 0113 19.75 $1,027.18 $205.44 38555 T Removal, neck/armpit lesion 0113 19.75 $1,027.18 $205.44 38562 C Removal, pelvic lymph nodes 38564 C Removal, abdomen lymph nodes 38570 T Laparoscopy, lymph node biop 0131 42.44 $2,207.26 $1,001.89 $441.45 38571 T Laparoscopy, lymphadenectomy 0132 57.95 $3,013.92 $1,239.22 $602.78 38572 T Laparoscopy, lymphadenectomy 0131 42.44 $2,207.26 $1,001.89 $441.45 38589 T Laparoscope proc, lymphatic 0130 31.99 $1,663.77 $659.53 $332.75 38700 T Removal of lymph nodes, neck 0113 19.75 $1,027.18 $205.44 38720 T Removal of lymph nodes, neck 0113 19.75 $1,027.18 $205.44 38724 C Removal of lymph nodes, neck 38740 T Remove armpit lymph nodes 0114 37.55 $1,952.94 $507.76 $390.59 38745 T Remove armpit lymph nodes 0114 37.55 $1,952.94 $507.76 $390.59 38746 C Remove thoracic lymph nodes 38747 C Remove abdominal lymph nodes 38760 T Remove groin lymph nodes 0113 19.75 $1,027.18 $205.44 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 Start Printed Page 52206 38794 N Access thoracic lymph duct 38999 S Blood/lymph system procedure 0110 4.04 $210.12 $42.02 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 29.51 $1,534.79 $591.64 $306.96 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 39599 C Diaphragm surgery procedure 40490 T Biopsy of lip 0251 1.92 $99.86 $19.97 40500 T Partial excision of lip 0253 14.79 $769.21 $284.61 $153.84 40510 T Partial excision of lip 0254 21.89 $1,138.48 $352.93 $227.70 40520 T Partial excision of lip 0253 14.79 $769.21 $284.61 $153.84 40525 T Reconstruct lip with flap 0254 21.89 $1,138.48 $352.93 $227.70 40527 T Reconstruct lip with flap 0254 21.89 $1,138.48 $352.93 $227.70 40530 T Partial removal of lip 0254 21.89 $1,138.48 $352.93 $227.70 40650 T Repair lip 0252 6.27 $326.10 $114.24 $65.22 40652 T Repair lip 0252 6.27 $326.10 $114.24 $65.22 40654 T Repair lip 0252 6.27 $326.10 $114.24 $65.22 40700 T Repair cleft lip/nasal 0256 35.51 $1,846.84 $369.37 40701 T Repair cleft lip/nasal 0256 35.51 $1,846.84 $369.37 40702 T Repair cleft lip/nasal 0256 35.51 $1,846.84 $369.37 40720 T Repair cleft lip/nasal 0256 35.51 $1,846.84 $369.37 40761 T Repair cleft lip/nasal 0256 35.51 $1,846.84 $369.37 40799 T Lip surgery procedure 0253 14.79 $769.21 $284.61 $153.84 40800 T Drainage of mouth lesion 0251 1.92 $99.86 $19.97 40801 T Drainage of mouth lesion 0252 6.27 $326.10 $114.24 $65.22 40804 X Removal, foreign body, mouth 0340 0.66 $34.33 $6.87 40805 T Removal, foreign body, mouth 0252 6.27 $326.10 $114.24 $65.22 40806 T Incision of lip fold 0251 1.92 $99.86 $19.97 40808 T Biopsy of mouth lesion 0251 1.92 $99.86 $19.97 40810 T Excision of mouth lesion 0253 14.79 $769.21 $284.61 $153.84 40812 T Excise/repair mouth lesion 0253 14.79 $769.21 $284.61 $153.84 40814 T Excise/repair mouth lesion 0253 14.79 $769.21 $284.61 $153.84 40816 T Excision of mouth lesion 0254 21.89 $1,138.48 $352.93 $227.70 40818 T Excise oral mucosa for graft 0251 1.92 $99.86 $19.97 40819 T Excise lip or cheek fold 0252 6.27 $326.10 $114.24 $65.22 40820 T Treatment of mouth lesion 0253 14.79 $769.21 $284.61 $153.84 40830 T Repair mouth laceration 0251 1.92 $99.86 $19.97 40831 T Repair mouth laceration 0252 6.27 $326.10 $114.24 $65.22 40840 T Reconstruction of mouth 0254 21.89 $1,138.48 $352.93 $227.70 40842 T Reconstruction of mouth 0254 21.89 $1,138.48 $352.93 $227.70 40843 T Reconstruction of mouth 0254 21.89 $1,138.48 $352.93 $227.70 40844 T Reconstruction of mouth 0256 35.51 $1,846.84 $369.37 40845 T Reconstruction of mouth 0256 35.51 $1,846.84 $369.37 40899 T Mouth surgery procedure 0252 6.27 $326.10 $114.24 $65.22 41000 T Drainage of mouth lesion 0253 14.79 $769.21 $284.61 $153.84 41005 T Drainage of mouth lesion 0251 1.92 $99.86 $19.97 41006 T Drainage of mouth lesion 0254 21.89 $1,138.48 $352.93 $227.70 41007 T Drainage of mouth lesion 0253 14.79 $769.21 $284.61 $153.84 41008 T Drainage of mouth lesion 0253 14.79 $769.21 $284.61 $153.84 41009 T Drainage of mouth lesion 0251 1.92 $99.86 $19.97 41010 T Incision of tongue fold 0253 14.79 $769.21 $284.61 $153.84 41015 T Drainage of mouth lesion 0251 1.92 $99.86 $19.97 41016 T Drainage of mouth lesion 0252 6.27 $326.10 $114.24 $65.22 Start Printed Page 52207 41017 T Drainage of mouth lesion 0252 6.27 $326.10 $114.24 $65.22 41018 T Drainage of mouth lesion 0252 6.27 $326.10 $114.24 $65.22 41100 T Biopsy of tongue 0252 6.27 $326.10 $114.24 $65.22 41105 T Biopsy of tongue 0253 14.79 $769.21 $284.61 $153.84 41108 T Biopsy of floor of mouth 0252 6.27 $326.10 $114.24 $65.22 41110 T Excision of tongue lesion 0253 14.79 $769.21 $284.61 $153.84 41112 T Excision of tongue lesion 0253 14.79 $769.21 $284.61 $153.84 41113 T Excision of tongue lesion 0253 14.79 $769.21 $284.61 $153.84 41114 T Excision of tongue lesion 0254 21.89 $1,138.48 $352.93 $227.70 41115 T Excision of tongue fold 0252 6.27 $326.10 $114.24 $65.22 41116 T Excision of mouth lesion 0253 14.79 $769.21 $284.61 $153.84 41120 T Partial removal of tongue 0254 21.89 $1,138.48 $352.93 $227.70 41130 C Partial removal of tongue 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 1.92 $99.86 $19.97 41251 T Repair tongue laceration 0252 6.27 $326.10 $114.24 $65.22 41252 T Repair tongue laceration 0252 6.27 $326.10 $114.24 $65.22 41500 T Fixation of tongue 0254 21.89 $1,138.48 $352.93 $227.70 41510 T Tongue to lip surgery 0253 14.79 $769.21 $284.61 $153.84 41520 T Reconstruction, tongue fold 0252 6.27 $326.10 $114.24 $65.22 41599 T Tongue and mouth surgery 0251 1.92 $99.86 $19.97 41800 T Drainage of gum lesion 0251 1.92 $99.86 $19.97 41805 T Removal foreign body, gum 0254 21.89 $1,138.48 $352.93 $227.70 41806 T Removal foreign body,jawbone 0253 14.79 $769.21 $284.61 $153.84 41820 T Excision, gum, each quadrant 0252 6.27 $326.10 $114.24 $65.22 41821 T Excision of gum flap 0252 6.27 $326.10 $114.24 $65.22 41822 T Excision of gum lesion 0253 14.79 $769.21 $284.61 $153.84 41823 T Excision of gum lesion 0254 21.89 $1,138.48 $352.93 $227.70 41825 T Excision of gum lesion 0253 14.79 $769.21 $284.61 $153.84 41826 T Excision of gum lesion 0253 14.79 $769.21 $284.61 $153.84 41827 T Excision of gum lesion 0254 21.89 $1,138.48 $352.93 $227.70 41828 T Excision of gum lesion 0253 14.79 $769.21 $284.61 $153.84 41830 T Removal of gum tissue 0253 14.79 $769.21 $284.61 $153.84 41850 T Treatment of gum lesion 0253 14.79 $769.21 $284.61 $153.84 41870 T Gum graft 0254 21.89 $1,138.48 $352.93 $227.70 41872 T Repair gum 0253 14.79 $769.21 $284.61 $153.84 41874 T Repair tooth socket 0254 21.89 $1,138.48 $352.93 $227.70 41899 T Dental surgery procedure 0253 14.79 $769.21 $284.61 $153.84 42000 T Drainage mouth roof lesion 0251 1.92 $99.86 $19.97 42100 T Biopsy roof of mouth 0252 6.27 $326.10 $114.24 $65.22 42104 T Excision lesion, mouth roof 0253 14.79 $769.21 $284.61 $153.84 42106 T Excision lesion, mouth roof 0253 14.79 $769.21 $284.61 $153.84 42107 T Excision lesion, mouth roof 0254 21.89 $1,138.48 $352.93 $227.70 42120 T Remove palate/lesion 0256 35.51 $1,846.84 $369.37 42140 T Excision of uvula 0252 6.27 $326.10 $114.24 $65.22 42145 T Repair palate, pharynx/uvula 0254 21.89 $1,138.48 $352.93 $227.70 42160 T Treatment mouth roof lesion 0253 14.79 $769.21 $284.61 $153.84 42180 T Repair palate 0251 1.92 $99.86 $19.97 42182 T Repair palate 0256 35.51 $1,846.84 $369.37 42200 T Reconstruct cleft palate 0256 35.51 $1,846.84 $369.37 42205 T Reconstruct cleft palate 0256 35.51 $1,846.84 $369.37 42210 T Reconstruct cleft palate 0256 35.51 $1,846.84 $369.37 42215 T Reconstruct cleft palate 0256 35.51 $1,846.84 $369.37 42220 T Reconstruct cleft palate 0256 35.51 $1,846.84 $369.37 42225 T Reconstruct cleft palate 0256 35.51 $1,846.84 $369.37 42226 T Lengthening of palate 0256 35.51 $1,846.84 $369.37 42227 T Lengthening of palate 0256 35.51 $1,846.84 $369.37 42235 T Repair palate 0253 14.79 $769.21 $284.61 $153.84 42260 T Repair nose to lip fistula 0254 21.89 $1,138.48 $352.93 $227.70 42280 T Preparation, palate mold 0251 1.92 $99.86 $19.97 42281 T Insertion, palate prosthesis 0253 14.79 $769.21 $284.61 $153.84 Start Printed Page 52208 42299 T Palate/uvula surgery 0251 1.92 $99.86 $19.97 42300 T Drainage of salivary gland 0253 14.79 $769.21 $284.61 $153.84 42305 T Drainage of salivary gland 0253 14.79 $769.21 $284.61 $153.84 42310 T Drainage of salivary gland 0251 1.92 $99.86 $19.97 42320 T Drainage of salivary gland 0251 1.92 $99.86 $19.97 42325 T Create salivary cyst drain 0251 1.92 $99.86 $19.97 42326 T Create salivary cyst drain 0252 6.27 $326.10 $114.24 $65.22 42330 T Removal of salivary stone 0253 14.79 $769.21 $284.61 $153.84 42335 T Removal of salivary stone 0253 14.79 $769.21 $284.61 $153.84 42340 T Removal of salivary stone 0253 14.79 $769.21 $284.61 $153.84 42400 T Biopsy of salivary gland 0004 1.63 $84.77 $22.04 $16.95 42405 T Biopsy of salivary gland 0253 14.79 $769.21 $284.61 $153.84 42408 T Excision of salivary cyst 0253 14.79 $769.21 $284.61 $153.84 42409 T Drainage of salivary cyst 0253 14.79 $769.21 $284.61 $153.84 42410 T Excise parotid gland/lesion 0256 35.51 $1,846.84 $369.37 42415 T Excise parotid gland/lesion 0256 35.51 $1,846.84 $369.37 42420 T Excise parotid gland/lesion 0256 35.51 $1,846.84 $369.37 42425 T Excise parotid gland/lesion 0256 35.51 $1,846.84 $369.37 42426 C Excise parotid gland/lesion 42440 T Excise submaxillary gland 0256 35.51 $1,846.84 $369.37 42450 T Excise sublingual gland 0254 21.89 $1,138.48 $352.93 $227.70 42500 T Repair salivary duct 0254 21.89 $1,138.48 $352.93 $227.70 42505 T Repair salivary duct 0256 35.51 $1,846.84 $369.37 42507 T Parotid duct diversion 0256 35.51 $1,846.84 $369.37 42508 T Parotid duct diversion 0256 35.51 $1,846.84 $369.37 42509 T Parotid duct diversion 0256 35.51 $1,846.84 $369.37 42510 T Parotid duct diversion 0256 35.51 $1,846.84 $369.37 42550 N Injection for salivary x-ray 42600 T Closure of salivary fistula 0253 14.79 $769.21 $284.61 $153.84 42650 T Dilation of salivary duct 0252 6.27 $326.10 $114.24 $65.22 42660 T Dilation of salivary duct 0252 6.27 $326.10 $114.24 $65.22 42665 T Ligation of salivary duct 0254 21.89 $1,138.48 $352.93 $227.70 42699 T Salivary surgery procedure 0253 14.79 $769.21 $284.61 $153.84 42700 T Drainage of tonsil abscess 0251 1.92 $99.86 $19.97 42720 T Drainage of throat abscess 0253 14.79 $769.21 $284.61 $153.84 42725 T Drainage of throat abscess 0256 35.51 $1,846.84 $369.37 42800 T Biopsy of throat 0252 6.27 $326.10 $114.24 $65.22 42802 T Biopsy of throat 0253 14.79 $769.21 $284.61 $153.84 42804 T Biopsy of upper nose/throat 0253 14.79 $769.21 $284.61 $153.84 42806 T Biopsy of upper nose/throat 0254 21.89 $1,138.48 $352.93 $227.70 42808 T Excise pharynx lesion 0253 14.79 $769.21 $284.61 $153.84 42809 X Remove pharynx foreign body 0340 0.66 $34.33 $6.87 42810 T Excision of neck cyst 0254 21.89 $1,138.48 $352.93 $227.70 42815 T Excision of neck cyst 0256 35.51 $1,846.84 $369.37 42820 T Remove tonsils and adenoids 0258 21.15 $1,099.99 $437.25 $220.00 42821 T Remove tonsils and adenoids 0258 21.15 $1,099.99 $437.25 $220.00 42825 T Removal of tonsils 0258 21.15 $1,099.99 $437.25 $220.00 42826 T Removal of tonsils 0258 21.15 $1,099.99 $437.25 $220.00 42830 T Removal of adenoids 0258 21.15 $1,099.99 $437.25 $220.00 42831 T Removal of adenoids 0258 21.15 $1,099.99 $437.25 $220.00 42835 T Removal of adenoids 0258 21.15 $1,099.99 $437.25 $220.00 42836 T Removal of adenoids 0258 21.15 $1,099.99 $437.25 $220.00 42842 T Extensive surgery of throat 0254 21.89 $1,138.48 $352.93 $227.70 42844 T Extensive surgery of throat 0256 35.51 $1,846.84 $369.37 42845 C Extensive surgery of throat 42860 T Excision of tonsil tags 0258 21.15 $1,099.99 $437.25 $220.00 42870 T Excision of lingual tonsil 0258 21.15 $1,099.99 $437.25 $220.00 42890 T Partial removal of pharynx 0256 35.51 $1,846.84 $369.37 42892 T Revision of pharyngeal walls 0256 35.51 $1,846.84 $369.37 42894 C Revision of pharyngeal walls 42900 T Repair throat wound 0252 6.27 $326.10 $114.24 $65.22 42950 T Reconstruction of throat 0254 21.89 $1,138.48 $352.93 $227.70 42953 C Repair throat, esophagus 42955 T Surgical opening of throat 0254 21.89 $1,138.48 $352.93 $227.70 42960 T Control throat bleeding 0250 1.68 $87.38 $30.58 $17.48 42961 C Control throat bleeding Start Printed Page 52209 42962 T Control throat bleeding 0256 35.51 $1,846.84 $369.37 42970 T Control nose/throat bleeding 0250 1.68 $87.38 $30.58 $17.48 42971 C Control nose/throat bleeding 42972 T Control nose/throat bleeding 0253 14.79 $769.21 $284.61 $153.84 42999 T Throat surgery procedure 0252 6.27 $326.10 $114.24 $65.22 43020 T Incision of esophagus 0252 6.27 $326.10 $114.24 $65.22 43030 T Throat muscle surgery 0253 14.79 $769.21 $284.61 $153.84 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 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 Parital removal of esophagus 43123 C Partial removal of esophagus 43124 C Removal of esophagus 43130 T Removal of esophagus pouch 0254 21.89 $1,138.48 $352.93 $227.70 43135 C Removal of esophagus pouch 43200 T Esophagus endoscopy 0141 7.82 $406.71 $150.48 $81.34 43202 T Esophagus endoscopy, biopsy 0141 7.82 $406.71 $150.48 $81.34 43204 T Esophagus endoscopy & inject 0141 7.82 $406.71 $150.48 $81.34 43205 T Esophagus endoscopy/ligation 0141 7.82 $406.71 $150.48 $81.34 43215 T Esophagus endoscopy 0141 7.82 $406.71 $150.48 $81.34 43216 T Esophagus endoscopy/lesion 0141 7.82 $406.71 $150.48 $81.34 43217 T Esophagus endoscopy 0141 7.82 $406.71 $150.48 $81.34 43219 T Esophagus endoscopy 0141 7.82 $406.71 $150.48 $81.34 43220 T Esoph endoscopy, dilation 0141 7.82 $406.71 $150.48 $81.34 43226 T Esoph endoscopy, dilation 0141 7.82 $406.71 $150.48 $81.34 43227 T Esoph endoscopy, repair 0141 7.82 $406.71 $150.48 $81.34 43228 T Esoph endoscopy, ablation 0141 7.82 $406.71 $150.48 $81.34 43231 T Esoph endoscopy w/us exam 0141 7.82 $406.71 $150.48 $81.34 43232 T Esoph endoscopy w/us fn bx 0141 7.82 $406.71 $150.48 $81.34 43234 T Upper GI endoscopy, exam 0141 7.82 $406.71 $150.48 $81.34 43235 T Uppr gi endoscopy, diagnosis 0141 7.82 $406.71 $150.48 $81.34 43239 T Upper GI endoscopy, biopsy 0141 7.82 $406.71 $150.48 $81.34 43240 T Esoph endoscope w/drain cyst 0141 7.82 $406.71 $150.48 $81.34 43241 T Upper GI endoscopy with tube 0141 7.82 $406.71 $150.48 $81.34 43242 T Uppr gi endoscopy w/us fn bx 0141 7.82 $406.71 $150.48 $81.34 43243 T Upper gi endoscopy & inject 0141 7.82 $406.71 $150.48 $81.34 43244 T Upper GI endoscopy/ligation 0141 7.82 $406.71 $150.48 $81.34 43245 T Operative upper GI endoscopy 0141 7.82 $406.71 $150.48 $81.34 43246 T Place gastrostomy tube 0141 7.82 $406.71 $150.48 $81.34 43247 T Operative upper GI endoscopy 0141 7.82 $406.71 $150.48 $81.34 43248 T Uppr gi endoscopy/guide wire 0141 7.82 $406.71 $150.48 $81.34 43249 T Esoph endoscopy, dilation 0141 7.82 $406.71 $150.48 $81.34 43250 T Upper GI endoscopy/tumor 0141 7.82 $406.71 $150.48 $81.34 43251 T Operative upper GI endoscopy 0141 7.82 $406.71 $150.48 $81.34 43255 T Operative upper GI endoscopy 0141 7.82 $406.71 $150.48 $81.34 43256 T Uppr gi endoscopy w stent 0141 7.82 $406.71 $150.48 $81.34 43258 T Operative upper GI endoscopy 0141 7.82 $406.71 $150.48 $81.34 43259 T Endoscopic ultrasound exam 0141 7.82 $406.71 $150.48 $81.34 43260 T Endo cholangiopancreatograph 0151 18.23 $948.12 $245.46 $189.62 43261 T Endo cholangiopancreatograph 0151 18.23 $948.12 $245.46 $189.62 43262 T Endo cholangiopancreatograph 0151 18.23 $948.12 $245.46 $189.62 43263 T Endo cholangiopancreatograph 0151 18.23 $948.12 $245.46 $189.62 43264 T Endo cholangiopancreatograph 0151 18.23 $948.12 $245.46 $189.62 43265 T Endo cholangiopancreatograph 0151 18.23 $948.12 $245.46 $189.62 43267 T Endo cholangiopancreatograph 0151 18.23 $948.12 $245.46 $189.62 43268 T Endo cholangiopancreatograph 0151 18.23 $948.12 $245.46 $189.62 43269 T Endo cholangiopancreatograph 0151 18.23 $948.12 $245.46 $189.62 43271 T Endo cholangiopancreatograph 0151 18.23 $948.12 $245.46 $189.62 Start Printed Page 52210 43272 T Endo cholangiopancreatograph 0151 18.23 $948.12 $245.46 $189.62 43280 T Laparoscopy, fundoplasty 0132 57.95 $3,013.92 $1,239.22 $602.78 43289 T Laparoscope proc, esoph 0130 31.99 $1,663.77 $659.53 $332.75 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 congential 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 5.84 $303.73 $107.24 $60.75 43453 T Dilate esophagus 0140 5.84 $303.73 $107.24 $60.75 43456 T Dilate esophagus 0140 5.84 $303.73 $107.24 $60.75 43458 T Dilate esophagus 0140 5.84 $303.73 $107.24 $60.75 43460 C Pressure treatment esophagus 43496 C Free jejunum flap, microvasc 43499 T Esophagus surgery procedure 0141 7.82 $406.71 $150.48 $81.34 43500 C Surgical opening of stomach 43501 C Surgical repair of stomach 43502 C Surgical repair of stomach 43510 C Surgical opening of stomach 43520 C Incision of pyloric muscle 43600 T Biopsy of stomach 0141 7.82 $406.71 $150.48 $81.34 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 43651 T Laparoscopy, vagus nerve 0132 57.95 $3,013.92 $1,239.22 $602.78 43652 T Laparoscopy, vagus nerve 0132 57.95 $3,013.92 $1,239.22 $602.78 43653 T Laparoscopy, gastrostomy 0131 42.44 $2,207.26 $1,001.89 $441.45 43659 T Laparoscope proc, stom 0130 31.99 $1,663.77 $659.53 $332.75 43750 T Place gastrostomy tube 0141 7.82 $406.71 $150.48 $81.34 43752 E Nasal/orogastric w/stent 43760 T Change gastrostomy tube 0121 2.17 $112.86 $45.14 $22.57 43761 T Reposition gastrostomy tube 0121 2.17 $112.86 $45.14 $22.57 43800 C Reconstruction of pylorus Start Printed Page 52211 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 0141 7.82 $406.71 $150.48 $81.34 43831 T Place gastrostomy tube 0141 7.82 $406.71 $150.48 $81.34 43832 C Place gastrostomy tube 43840 C Repair of stomach lesion 43842 C Gastroplasty for obesity 43843 C Gastroplasty for obesity 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 7.82 $406.71 $150.48 $81.34 43880 C Repair stomach-bowel fistula 43999 T Stomach surgery procedure 0141 7.82 $406.71 $150.48 $81.34 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 7.82 $406.71 $150.48 $81.34 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/taper, cong 44127 C Enterectomy w/o 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 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 42.44 $2,207.26 $1,001.89 $441.45 44201 T Laparoscopy, jejunostomy 0131 42.44 $2,207.26 $1,001.89 $441.45 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 44209 T Laparoscope proc, intestine 0130 31.99 $1,663.77 $659.53 $332.75 44300 C Open bowel to skin 44310 C Ileostomy/jejunostomy 44312 T Revision of ileostomy 0027 15.73 $818.10 $343.60 $163.62 Start Printed Page 52212 44314 C Revision of ileostomy 44316 C Devise bowel pouch 44320 C Colostomy 44322 C Colostomy with biopsies 44340 T Revision of colostomy 0027 15.73 $818.10 $343.60 $163.62 44345 C Revision of colostomy 44346 C Revision of colostomy 44360 T Small bowel endoscopy 0142 8.21 $426.99 $152.78 $85.40 44361 T Small bowel endoscopy/biopsy 0142 8.21 $426.99 $152.78 $85.40 44363 T Small bowel endoscopy 0142 8.21 $426.99 $152.78 $85.40 44364 T Small bowel endoscopy 0142 8.21 $426.99 $152.78 $85.40 44365 T Small bowel endoscopy 0142 8.21 $426.99 $152.78 $85.40 44366 T Small bowel endoscopy 0142 8.21 $426.99 $152.78 $85.40 44369 T Small bowel endoscopy 0142 8.21 $426.99 $152.78 $85.40 44370 T Small bowel endoscopy/stent 0142 8.21 $426.99 $152.78 $85.40 44372 T Small bowel endoscopy 0142 8.21 $426.99 $152.78 $85.40 44373 T Small bowel endoscopy 0142 8.21 $426.99 $152.78 $85.40 44376 T Small bowel endoscopy 0142 8.21 $426.99 $152.78 $85.40 44377 T Small bowel endoscopy/biopsy 0142 8.21 $426.99 $152.78 $85.40 44378 T Small bowel endoscopy 0142 8.21 $426.99 $152.78 $85.40 44379 T S bowel endoscope w/stent 0142 8.21 $426.99 $152.78 $85.40 44380 T Small bowel endoscopy 0142 8.21 $426.99 $152.78 $85.40 44382 T Small bowel endoscopy 0142 8.21 $426.99 $152.78 $85.40 44383 T Ileoscopy w/stent 0142 8.21 $426.99 $152.78 $85.40 44385 T Endoscopy of bowel pouch 0143 8.37 $435.32 $186.06 $87.06 44386 T Endoscopy, bowel pouch/biop 0143 8.37 $435.32 $186.06 $87.06 44388 T Colon endoscopy 0143 8.37 $435.32 $186.06 $87.06 44389 T Colonoscopy with biopsy 0143 8.37 $435.32 $186.06 $87.06 44390 T Colonoscopy for foreign body 0143 8.37 $435.32 $186.06 $87.06 44391 T Colonoscopy for bleeding 0143 8.37 $435.32 $186.06 $87.06 44392 T Colonoscopy & polypectomy 0143 8.37 $435.32 $186.06 $87.06 44393 T Colonoscopy, lesion removal 0143 8.37 $435.32 $186.06 $87.06 44394 T Colonoscopy w/snare 0143 8.37 $435.32 $186.06 $87.06 44397 T Colonoscopy w stent 0143 8.37 $435.32 $186.06 $87.06 44500 T Intro, gastrointestinal tube 0121 2.17 $112.86 $45.14 $22.57 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 44799 T Intestine surgery procedure 0142 8.21 $426.99 $152.78 $85.40 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 C Drain app abscess, percut 44950 C Appendectomy 44955 C Appendectomy add-on 44960 C Appendectomy 44970 T Laparoscopy, appendectomy 0130 31.99 $1,663.77 $659.53 $332.75 44979 T Laparoscope proc, app 0130 31.99 $1,663.77 $659.53 $332.75 45000 T Drainage of pelvic abscess 0149 16.91 $879.47 $293.06 $175.89 45005 T Drainage of rectal abscess 0148 3.61 $187.75 $67.59 $37.55 45020 T Drainage of rectal abscess 0149 16.91 $879.47 $293.06 $175.89 45100 T Biopsy of rectum 0149 16.91 $879.47 $293.06 $175.89 45108 T Removal of anorectal lesion 0150 22.02 $1,145.24 $437.12 $229.05 Start Printed Page 52213 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 reservoir 45150 T Excision of rectal stricture 0150 22.02 $1,145.24 $437.12 $229.05 45160 T Excision of rectal lesion 0150 22.02 $1,145.24 $437.12 $229.05 45170 T Excision of rectal lesion 0150 22.02 $1,145.24 $437.12 $229.05 45190 T Destruction, rectal tumor 0150 22.02 $1,145.24 $437.12 $229.05 45300 T Proctosigmoidoscopy dx 0146 3.47 $180.47 $64.40 $36.09 45303 T Proctosigmoidoscopy dilate 0146 3.47 $180.47 $64.40 $36.09 45305 T Protosigmoidoscopy w/bx 0146 3.47 $180.47 $64.40 $36.09 45307 T Protosigmoidoscopy fb 0146 3.47 $180.47 $64.40 $36.09 45308 T Protosigmoidoscopy removal 0147 7.30 $379.67 $83.53 $75.93 45309 T Protosigmoidoscopy removal 0147 7.30 $379.67 $83.53 $75.93 45315 T Protosigmoidoscopy removal 0147 7.30 $379.67 $83.53 $75.93 45317 T Protosigmoidoscopy bleed 0146 3.47 $180.47 $64.40 $36.09 45320 T Protosigmoidoscopy ablate 0147 7.30 $379.67 $83.53 $75.93 45321 T Protosigmoidoscopy volvul 0147 7.30 $379.67 $83.53 $75.93 45327 T Proctosigmoidoscopy w/stent 0147 7.30 $379.67 $83.53 $75.93 45330 T Diagnostic sigmoidoscopy 0146 3.47 $180.47 $64.40 $36.09 45331 T Sigmoidoscopy and biopsy 0146 3.47 $180.47 $64.40 $36.09 45332 T Sigmoidoscopy w/fb removal 0146 3.47 $180.47 $64.40 $36.09 45333 T Sigmoidoscopy & polypectomy 0147 7.30 $379.67 $83.53 $75.93 45334 T Sigmoidoscopy for bleeding 0147 7.30 $379.67 $83.53 $75.93 45337 T Sigmoidoscopy & decompress 0147 7.30 $379.67 $83.53 $75.93 45338 T Sigmoidoscpy w/tumr remove 0147 7.30 $379.67 $83.53 $75.93 45339 T Sigmoidoscopy w/ablate tumr 0147 7.30 $379.67 $83.53 $75.93 45341 T Sigmoidoscopy w/ultrasound 0147 7.30 $379.67 $83.53 $75.93 45342 T Sigmoidoscopy w/us guide bx 0147 7.30 $379.67 $83.53 $75.93 45345 T Sigmodoscopy w/stent 0147 7.30 $379.67 $83.53 $75.93 45355 T Surgical colonoscopy 0143 8.37 $435.32 $186.06 $87.06 45378 T Diagnostic colonoscopy 0143 8.37 $435.32 $186.06 $87.06 45379 T Colonoscopy w/fb removal 0143 8.37 $435.32 $186.06 $87.06 45380 T Colonoscopy and biopsy 0143 8.37 $435.32 $186.06 $87.06 45382 T Colonoscopy/control bleeding 0143 8.37 $435.32 $186.06 $87.06 45383 T Lesion removal colonoscopy 0143 8.37 $435.32 $186.06 $87.06 45384 T Lesion remove colonoscopy 0143 8.37 $435.32 $186.06 $87.06 45385 T Lesion removal colonoscopy 0143 8.37 $435.32 $186.06 $87.06 45387 T Colonoscopy w/stent 0143 8.37 $435.32 $186.06 $87.06 45500 T Repair of rectum 0150 22.02 $1,145.24 $437.12 $229.05 45505 T Repair of rectum 0150 22.02 $1,145.24 $437.12 $229.05 45520 T Treatment of rectal prolapse 0098 1.90 $98.82 $20.88 $19.76 45540 C Correct rectal prolapse 45541 C Correct rectal prolapse 45550 C Repair rectum/remove sigmoid 45560 T Repair of rectocele 0150 22.02 $1,145.24 $437.12 $229.05 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 3.61 $187.75 $67.59 $37.55 45905 T Dilation of anal sphincter 0149 16.91 $879.47 $293.06 $175.89 45910 T Dilation of rectal narrowing 0149 16.91 $879.47 $293.06 $175.89 45915 T Remove rectal obstruction 0148 3.61 $187.75 $67.59 $37.55 Start Printed Page 52214 45999 T Rectum surgery procedure 0148 3.61 $187.75 $67.59 $37.55 46020 T Placement of seton 0148 3.61 $187.75 $67.59 $37.55 46030 T Removal of rectal marker 0148 3.61 $187.75 $67.59 $37.55 46040 T Incision of rectal abscess 0155 10.05 $522.69 $188.17 $104.54 46045 T Incision of rectal abscess 0150 22.02 $1,145.24 $437.12 $229.05 46050 T Incision of anal abscess 0155 10.05 $522.69 $188.17 $104.54 46060 T Incision of rectal abscess 0150 22.02 $1,145.24 $437.12 $229.05 46070 T Incision of anal septum 0155 10.05 $522.69 $188.17 $104.54 46080 T Incision of anal sphincter 0149 16.91 $879.47 $293.06 $175.89 46083 T Incise external hemorrhoid 0148 3.61 $187.75 $67.59 $37.55 46200 T Removal of anal fissure 0150 22.02 $1,145.24 $437.12 $229.05 46210 T Removal of anal crypt 0149 16.91 $879.47 $293.06 $175.89 46211 T Removal of anal crypts 0150 22.02 $1,145.24 $437.12 $229.05 46220 T Removal of anal tab 0149 16.91 $879.47 $293.06 $175.89 46221 T Ligation of hemorrhoid(s) 0148 3.61 $187.75 $67.59 $37.55 46230 T Removal of anal tabs 0149 16.91 $879.47 $293.06 $175.89 46250 T Hemorrhoidectomy 0150 22.02 $1,145.24 $437.12 $229.05 46255 T Hemorrhoidectomy 0150 22.02 $1,145.24 $437.12 $229.05 46257 T Remove hemorrhoids & fissure 0150 22.02 $1,145.24 $437.12 $229.05 46258 T Remove hemorrhoids & fistula 0150 22.02 $1,145.24 $437.12 $229.05 46260 T Hemorrhoidectomy 0150 22.02 $1,145.24 $437.12 $229.05 46261 T Remove hemorrhoids & fissure 0150 22.02 $1,145.24 $437.12 $229.05 46262 T Remove hemorrhoids & fistula 0150 22.02 $1,145.24 $437.12 $229.05 46270 T Removal of anal fistula 0150 22.02 $1,145.24 $437.12 $229.05 46275 T Removal of anal fistula 0150 22.02 $1,145.24 $437.12 $229.05 46280 T Removal of anal fistula 0150 22.02 $1,145.24 $437.12 $229.05 46285 T Removal of anal fistula 0150 22.02 $1,145.24 $437.12 $229.05 46288 T Repair anal fistula 0150 22.02 $1,145.24 $437.12 $229.05 46320 T Removal of hemorrhoid clot 0148 3.61 $187.75 $67.59 $37.55 46500 T Injection into hemorrhoid(s) 0155 10.05 $522.69 $188.17 $104.54 46600 X Diagnostic anoscopy 0340 0.66 $34.33 $6.87 46604 T Anoscopy and dilation 0147 7.30 $379.67 $83.53 $75.93 46606 T Anoscopy and biopsy 0147 7.30 $379.67 $83.53 $75.93 46608 T Anoscopy/ remove for body 0147 7.30 $379.67 $83.53 $75.93 46610 T Anoscopy/remove lesion 0147 7.30 $379.67 $83.53 $75.93 46611 T Anoscopy 0147 7.30 $379.67 $83.53 $75.93 46612 T Anoscopy/ remove lesions 0147 7.30 $379.67 $83.53 $75.93 46614 T Anoscopy/control bleeding 0147 7.30 $379.67 $83.53 $75.93 46615 T Anoscopy 0147 7.30 $379.67 $83.53 $75.93 46700 T Repair of anal stricture 0150 22.02 $1,145.24 $437.12 $229.05 46705 C Repair of anal stricture 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 22.02 $1,145.24 $437.12 $229.05 46751 C Repair of anal sphincter 46753 T Reconstruction of anus 0150 22.02 $1,145.24 $437.12 $229.05 46754 T Removal of suture from anus 0149 16.91 $879.47 $293.06 $175.89 46760 T Repair of anal sphincter 0150 22.02 $1,145.24 $437.12 $229.05 46761 T Repair of anal sphincter 0150 22.02 $1,145.24 $437.12 $229.05 46762 T Implant artificial sphincter 0150 22.02 $1,145.24 $437.12 $229.05 46900 T Destruction, anal lesion(s) 0016 2.57 $133.66 $56.14 $26.73 46910 T Destruction, anal lesion(s) 0017 16.46 $856.07 $227.84 $171.21 46916 T Cryosurgery, anal lesion(s) 0013 1.10 $57.21 $14.30 $11.44 46917 T Laser surgery, anal lesions 0695 19.65 $1,021.98 $266.59 $204.40 46922 T Excision of anal lesion(s) 0695 19.65 $1,021.98 $266.59 $204.40 46924 T Destruction, anal lesion(s) 0695 19.65 $1,021.98 $266.59 $204.40 46934 T Destruction of hemorrhoids 0155 10.05 $522.69 $188.17 $104.54 46935 T Destruction of hemorrhoids 0155 10.05 $522.69 $188.17 $104.54 46936 T Destruction of hemorrhoids 0149 16.91 $879.47 $293.06 $175.89 Start Printed Page 52215 46937 T Cryotherapy of rectal lesion 0149 16.91 $879.47 $293.06 $175.89 46938 T Cryotherapy of rectal lesion 0150 22.02 $1,145.24 $437.12 $229.05 46940 T Treatment of anal fissure 0149 16.91 $879.47 $293.06 $175.89 46942 T Treatment of anal fissure 0148 3.61 $187.75 $67.59 $37.55 46945 T Ligation of hemorrhoids 0155 10.05 $522.69 $188.17 $104.54 46946 T Ligation of hemorrhoids 0155 10.05 $522.69 $188.17 $104.54 46999 T Anus surgery procedure 0148 3.61 $187.75 $67.59 $37.55 47000 T Needle biopsy of liver 0685 4.47 $232.48 $102.29 $46.50 47001 N Needle biopsy, liver add-on 47010 C Open drainage, liver lesion 47011 T Percut drain, liver lesion 0005 3.02 $157.07 $69.11 $31.41 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 47134 C Partial removal, donor liver 47135 C Transplantation of liver 47136 C Transplantation of liver 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 0130 31.99 $1,663.77 $659.53 $332.75 47371 T Laparo ablate liver cryosug 0130 31.99 $1,663.77 $659.53 $332.75 47379 T Laparoscope procedure, liver 0130 31.99 $1,663.77 $659.53 $332.75 47380 C Open ablate liver tumor rf 47381 C Open ablate liver tumor cryo 47382 T Percut ablate liver rf 0980 $1,875.00 $375.00 47399 T Liver surgery procedure 0005 3.02 $157.07 $69.11 $31.41 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 6.18 $321.42 $80.36 $64.28 47500 N Injection for liver x-rays 47505 N Injection for liver x-rays 47510 T Insert catheter, bile duct 0152 6.18 $321.42 $80.36 $64.28 47511 T Insert bile duct drain 0152 6.18 $321.42 $80.36 $64.28 47525 T Change bile duct catheter 0122 3.89 $202.32 $46.53 $40.46 47530 T Revise/reinsert bile tube 0121 2.17 $112.86 $45.14 $22.57 47550 C Bile duct endoscopy add-on 47552 T Biliary endoscopy thru skin 0152 6.18 $321.42 $80.36 $64.28 47553 T Biliary endoscopy thru skin 0152 6.18 $321.42 $80.36 $64.28 47554 T Biliary endoscopy thru skin 0152 6.18 $321.42 $80.36 $64.28 47555 T Biliary endoscopy thru skin 0152 6.18 $321.42 $80.36 $64.28 47556 T Biliary endoscopy thru skin 0152 6.18 $321.42 $80.36 $64.28 47560 T Laparoscopy w/cholangio 0130 31.99 $1,663.77 $659.53 $332.75 47561 T Laparo w/cholangio/biopsy 0130 31.99 $1,663.77 $659.53 $332.75 47562 T Laparoscopic cholecystectomy 0131 42.44 $2,207.26 $1,001.89 $441.45 47563 T Laparo cholecystectomy/graph 0131 42.44 $2,207.26 $1,001.89 $441.45 47564 T Laparo cholecystectomy/explr 0131 42.44 $2,207.26 $1,001.89 $441.45 47570 C Laparo cholecystoenterostomy 47579 T Laparoscope proc, biliary 0130 31.99 $1,663.77 $659.53 $332.75 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 6.18 $321.42 $80.36 $64.28 47700 C Exploration of bile ducts 47701 C Bile duct revision Start Printed Page 52216 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 6.18 $321.42 $80.36 $64.28 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 4.47 $232.48 $102.29 $46.50 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 0005 3.02 $157.07 $69.11 $31.41 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 48554 E Transpl allograft pancreas 48556 C Removal, allograft pancreas 48999 T Pancreas surgery procedure 0005 3.02 $157.07 $69.11 $31.41 49000 C Exploration of abdomen 49002 C Reopening of abdomen 49010 C Exploration behind abdomen 49020 C Drain abdominal abscess 49021 C Drain abdominal abscess 49040 C Drain, open, abdom abscess 49041 C Drain, percut, abdom abscess 49060 C Drain, open, retrop abscess 49061 C Drain, percut, retroper absc 49062 C Drain to peritoneal cavity 49080 T Puncture, peritoneal cavity 0070 3.30 $171.63 $34.33 49081 T Removal of abdominal fluid 0070 3.30 $171.63 $34.33 49085 T Remove abdomen foreign body 0153 25.99 $1,351.71 $540.68 $270.34 49180 T Biopsy, abdominal mass 0685 4.47 $232.48 $102.29 $46.50 49200 T Removal of abdominal lesion 0130 31.99 $1,663.77 $659.53 $332.75 49201 C Removal of abdominal lesion 49215 C Excise sacral spine tumor 49220 C Multiple surgery, abdomen 49250 T Excision of umbilicus 0153 25.99 $1,351.71 $540.68 $270.34 Start Printed Page 52217 49255 C Removal of omentum 49320 T Diag laparo separate proc 0130 31.99 $1,663.77 $659.53 $332.75 49321 T Laparoscopy, biopsy 0130 31.99 $1,663.77 $659.53 $332.75 49322 T Laparoscopy, aspiration 0130 31.99 $1,663.77 $659.53 $332.75 49323 T Laparo drain lymphocele 0130 31.99 $1,663.77 $659.53 $332.75 49329 T Laparo proc, abdm/per/oment 0130 31.99 $1,663.77 $659.53 $332.75 49400 N Air injection into abdomen 49420 T Insert abdominal drain 0153 25.99 $1,351.71 $540.68 $270.34 49421 T Insert abdominal drain 0153 25.99 $1,351.71 $540.68 $270.34 49422 T Remove perm cannula/catheter 0105 19.14 $995.45 $370.40 $199.09 49423 T Exchange drainage catheter 0152 6.18 $321.42 $80.36 $64.28 49424 N Assess cyst, contrast inject 49425 C Insert abdomen-venous drain 49426 T Revise abdomen-venous shunt 0153 25.99 $1,351.71 $540.68 $270.34 49427 N Injection, abdominal shunt 49428 C Ligation of shunt 49429 T Removal of shunt 0105 19.14 $995.45 $370.40 $199.09 49491 T Repairing hern premie reduc 0154 26.98 $1,403.20 $491.12 $280.64 49492 T Rpr ing hern premie, blocked 0154 26.98 $1,403.20 $491.12 $280.64 49495 T Rpr ing hernia baby, reduc 0154 26.98 $1,403.20 $491.12 $280.64 49496 T Rpr ing hernia baby, blocked 0154 26.98 $1,403.20 $491.12 $280.64 49500 T Rpr ing hernia, init, reduce 0154 26.98 $1,403.20 $491.12 $280.64 49501 T Rpr ing hernia, init blocked 0154 26.98 $1,403.20 $491.12 $280.64 49505 T Rpr i/hern init reduc>5 yr 0154 26.98 $1,403.20 $491.12 $280.64 49507 T Rpr i/hern init block>5 yr 0154 26.98 $1,403.20 $491.12 $280.64 49520 T Rerepair ing hernia, reduce 0154 26.98 $1,403.20 $491.12 $280.64 49521 T Rerepair ing hernia, blocked 0154 26.98 $1,403.20 $491.12 $280.64 49525 T Repair ing hernia, sliding 0154 26.98 $1,403.20 $491.12 $280.64 49540 T Repair lumbar hernia 0154 26.98 $1,403.20 $491.12 $280.64 49550 T Rpr fem hernia, init, reduce 0154 26.98 $1,403.20 $491.12 $280.64 49553 T Rpr fem hernia, init blocked 0154 26.98 $1,403.20 $491.12 $280.64 49555 T Rerepair fem hernia, reduce 0154 26.98 $1,403.20 $491.12 $280.64 49557 T Rerepair fem hernia, blocked 0154 26.98 $1,403.20 $491.12 $280.64 49560 T Rpr ventral hern init, reduc 0154 26.98 $1,403.20 $491.12 $280.64 49561 T Rpr ventral hern init, block 0154 26.98 $1,403.20 $491.12 $280.64 49565 T Rerepair ventrl hern, reduce 0154 26.98 $1,403.20 $491.12 $280.64 49566 T Rerepair ventrl hern, block 0154 26.98 $1,403.20 $491.12 $280.64 49568 T Hernia repair w/mesh 0154 26.98 $1,403.20 $491.12 $280.64 49570 T Rpr epigastric hern, reduce 0154 26.98 $1,403.20 $491.12 $280.64 49572 T Rpr epigastric hern, blocked 0154 26.98 $1,403.20 $491.12 $280.64 49580 T Rpr umbil hern, reduc <5 yr 0154 26.98 $1,403.20 $491.12 $280.64 49582 T Rpr umbil hern, block < 5 yr 0154 26.98 $1,403.20 $491.12 $280.64 49585 T Rpr umbil hern, reduc > 5 yr 0154 26.98 $1,403.20 $491.12 $280.64 49587 T Rpr umbil hern, block > 5 yr 0154 26.98 $1,403.20 $491.12 $280.64 49590 T Repair spigelian hernia 0154 26.98 $1,403.20 $491.12 $280.64 49600 T Repair umbilical lesion 0154 26.98 $1,403.20 $491.12 $280.64 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 42.44 $2,207.26 $1,001.89 $441.45 49651 T Laparo hernia repair recur 0131 42.44 $2,207.26 $1,001.89 $441.45 49659 T Laparo proc, hernia repair 0131 42.44 $2,207.26 $1,001.89 $441.45 49900 C Repair of abdominal wall 49905 C Omental flap 49906 C Free omental flap, microvasc 49999 T Abdomen surgery procedure 0153 25.99 $1,351.71 $540.68 $270.34 50010 C Exploration of kidney 50020 C Renal abscess, open drain 50021 T Renal abscess, percut drain 0005 3.02 $157.07 $69.11 $31.41 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 Start Printed Page 52218 50080 T Removal of kidney stone 0163 24.77 $1,288.26 $257.65 50081 T Removal of kidney stone 0163 24.77 $1,288.26 $257.65 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 4.47 $232.48 $102.29 $46.50 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 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 4.47 $232.48 $102.29 $46.50 50392 T Insert kidney drain 0161 16.03 $833.70 $249.36 $166.74 50393 T Insert ureteral tube 0161 16.03 $833.70 $249.36 $166.74 50394 N Injection for kidney x-ray 50395 T Create passage to kidney 0161 16.03 $833.70 $249.36 $166.74 50396 T Measure kidney pressure 0164 1.18 $61.37 $18.41 $12.27 50398 T Change kidney tube 0122 3.89 $202.32 $46.53 $40.46 50400 C Revision of kidney/ureter 50405 C Revision of kidney/ureter 50500 C Repair of kidney wound 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 31.99 $1,663.77 $659.53 $332.75 50544 T Laparoscopy, pyeloplasty 0130 31.99 $1,663.77 $659.53 $332.75 50545 C Laparo radical nephrectomy 50546 C Laparoscopic nephrectomy 50547 C Laparo removal donor kidney 50548 C Laparo remove k/ureter 50549 T Laparoscope proc, renal 0130 31.99 $1,663.77 $659.53 $332.75 50551 T Kidney endoscopy 0160 6.44 $334.94 $105.06 $66.99 50553 T Kidney endoscopy 0161 16.03 $833.70 $249.36 $166.74 50555 T Kidney endoscopy & biopsy 0160 6.44 $334.94 $105.06 $66.99 50557 T Kidney endoscopy & treatment 0162 21.50 $1,118.19 $223.64 50559 T Renal endoscopy/radiotracer 0160 6.44 $334.94 $105.06 $66.99 50561 T Kidney endoscopy & treatment 0161 16.03 $833.70 $249.36 $166.74 50570 C Kidney endoscopy 50572 C Kidney endoscopy 50574 C Kidney endoscopy & biopsy 50575 C Kidney endoscopy 50576 C Kidney endoscopy & treatment 50578 C Renal endoscopy/radiotracer 50580 C Kidney endoscopy & treatment 50590 T Fragmenting of kidney stone 0169 46.44 $2,415.30 $1,115.69 $483.06 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 Start Printed Page 52219 50684 N Injection for ureter x-ray 50686 T Measure ureter pressure 0164 1.18 $61.37 $18.41 $12.27 50688 T Change of ureter tube 0121 2.17 $112.86 $45.14 $22.57 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 42.44 $2,207.26 $1,001.89 $441.45 50947 T Laparo new ureter/bladder 0131 42.44 $2,207.26 $1,001.89 $441.45 50948 T Laparo new ureter/bladder 0131 42.44 $2,207.26 $1,001.89 $441.45 50949 T Laparoscope proc, ureter 0130 31.99 $1,663.77 $659.53 $332.75 50951 T Endoscopy of ureter 0160 6.44 $334.94 $105.06 $66.99 50953 T Endoscopy of ureter 0160 6.44 $334.94 $105.06 $66.99 50955 T Ureter endoscopy & biopsy 0161 16.03 $833.70 $249.36 $166.74 50957 T Ureter endoscopy & treatment 0161 16.03 $833.70 $249.36 $166.74 50959 T Ureter endoscopy & tracer 0161 16.03 $833.70 $249.36 $166.74 50961 T Ureter endoscopy & treatment 0161 16.03 $833.70 $249.36 $166.74 50970 T Ureter endoscopy 0160 6.44 $334.94 $105.06 $66.99 50972 T Ureter endoscopy & catheter 0160 6.44 $334.94 $105.06 $66.99 50974 T Ureter endoscopy & biopsy 0161 16.03 $833.70 $249.36 $166.74 50976 T Ureter endoscopy & treatment 0161 16.03 $833.70 $249.36 $166.74 50978 T Ureter endoscopy & tracer 0161 16.03 $833.70 $249.36 $166.74 50980 T Ureter endoscopy & treatment 0161 16.03 $833.70 $249.36 $166.74 51000 T Drainage of bladder 0165 12.62 $656.35 $131.27 51005 T Drainage of bladder 0164 1.18 $61.37 $18.41 $12.27 51010 T Drainage of bladder 0165 12.62 $656.35 $131.27 51020 T Incise & treat bladder 0162 21.50 $1,118.19 $223.64 51030 T Incise & treat bladder 0162 21.50 $1,118.19 $223.64 51040 T Incise & drain bladder 0162 21.50 $1,118.19 $223.64 51045 T Incise bladder/drain ureter 0160 6.44 $334.94 $105.06 $66.99 51050 T Removal of bladder stone 0162 21.50 $1,118.19 $223.64 51060 C Removal of ureter stone 51065 T Remove ureter calculus 0162 21.50 $1,118.19 $223.64 51080 T Drainage of bladder abscess 0007 9.44 $490.96 $103.10 $98.19 51500 T Removal of bladder cyst 0154 26.98 $1,403.20 $491.12 $280.64 51520 T Removal of bladder lesion 0162 21.50 $1,118.19 $223.64 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) Start Printed Page 52220 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 1.18 $61.37 $18.41 $12.27 51705 T Change of bladder tube 0121 2.17 $112.86 $45.14 $22.57 51710 T Change of bladder tube 0121 2.17 $112.86 $45.14 $22.57 51715 T Endoscopic injection/implant 0167 27.15 $1,412.04 $555.84 $282.41 51720 T Treatment of bladder lesion 0156 3.10 $161.23 $48.37 $32.25 51725 T Simple cystometrogram 0156 3.10 $161.23 $48.37 $32.25 51726 T Complex cystometrogram 0156 3.10 $161.23 $48.37 $32.25 51736 T Urine flow measurement 0164 1.18 $61.37 $18.41 $12.27 51741 T Electro-uroflowmetry, first 0164 1.18 $61.37 $18.41 $12.27 51772 T Urethra pressure profile 0164 1.18 $61.37 $18.41 $12.27 51784 T Anal/urinary muscle study 0164 1.18 $61.37 $18.41 $12.27 51785 T Anal/urinary muscle study 0164 1.18 $61.37 $18.41 $12.27 51792 T Urinary reflex study 0164 1.18 $61.37 $18.41 $12.27 51795 T Urine voiding pressure study 0164 1.18 $61.37 $18.41 $12.27 51797 T Intraabdominal pressure test 0164 1.18 $61.37 $18.41 $12.27 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 51860 C Repair of bladder wound 51865 C Repair of bladder wound 51880 T Repair of bladder opening 0162 21.50 $1,118.19 $223.64 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 42.44 $2,207.26 $1,001.89 $441.45 51992 T Laparo sling operation 0132 57.95 $3,013.92 $1,239.22 $602.78 52000 T Cystoscopy 0160 6.44 $334.94 $105.06 $66.99 52001 T Cystoscopy, removal of clots 0160 6.44 $334.94 $105.06 $66.99 52005 T Cystoscopy & ureter catheter 0161 16.03 $833.70 $249.36 $166.74 52007 T Cystoscopy and biopsy 0161 16.03 $833.70 $249.36 $166.74 52010 T Cystoscopy & duct catheter 0160 6.44 $334.94 $105.06 $66.99 52204 T Cystoscopy 0161 16.03 $833.70 $249.36 $166.74 52214 T Cystoscopy and treatment 0162 21.50 $1,118.19 $223.64 52224 T Cystoscopy and treatment 0162 21.50 $1,118.19 $223.64 52234 T Cystoscopy and treatment 0163 24.77 $1,288.26 $257.65 52235 T Cystoscopy and treatment 0163 24.77 $1,288.26 $257.65 52240 T Cystoscopy and treatment 0162 21.50 $1,118.19 $223.64 52250 T Cystoscopy and radiotracer 0162 21.50 $1,118.19 $223.64 52260 T Cystoscopy and treatment 0161 16.03 $833.70 $249.36 $166.74 52265 T Cystoscopy and treatment 0160 6.44 $334.94 $105.06 $66.99 52270 T Cystoscopy & revise urethra 0161 16.03 $833.70 $249.36 $166.74 52275 T Cystoscopy & revise urethra 0161 16.03 $833.70 $249.36 $166.74 52276 T Cystoscopy and treatment 0161 16.03 $833.70 $249.36 $166.74 52277 T Cystoscopy and treatment 0162 21.50 $1,118.19 $223.64 52281 T Cystoscopy and treatment 0161 16.03 $833.70 $249.36 $166.74 52282 T Cystoscopy, implant stent 0163 24.77 $1,288.26 $257.65 52283 T Cystoscopy and treatment 0161 16.03 $833.70 $249.36 $166.74 52285 T Cystoscopy and treatment 0161 16.03 $833.70 $249.36 $166.74 52290 T Cystoscopy and treatment 0161 16.03 $833.70 $249.36 $166.74 52300 T Cystoscopy and treatment 0161 16.03 $833.70 $249.36 $166.74 Start Printed Page 52221 52301 T Cystoscopy and treatment 0161 16.03 $833.70 $249.36 $166.74 52305 T Cystoscopy and treatment 0161 16.03 $833.70 $249.36 $166.74 52310 T Cystoscopy and treatment 0160 6.44 $334.94 $105.06 $66.99 52315 T Cystoscopy and treatment 0161 16.03 $833.70 $249.36 $166.74 52317 T Remove bladder stone 0162 21.50 $1,118.19 $223.64 52318 T Remove bladder stone 0162 21.50 $1,118.19 $223.64 52320 T Cystoscopy and treatment 0162 21.50 $1,118.19 $223.64 52325 T Cystoscopy, stone removal 0162 21.50 $1,118.19 $223.64 52327 T Cystoscopy, inject material 0162 21.50 $1,118.19 $223.64 52330 T Cystoscopy and treatment 0162 21.50 $1,118.19 $223.64 52332 T Cystoscopy and treatment 0162 21.50 $1,118.19 $223.64 52334 T Create passage to kidney 0162 21.50 $1,118.19 $223.64 52341 T Cysto w/ureter stricture tx 0162 21.50 $1,118.19 $223.64 52342 T Cysto w/up stricture tx 0162 21.50 $1,118.19 $223.64 52343 T Cysto w/renal stricture tx 0162 21.50 $1,118.19 $223.64 52344 T Cysto/uretero, stone remove 0162 21.50 $1,118.19 $223.64 52345 T Cysto/uretero w/up stricture 0162 21.50 $1,118.19 $223.64 52346 T Cystouretero w/renal strict 0162 21.50 $1,118.19 $223.64 52347 T Cystoscopy, resect ducts 0160 6.44 $334.94 $105.06 $66.99 52351 T Cystouretro & or pyeloscope 0160 6.44 $334.94 $105.06 $66.99 52352 T Cystouretro w/stone remove 0162 21.50 $1,118.19 $223.64 52353 T Cystouretero w/lithotripsy 0163 24.77 $1,288.26 $257.65 52354 T Cystouretero w/biopsy 0162 21.50 $1,118.19 $223.64 52355 T Cystouretero w/excise tumor 0162 21.50 $1,118.19 $223.64 52400 T Cystouretero w/congen repr 0162 21.50 $1,118.19 $223.64 52450 T Incision of prostate 0162 21.50 $1,118.19 $223.64 52500 T Revision of bladder neck 0162 21.50 $1,118.19 $223.64 52510 T Dilation prostatic urethra 0161 16.03 $833.70 $249.36 $166.74 52601 T Prostatectomy (TURP) 0163 24.77 $1,288.26 $257.65 52606 T Control postop bleeding 0162 21.50 $1,118.19 $223.64 52612 T Prostatectomy, first stage 0163 24.77 $1,288.26 $257.65 52614 T Prostatectomy, second stage 0163 24.77 $1,288.26 $257.65 52620 T Remove residual prostate 0163 24.77 $1,288.26 $257.65 52630 T Remove prostate regrowth 0163 24.77 $1,288.26 $257.65 52640 T Relieve bladder contracture 0162 21.50 $1,118.19 $223.64 52647 T Laser surgery of prostate 0163 24.77 $1,288.26 $257.65 52648 T Laser surgery of prostate 0163 24.77 $1,288.26 $257.65 52700 T Drainage of prostate abscess 0162 21.50 $1,118.19 $223.64 53000 T Incision of urethra 0166 15.63 $812.90 $218.73 $162.58 53010 T Incision of urethra 0166 15.63 $812.90 $218.73 $162.58 53020 T Incision of urethra 0166 15.63 $812.90 $218.73 $162.58 53025 T Incision of urethra 0166 15.63 $812.90 $218.73 $162.58 53040 T Drainage of urethra abscess 0166 15.63 $812.90 $218.73 $162.58 53060 T Drainage of urethra abscess 0166 15.63 $812.90 $218.73 $162.58 53080 T Drainage of urinary leakage 0166 15.63 $812.90 $218.73 $162.58 53085 C Drainage of urinary leakage 53200 T Biopsy of urethra 0166 15.63 $812.90 $218.73 $162.58 53210 T Removal of urethra 0168 24.10 $1,253.42 $405.60 $250.68 53215 T Removal of urethra 0168 24.10 $1,253.42 $405.60 $250.68 53220 T Treatment of urethra lesion 0168 24.10 $1,253.42 $405.60 $250.68 53230 T Removal of urethra lesion 0168 24.10 $1,253.42 $405.60 $250.68 53235 T Removal of urethra lesion 0168 24.10 $1,253.42 $405.60 $250.68 53240 T Surgery for urethra pouch 0168 24.10 $1,253.42 $405.60 $250.68 53250 T Removal of urethra gland 0166 15.63 $812.90 $218.73 $162.58 53260 T Treatment of urethra lesion 0166 15.63 $812.90 $218.73 $162.58 53265 T Treatment of urethra lesion 0166 15.63 $812.90 $218.73 $162.58 53270 T Removal of urethra gland 0167 27.15 $1,412.04 $555.84 $282.41 53275 T Repair of urethra defect 0166 15.63 $812.90 $218.73 $162.58 53400 T Revise urethra, stage 1 0168 24.10 $1,253.42 $405.60 $250.68 53405 T Revise urethra, stage 2 0168 24.10 $1,253.42 $405.60 $250.68 53410 T Reconstruction of urethra 0168 24.10 $1,253.42 $405.60 $250.68 53415 C Reconstruction of urethra 53420 T Reconstruct urethra, stage 1 0168 24.10 $1,253.42 $405.60 $250.68 53425 T Reconstruct urethra, stage 2 0168 24.10 $1,253.42 $405.60 $250.68 53430 T Reconstruction of urethra 0168 24.10 $1,253.42 $405.60 $250.68 53431 T Reconstruct urethra/bladder 0168 24.10 $1,253.42 $405.60 $250.68 Start Printed Page 52222 53440 T Correct bladder function 0179 81.28 $4,227.29 $1,817.73 $845.46 53442 T Remove perineal prosthesis 0166 15.63 $812.90 $218.73 $162.58 53444 T Insert tandem cuff 0179 81.28 $4,227.29 $1,817.73 $845.46 53445 T Insert uro/ves nck sphincter 0179 81.28 $4,227.29 $1,817.73 $845.46 53446 T Remove uro sphincter 0168 24.10 $1,253.42 $405.60 $250.68 53447 T Remove/replace ur sphincter 0179 81.28 $4,227.29 $1,817.73 $845.46 53448 C Remov/replc ur sphinctr comp 53449 T Repair uro sphincter 0168 24.10 $1,253.42 $405.60 $250.68 53450 T Revision of urethra 0168 24.10 $1,253.42 $405.60 $250.68 53460 T Revision of urethra 0168 24.10 $1,253.42 $405.60 $250.68 53502 T Repair of urethra injury 0166 15.63 $812.90 $218.73 $162.58 53505 T Repair of urethra injury 0167 27.15 $1,412.04 $555.84 $282.41 53510 T Repair of urethra injury 0166 15.63 $812.90 $218.73 $162.58 53515 T Repair of urethra injury 0168 24.10 $1,253.42 $405.60 $250.68 53520 T Repair of urethra defect 0168 24.10 $1,253.42 $405.60 $250.68 53600 T Dilate urethra stricture 0156 3.10 $161.23 $48.37 $32.25 53601 T Dilate urethra stricture 0164 1.18 $61.37 $18.41 $12.27 53605 T Dilate urethra stricture 0161 16.03 $833.70 $249.36 $166.74 53620 T Dilate urethra stricture 0165 12.62 $656.35 $131.27 53621 T Dilate urethra stricture 0164 1.18 $61.37 $18.41 $12.27 53660 T Dilation of urethra 0164 1.18 $61.37 $18.41 $12.27 53661 T Dilation of urethra 0164 1.18 $61.37 $18.41 $12.27 53665 T Dilation of urethra 0166 15.63 $812.90 $218.73 $162.58 53670 N Insert urinary catheter 53675 T Insert urinary catheter 0164 1.18 $61.37 $18.41 $12.27 53850 T Prostatic microwave thermotx 0675 51.57 $2,682.10 $536.42 53852 T Prostatic rf thermotx 0675 51.57 $2,682.10 $536.42 53853 T Prostatic water thermother 0977 $1,125.00 $225.00 53899 T Urology surgery procedure 0164 1.18 $61.37 $18.41 $12.27 54000 T Slitting of prepuce 0166 15.63 $812.90 $218.73 $162.58 54001 T Slitting of prepuce 0166 15.63 $812.90 $218.73 $162.58 54015 T Drain penis lesion 0007 9.44 $490.96 $103.10 $98.19 54050 T Destruction, penis lesion(s) 0013 1.10 $57.21 $14.30 $11.44 54055 T Destruction, penis lesion(s) 0017 16.46 $856.07 $227.84 $171.21 54056 T Cryosurgery, penis lesion(s) 0012 0.76 $39.53 $10.67 $7.91 54057 T Laser surg, penis lesion(s) 0017 16.46 $856.07 $227.84 $171.21 54060 T Excision of penis lesion(s) 0017 16.46 $856.07 $227.84 $171.21 54065 T Destruction, penis lesion(s) 0695 19.65 $1,021.98 $266.59 $204.40 54100 T Biopsy of penis 0021 14.58 $758.29 $227.49 $151.66 54105 T Biopsy of penis 0022 18.10 $941.36 $367.13 $188.27 54110 T Treatment of penis lesion 0181 29.88 $1,554.03 $621.82 $310.81 54111 T Treat penis lesion, graft 0181 29.88 $1,554.03 $621.82 $310.81 54112 T Treat penis lesion, graft 0181 29.88 $1,554.03 $621.82 $310.81 54115 T Treatment of penis lesion 0008 16.32 $848.79 $169.76 54120 T Partial removal of penis 0181 29.88 $1,554.03 $621.82 $310.81 54125 C Removal of penis 54130 C Remove penis & nodes 54135 C Remove penis & nodes 54150 T Circumcision 0180 18.95 $985.57 $304.87 $197.11 54152 T Circumcision 0180 18.95 $985.57 $304.87 $197.11 54160 T Circumcision 0180 18.95 $985.57 $304.87 $197.11 54161 T Circumcision 0180 18.95 $985.57 $304.87 $197.11 54162 T Lysis penil circumcis lesion 0180 18.95 $985.57 $304.87 $197.11 54163 T Repair of circumcision 0180 18.95 $985.57 $304.87 $197.11 54164 T Frenulotomy of penis 0180 18.95 $985.57 $304.87 $197.11 54200 T Treatment of penis lesion 0156 3.10 $161.23 $48.37 $32.25 54205 T Treatment of penis lesion 0181 29.88 $1,554.03 $621.82 $310.81 54220 T Treatment of penis lesion 0156 3.10 $161.23 $48.37 $32.25 54230 N Prepare penis study 54231 T Dynamic cavernosometry 0165 12.62 $656.35 $131.27 54235 T Penile injection 0164 1.18 $61.37 $18.41 $12.27 54240 T Penis study 0164 1.18 $61.37 $18.41 $12.27 54250 T Penis study 0165 12.62 $656.35 $131.27 54300 T Revision of penis 0181 29.88 $1,554.03 $621.82 $310.81 54304 T Revision of penis 0181 29.88 $1,554.03 $621.82 $310.81 54308 T Reconstruction of urethra 0181 29.88 $1,554.03 $621.82 $310.81 Start Printed Page 52223 54312 T Reconstruction of urethra 0181 29.88 $1,554.03 $621.82 $310.81 54316 T Reconstruction of urethra 0181 29.88 $1,554.03 $621.82 $310.81 54318 T Reconstruction of urethra 0181 29.88 $1,554.03 $621.82 $310.81 54322 T Reconstruction of urethra 0181 29.88 $1,554.03 $621.82 $310.81 54324 T Reconstruction of urethra 0181 29.88 $1,554.03 $621.82 $310.81 54326 T Reconstruction of urethra 0181 29.88 $1,554.03 $621.82 $310.81 54328 T Revise penis/urethra 0181 29.88 $1,554.03 $621.82 $310.81 54332 C Revise penis/urethra 54336 C Revise penis/urethra 54340 T Secondary urethral surgery 0181 29.88 $1,554.03 $621.82 $310.81 54344 T Secondary urethral surgery 0181 29.88 $1,554.03 $621.82 $310.81 54348 T Secondary urethral surgery 0181 29.88 $1,554.03 $621.82 $310.81 54352 T Reconstruct urethra/penis 0181 29.88 $1,554.03 $621.82 $310.81 54360 T Penis plastic surgery 0181 29.88 $1,554.03 $621.82 $310.81 54380 T Repair penis 0181 29.88 $1,554.03 $621.82 $310.81 54385 T Repair penis 0181 29.88 $1,554.03 $621.82 $310.81 54390 C Repair penis and bladder 54400 T Insert semi-rigid prosthesis 0182 83.80 $4,358.35 $1,438.26 $871.67 54401 T Insert self-contd prosthesis 0182 83.80 $4,358.35 $1,438.26 $871.67 54405 T Insert multi-comp penis pros 0182 83.80 $4,358.35 $1,438.26 $871.67 54406 T Remove multi-comp penis pros 0181 29.88 $1,554.03 $621.82 $310.81 54408 T Repair multi-comp penis pros 0181 29.88 $1,554.03 $621.82 $310.81 54410 T Remove/replace penis prosth 0182 83.80 $4,358.35 $1,438.26 $871.67 54411 C Remv/replc penis pros, comp 54415 T Remove self-contd penis pros 0181 29.88 $1,554.03 $621.82 $310.81 54416 T Remv/repl penis contain pros 0182 83.80 $4,358.35 $1,438.26 $871.67 54417 C Remv/replc penis pros, compl 54420 T Revision of penis 0181 29.88 $1,554.03 $621.82 $310.81 54430 C Revision of penis 54435 T Revision of penis 0181 29.88 $1,554.03 $621.82 $310.81 54440 T Repair of penis 0181 29.88 $1,554.03 $621.82 $310.81 54450 T Preputial stretching 0156 3.10 $161.23 $48.37 $32.25 54500 T Biopsy of testis 0005 3.02 $157.07 $69.11 $31.41 54505 T Biopsy of testis 0183 22.19 $1,154.08 $448.94 $230.82 54512 T Excise lesion testis 0183 22.19 $1,154.08 $448.94 $230.82 54520 T Removal of testis 0183 22.19 $1,154.08 $448.94 $230.82 54522 T Orchiectomy, partial 0183 22.19 $1,154.08 $448.94 $230.82 54530 T Removal of testis 0154 26.98 $1,403.20 $491.12 $280.64 54535 C Extensive testis surgery 54550 T Exploration for testis 0154 26.98 $1,403.20 $491.12 $280.64 54560 C Exploration for testis 54600 T Reduce testis torsion 0183 22.19 $1,154.08 $448.94 $230.82 54620 T Suspension of testis 0183 22.19 $1,154.08 $448.94 $230.82 54640 T Suspension of testis 0154 26.98 $1,403.20 $491.12 $280.64 54650 C Orchiopexy (Fowler-Stephens) 54660 T Revision of testis 0183 22.19 $1,154.08 $448.94 $230.82 54670 T Repair testis injury 0183 22.19 $1,154.08 $448.94 $230.82 54680 T Relocation of testis(es) 0183 22.19 $1,154.08 $448.94 $230.82 54690 T Laparoscopy, orchiectomy 0131 42.44 $2,207.26 $1,001.89 $441.45 54692 T Laparoscopy, orchiopexy 0132 57.95 $3,013.92 $1,239.22 $602.78 54699 T Laparoscope proc, testis 0130 31.99 $1,663.77 $659.53 $332.75 54700 T Drainage of scrotum 0183 22.19 $1,154.08 $448.94 $230.82 54800 T Biopsy of epididymis 0004 1.63 $84.77 $22.04 $16.95 54820 T Exploration of epididymis 0183 22.19 $1,154.08 $448.94 $230.82 54830 T Remove epididymis lesion 0183 22.19 $1,154.08 $448.94 $230.82 54840 T Remove epididymis lesion 0183 22.19 $1,154.08 $448.94 $230.82 54860 T Removal of epididymis 0183 22.19 $1,154.08 $448.94 $230.82 54861 T Removal of epididymis 0183 22.19 $1,154.08 $448.94 $230.82 54900 T Fusion of spermatic ducts 0183 22.19 $1,154.08 $448.94 $230.82 54901 T Fusion of spermatic ducts 0183 22.19 $1,154.08 $448.94 $230.82 55000 T Drainage of hydrocele 0004 1.63 $84.77 $22.04 $16.95 55040 T Removal of hydrocele 0154 26.98 $1,403.20 $491.12 $280.64 55041 T Removal of hydroceles 0154 26.98 $1,403.20 $491.12 $280.64 55060 T Repair of hydrocele 0183 22.19 $1,154.08 $448.94 $230.82 55100 T Drainage of scrotum abscess 0007 9.44 $490.96 $103.10 $98.19 55110 T Explore scrotum 0183 22.19 $1,154.08 $448.94 $230.82 Start Printed Page 52224 55120 T Removal of scrotum lesion 0183 22.19 $1,154.08 $448.94 $230.82 55150 T Removal of scrotum 0183 22.19 $1,154.08 $448.94 $230.82 55175 T Revision of scrotum 0183 22.19 $1,154.08 $448.94 $230.82 55180 T Revision of scrotum 0183 22.19 $1,154.08 $448.94 $230.82 55200 T Incision of sperm duct 0183 22.19 $1,154.08 $448.94 $230.82 55250 T Removal of sperm duct(s) 0183 22.19 $1,154.08 $448.94 $230.82 55300 N Prepare, sperm duct x-ray 55400 T Repair of sperm duct 0183 22.19 $1,154.08 $448.94 $230.82 55450 T Ligation of sperm duct 0183 22.19 $1,154.08 $448.94 $230.82 55500 T Removal of hydrocele 0183 22.19 $1,154.08 $448.94 $230.82 55520 T Removal of sperm cord lesion 0183 22.19 $1,154.08 $448.94 $230.82 55530 T Revise spermatic cord veins 0183 22.19 $1,154.08 $448.94 $230.82 55535 T Revise spermatic cord veins 0154 26.98 $1,403.20 $491.12 $280.64 55540 T Revise hernia & sperm veins 0154 26.98 $1,403.20 $491.12 $280.64 55550 T Laparo ligate spermatic vein 0131 42.44 $2,207.26 $1,001.89 $441.45 55559 T Laparo proc, spermatic cord 0130 31.99 $1,663.77 $659.53 $332.75 55600 C Incise sperm duct pouch 55605 C Incise sperm duct pouch 55650 C Remove sperm duct pouch 55680 T Remove sperm pouch lesion 0183 22.19 $1,154.08 $448.94 $230.82 55700 T Biopsy of prostate 0184 3.66 $190.35 $95.18 $38.07 55705 T Biopsy of prostate 0184 3.66 $190.35 $95.18 $38.07 55720 T Drainage of prostate abscess 0162 21.50 $1,118.19 $223.64 55725 T Drainage of prostate abscess 0162 21.50 $1,118.19 $223.64 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 55845 C Extensive prostate surgery 55859 T Percut/needle insert, pros 0163 24.77 $1,288.26 $257.65 55860 T Surgical exposure, prostate 0165 12.62 $656.35 $131.27 55862 C Extensive prostate surgery 55865 C Extensive prostate surgery 55870 T Electroejaculation 0197 1.19 $61.89 $24.76 $12.38 55873 T Cryoablate prostate 0674 69.25 $3,601.62 $720.32 55899 T Genital surgery procedure 0164 1.18 $61.37 $18.41 $12.27 55970 E Sex transformation, M to F 55980 E Sex transformation, F to M 56405 T I & D of vulva/perineum 0192 2.94 $152.91 $42.81 $30.58 56420 T Drainage of gland abscess 0192 2.94 $152.91 $42.81 $30.58 56440 T Surgery for vulva lesion 0194 18.88 $981.93 $397.84 $196.39 56441 T Lysis of labial lesion(s) 0193 14.57 $757.77 $171.13 $151.55 56501 T Destroy, vulva lesions, simp 0017 16.46 $856.07 $227.84 $171.21 56515 T Destroy vulva lesion/s compl 0695 19.65 $1,021.98 $266.59 $204.40 56605 T Biopsy of vulva/perineum 0019 3.94 $204.92 $75.82 $40.98 56606 T Biopsy of vulva/perineum 0019 3.94 $204.92 $75.82 $40.98 56620 T Partial removal of vulva 0195 24.37 $1,267.46 $483.80 $253.49 56625 T Complete removal of vulva 0195 24.37 $1,267.46 $483.80 $253.49 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 18.88 $981.93 $397.84 $196.39 56720 T Incision of hymen 0193 14.57 $757.77 $171.13 $151.55 56740 T Remove vagina gland lesion 0194 18.88 $981.93 $397.84 $196.39 56800 T Repair of vagina 0194 18.88 $981.93 $397.84 $196.39 56805 T Repair clitoris 0194 18.88 $981.93 $397.84 $196.39 56810 T Repair of perineum 0194 18.88 $981.93 $397.84 $196.39 57000 T Exploration of vagina 0194 18.88 $981.93 $397.84 $196.39 Start Printed Page 52225 57010 T Drainage of pelvic abscess 0194 18.88 $981.93 $397.84 $196.39 57020 T Drainage of pelvic fluid 0192 2.94 $152.91 $42.81 $30.58 57022 T I & d vaginal hematoma, pp 0007 9.44 $490.96 $103.10 $98.19 57023 T I & d vag hematoma, non-ob 0007 9.44 $490.96 $103.10 $98.19 57061 T Destroy vag lesions, simple 0194 18.88 $981.93 $397.84 $196.39 57065 T Destroy vag lesions, complex 0194 18.88 $981.93 $397.84 $196.39 57100 T Biopsy of vagina 0192 2.94 $152.91 $42.81 $30.58 57105 T Biopsy of vagina 0194 18.88 $981.93 $397.84 $196.39 57106 T Remove vagina wall, partial 0194 18.88 $981.93 $397.84 $196.39 57107 T Remove vagina tissue, part 0195 24.37 $1,267.46 $483.80 $253.49 57109 T Vaginectomy partial w/nodes 0202 39.09 $2,033.03 $996.18 $406.61 57110 C Remove vagina wall, complete 57111 C Remove vagina tissue, compl 57112 C Vaginectomy w/nodes, compl 57120 T Closure of vagina 0194 18.88 $981.93 $397.84 $196.39 57130 T Remove vagina lesion 0194 18.88 $981.93 $397.84 $196.39 57135 T Remove vagina lesion 0194 18.88 $981.93 $397.84 $196.39 57150 T Treat vagina infection 0191 0.22 $11.44 $3.32 $2.29 57155 T Insert uteri tandems/ovoids 0192 2.94 $152.91 $42.81 $30.58 57160 T Insert pessary/other device 0188 1.12 $58.25 $11.95 $11.65 57170 T Fitting of diaphragm/cap 0191 0.22 $11.44 $3.32 $2.29 57180 T Treat vaginal bleeding 0192 2.94 $152.91 $42.81 $30.58 57200 T Repair of vagina 0194 18.88 $981.93 $397.84 $196.39 57210 T Repair vagina/perineum 0194 18.88 $981.93 $397.84 $196.39 57220 T Revision of urethra 0195 24.37 $1,267.46 $483.80 $253.49 57230 T Repair of urethral lesion 0194 18.88 $981.93 $397.84 $196.39 57240 T Repair bladder & vagina 0195 24.37 $1,267.46 $483.80 $253.49 57250 T Repair rectum & vagina 0195 24.37 $1,267.46 $483.80 $253.49 57260 T Repair of vagina 0195 24.37 $1,267.46 $483.80 $253.49 57265 T Extensive repair of vagina 0195 24.37 $1,267.46 $483.80 $253.49 57268 T Repair of bowel bulge 0195 24.37 $1,267.46 $483.80 $253.49 57270 C Repair of bowel pouch 57280 C Suspension of vagina 57282 C Repair of vaginal prolapse 57284 T Repair paravaginal defect 0195 24.37 $1,267.46 $483.80 $253.49 57287 T Revise/remove sling repair 0202 39.09 $2,033.03 $996.18 $406.61 57288 T Repair bladder defect 0202 39.09 $2,033.03 $996.18 $406.61 57289 T Repair bladder & vagina 0195 24.37 $1,267.46 $483.80 $253.49 57291 T Construction of vagina 0195 24.37 $1,267.46 $483.80 $253.49 57292 C Construct vagina with graft 57300 T Repair rectum-vagina fistula 0195 24.37 $1,267.46 $483.80 $253.49 57305 C Repair rectum-vagina fistula 57307 C Fistula repair & colostomy 57308 C Fistula repair, transperine 57310 T Repair urethrovaginal lesion 0195 24.37 $1,267.46 $483.80 $253.49 57311 C Repair urethrovaginal lesion 57320 T Repair bladder-vagina lesion 0195 24.37 $1,267.46 $483.80 $253.49 57330 T Repair bladder-vagina lesion 0195 24.37 $1,267.46 $483.80 $253.49 57335 C Repair vagina 57400 T Dilation of vagina 0194 18.88 $981.93 $397.84 $196.39 57410 T Pelvic examination 0194 18.88 $981.93 $397.84 $196.39 57415 T Remove vaginal foreign body 0194 18.88 $981.93 $397.84 $196.39 57452 T Examination of vagina 0189 1.63 $84.77 $18.60 $16.95 57454 T Vagina examination & biopsy 0192 2.94 $152.91 $42.81 $30.58 57460 T Cervix excision 0193 14.57 $757.77 $171.13 $151.55 57500 T Biopsy of cervix 0192 2.94 $152.91 $42.81 $30.58 57505 T Endocervical curettage 0192 2.94 $152.91 $42.81 $30.58 57510 T Cauterization of cervix 0193 14.57 $757.77 $171.13 $151.55 57511 T Cryocautery of cervix 0189 1.63 $84.77 $18.60 $16.95 57513 T Laser surgery of cervix 0193 14.57 $757.77 $171.13 $151.55 57520 T Conization of cervix 0194 18.88 $981.93 $397.84 $196.39 57522 T Conization of cervix 0195 24.37 $1,267.46 $483.80 $253.49 57530 T Removal of cervix 0195 24.37 $1,267.46 $483.80 $253.49 57531 C Removal of cervix, radical 57540 C Removal of residual cervix 57545 C Remove cervix/repair pelvis Start Printed Page 52226 57550 T Removal of residual cervix 0195 24.37 $1,267.46 $483.80 $253.49 57555 T Remove cervix/repair vagina 0195 24.37 $1,267.46 $483.80 $253.49 57556 T Remove cervix, repair bowel 0195 24.37 $1,267.46 $483.80 $253.49 57700 T Revision of cervix 0194 18.88 $981.93 $397.84 $196.39 57720 T Revision of cervix 0194 18.88 $981.93 $397.84 $196.39 57800 T Dilation of cervical canal 0192 2.94 $152.91 $42.81 $30.58 57820 T D & c of residual cervix 0196 16.32 $848.79 $338.23 $169.76 58100 T Biopsy of uterus lining 0188 1.12 $58.25 $11.95 $11.65 58120 T Dilation and curettage 0196 16.32 $848.79 $338.23 $169.76 58140 C Removal of uterus lesion 58145 T Removal of uterus lesion 0195 24.37 $1,267.46 $483.80 $253.49 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 Vaginal hysterectomy 58263 C Vaginal hysterectomy 58267 C Hysterectomy & vagina repair 58270 C Hysterectomy & vagina repair 58275 C Hysterectomy/revise vagina 58280 C Hysterectomy/revise vagina 58285 C Extensive hysterectomy 58300 E Insert intrauterine device 58301 T Remove intrauterine device 0189 1.63 $84.77 $18.60 $16.95 58321 T Artificial insemination 0197 1.19 $61.89 $24.76 $12.38 58322 T Artificial insemination 0197 1.19 $61.89 $24.76 $12.38 58323 T Sperm washing 0197 1.19 $61.89 $24.76 $12.38 58340 N Catheter for hysterography 58345 T Reopen fallopian tube 0194 18.88 $981.93 $397.84 $196.39 58346 T Insert heyman uteri capsule 0192 2.94 $152.91 $42.81 $30.58 58350 T Reopen fallopian tube 0194 18.88 $981.93 $397.84 $196.39 58353 T Endometr ablate, thermal 0193 14.57 $757.77 $171.13 $151.55 58400 C Suspension of uterus 58410 C Suspension of uterus 58520 C Repair of ruptured uterus 58540 C Revision of uterus 58550 T Laparo-asst vag hysterectomy 0132 57.95 $3,013.92 $1,239.22 $602.78 58551 T Laparoscopy, remove myoma 0131 42.44 $2,207.26 $1,001.89 $441.45 58555 T Hysteroscopy, dx, sep proc 0194 18.88 $981.93 $397.84 $196.39 58558 T Hysteroscopy, biopsy 0190 20.06 $1,043.30 $424.28 $208.66 58559 T Hysteroscopy, lysis 0190 20.06 $1,043.30 $424.28 $208.66 58560 T Hysteroscopy, resect septum 0190 20.06 $1,043.30 $424.28 $208.66 58561 T Hysteroscopy, remove myoma 0190 20.06 $1,043.30 $424.28 $208.66 58562 T Hysteroscopy, remove fb 0190 20.06 $1,043.30 $424.28 $208.66 58563 T Hysteroscopy, ablation 0190 20.06 $1,043.30 $424.28 $208.66 58578 T Laparo proc, uterus 0190 20.06 $1,043.30 $424.28 $208.66 58579 T Hysteroscope procedure 0190 20.06 $1,043.30 $424.28 $208.66 58600 T Division of fallopian tube 0194 18.88 $981.93 $397.84 $196.39 58605 C Division of fallopian tube 58611 C Ligate oviduct(s) add-on 58615 T Occlude fallopian tube(s) 0194 18.88 $981.93 $397.84 $196.39 58660 T Laparoscopy, lysis 0131 42.44 $2,207.26 $1,001.89 $441.45 58661 T Laparoscopy, remove adnexa 0131 42.44 $2,207.26 $1,001.89 $441.45 58662 T Laparoscopy, excise lesions 0131 42.44 $2,207.26 $1,001.89 $441.45 58670 T Laparoscopy, tubal cautery 0131 42.44 $2,207.26 $1,001.89 $441.45 58671 T Laparoscopy, tubal block 0131 42.44 $2,207.26 $1,001.89 $441.45 58672 T Laparoscopy, fimbrioplasty 0131 42.44 $2,207.26 $1,001.89 $441.45 58673 T Laparoscopy, salpingostomy 0131 42.44 $2,207.26 $1,001.89 $441.45 58679 T Laparo proc, oviduct-ovary 0130 31.99 $1,663.77 $659.53 $332.75 58700 C Removal of fallopian tube 58720 C Removal of ovary/tube(s) 58740 C Revise fallopian tube(s) 58750 C Repair oviduct Start Printed Page 52227 58752 C Revise ovarian tube(s) 58760 C Remove tubal obstruction 58770 C Create new tubal opening 58800 T Drainage of ovarian cyst(s) 0195 24.37 $1,267.46 $483.80 $253.49 58805 C Drainage of ovarian cyst(s) 58820 T Drain ovary abscess, open 0195 24.37 $1,267.46 $483.80 $253.49 58822 C Drain ovary abscess, percut 58823 T Drain pelvic abscess, percut 0193 14.57 $757.77 $171.13 $151.55 58825 C Transposition, ovary(s) 58900 T Biopsy of ovary(s) 0195 24.37 $1,267.46 $483.80 $253.49 58920 T Partial removal of ovary(s) 0202 39.09 $2,033.03 $996.18 $406.61 58925 T Removal of ovarian cyst(s) 0202 39.09 $2,033.03 $996.18 $406.61 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 58960 C Exploration of abdomen 58970 T Retrieval of oocyte 0194 18.88 $981.93 $397.84 $196.39 58974 T Transfer of embryo 0197 1.19 $61.89 $24.76 $12.38 58976 T Transfer of embryo 0197 1.19 $61.89 $24.76 $12.38 58999 T Genital surgery procedure 0191 0.22 $11.44 $3.32 $2.29 59000 T Amniocentesis, diagnostic 0198 1.33 $69.17 $32.92 $13.83 59001 T Amniocentesis, therapeutic 0198 1.33 $69.17 $32.92 $13.83 59012 T Fetal cord puncture,prenatal 0198 1.33 $69.17 $32.92 $13.83 59015 T Chorion biopsy 0198 1.33 $69.17 $32.92 $13.83 59020 T Fetal contract stress test 0198 1.33 $69.17 $32.92 $13.83 59025 T Fetal non-stress test 0198 1.33 $69.17 $32.92 $13.83 59030 T Fetal scalp blood sample 0198 1.33 $69.17 $32.92 $13.83 59050 E Fetal monitor w/report 59051 E Fetal monitor/interpret only 59100 C Remove uterus lesion 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 42.44 $2,207.26 $1,001.89 $441.45 59151 T Treat ectopic pregnancy 0131 42.44 $2,207.26 $1,001.89 $441.45 59160 T D & c after delivery 0196 16.32 $848.79 $338.23 $169.76 59200 T Insert cervical dilator 0189 1.63 $84.77 $18.60 $16.95 59300 T Episiotomy or vaginal repair 0193 14.57 $757.77 $171.13 $151.55 59320 T Revision of cervix 0194 18.88 $981.93 $397.84 $196.39 59325 C Revision of cervix 59350 C Repair of uterus 59400 E Obstetrical care 59409 T Obstetrical care 0199 5.69 $295.93 $72.98 $59.19 59410 E Obstetrical care 59412 T Antepartum manipulation 0199 5.69 $295.93 $72.98 $59.19 59414 T Deliver placenta 0199 5.69 $295.93 $72.98 $59.19 59425 E Antepartum care only 59426 E Antepartum care only 59430 E 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 0199 5.69 $295.93 $72.98 $59.19 59614 E Vbac care after delivery 59618 E Attempted vbac delivery 59620 C Attempted vbac delivery only 59622 E Attempted vbac after care Start Printed Page 52228 59812 T Treatment of miscarriage 0201 15.84 $823.82 $329.65 $164.76 59820 T Care of miscarriage 0201 15.84 $823.82 $329.65 $164.76 59821 T Treatment of miscarriage 0201 15.84 $823.82 $329.65 $164.76 59830 C Treat uterus infection 59840 T Abortion 0200 14.49 $753.61 $307.83 $150.72 59841 T Abortion 0200 14.49 $753.61 $307.83 $150.72 59850 C Abortion 59851 C Abortion 59852 C Abortion 59855 C Abortion 59856 C Abortion 59857 C Abortion 59866 T Abortion (mpr) 0198 1.33 $69.17 $32.92 $13.83 59870 T Evacuate mole of uterus 0201 15.84 $823.82 $329.65 $164.76 59871 T Remove cerclage suture 0194 18.88 $981.93 $397.84 $196.39 59898 T Laparo proc, ob care/deliver 0130 31.99 $1,663.77 $659.53 $332.75 59899 T Maternity care procedure 0198 1.33 $69.17 $32.92 $13.83 60000 T Drain thyroid/tongue cyst 0252 6.27 $326.10 $114.24 $65.22 60001 T Aspirate/inject thyriod cyst 0004 1.63 $84.77 $22.04 $16.95 60100 T Biopsy of thyroid 0004 1.63 $84.77 $22.04 $16.95 60200 T Remove thyroid lesion 0114 37.55 $1,952.94 $507.76 $390.59 60210 T Partial thyroid excision 0114 37.55 $1,952.94 $507.76 $390.59 60212 T Parital thyroid excision 0114 37.55 $1,952.94 $507.76 $390.59 60220 T Partial removal of thyroid 0114 37.55 $1,952.94 $507.76 $390.59 60225 T Partial removal of thyroid 0114 37.55 $1,952.94 $507.76 $390.59 60240 T Removal of thyroid 0114 37.55 $1,952.94 $507.76 $390.59 60252 T Removal of thyroid 0256 35.51 $1,846.84 $369.37 60254 C Extensive thyroid surgery 60260 T Repeat thyroid surgery 0256 35.51 $1,846.84 $369.37 60270 C Removal of thyroid 60271 C Removal of thyroid 60280 T Remove thyroid duct lesion 0114 37.55 $1,952.94 $507.76 $390.59 60281 T Remove thyroid duct lesion 0114 37.55 $1,952.94 $507.76 $390.59 60500 T Explore parathyroid glands 0256 35.51 $1,846.84 $369.37 60502 C Re-explore parathyroids 60505 C Explore parathyroid glands 60512 T Autotransplant parathyroid 0022 18.10 $941.36 $367.13 $188.27 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 31.99 $1,663.77 $659.53 $332.75 60699 T Endocrine surgery procedure 0114 37.55 $1,952.94 $507.76 $390.59 61000 T Remove cranial cavity fluid 0212 3.53 $183.59 $84.45 $36.72 61001 T Remove cranial cavity fluid 0212 3.53 $183.59 $84.45 $36.72 61020 T Remove brain cavity fluid 0212 3.53 $183.59 $84.45 $36.72 61026 T Injection into brain canal 0212 3.53 $183.59 $84.45 $36.72 61050 T Remove brain canal fluid 0212 3.53 $183.59 $84.45 $36.72 61055 T Injection into brain canal 0212 3.53 $183.59 $84.45 $36.72 61070 T Brain canal shunt procedure 0212 3.53 $183.59 $84.45 $36.72 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 39.14 $2,035.63 $453.41 $407.13 61250 C Pierce skull & explore Start Printed Page 52229 61253 C Pierce skull & explore 61304 C Open skull for exploration 61305 C Open skull for exploration 61312 C Open skull for drainage 61313 C Open skull for drainage 61314 C Open skull for drainage 61315 C Open skull for drainage 61320 C Open skull for drainage 61321 C Open skull for drainage 61330 T Decompress eye socket 0256 35.51 $1,846.84 $369.37 61332 C Explore/biopsy eye socket 61333 C Explore orbit/remove lesion 61334 C Explore orbit/remove object 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 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 61538 C Removal of brain tissue 61539 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 61570 C Remove foreign body, brain 61571 C Incise skull for brain wound 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 Start Printed Page 52230 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 61624 C Occlusion/embolization cath 61626 T Occlusion/embolization cath 0081 22.69 $1,180.08 $236.02 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 16.66 $866.47 $173.29 61791 T Treat trigeminal tract 0204 2.13 $110.78 $42.10 $22.16 61793 E Focus radiation beam 61795 S Brain surgery using computer 0302 10.17 $528.93 $200.99 $105.79 61850 C Implant neuroelectrodes 61860 C Implant neuroelectrodes 61862 C Implant neurostimul, subcort 61870 C Implant neuroelectrodes 61875 C Implant neuroelectrodes 61880 T Revise/remove neuroelectrode 0687 19.50 $1,014.18 $466.52 $202.84 61885 T Implant neurostim one array 0222 140.56 $7,310.39 $1,462.08 61886 T Implant neurostim arrays 0222 140.56 $7,310.39 $1,462.08 61888 T Revise/remove neuroreceiver 0688 30.58 $1,590.44 $779.32 $318.09 62000 C Treat skull fracture 62005 C Treat skull fracture 62010 C Treatment of head injury 62100 C Repair brain fluid leakage Start Printed Page 52231 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 62180 C Establish brain cavity shunt 62190 C Establish brain cavity shunt 62192 C Establish brain cavity shunt 62194 T Replace/irrigate catheter 0121 2.17 $112.86 $45.14 $22.57 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 0121 2.17 $112.86 $45.14 $22.57 62230 T Replace/revise brain shunt 0224 39.14 $2,035.63 $453.41 $407.13 62252 S Csf shunt reprogram 0691 3.14 $163.31 $89.02 $32.66 62256 C Remove brain cavity shunt 62258 C Replace brain cavity shunt 62263 T Lysis epidural adhesions 0203 10.96 $570.02 $256.51 $114.00 62268 T Drain spinal cord cyst 0212 3.53 $183.59 $84.45 $36.72 62269 T Needle biopsy, spinal cord 0005 3.02 $157.07 $69.11 $31.41 62270 T Spinal fluid tap, diagnostic 0206 4.89 $254.32 $75.55 $50.86 62272 T Drain cerebro spinal fluid 0206 4.89 $254.32 $75.55 $50.86 62273 T Treat epidural spine lesion 0206 4.89 $254.32 $75.55 $50.86 62280 T Treat spinal cord lesion 0207 5.97 $310.49 $123.69 $62.10 62281 T Treat spinal cord lesion 0207 5.97 $310.49 $123.69 $62.10 62282 T Treat spinal canal lesion 0207 5.97 $310.49 $123.69 $62.10 62284 N Injection for myelogram 62287 T Percutaneous diskectomy 0220 16.66 $866.47 $173.29 62290 N Inject for spine disk x-ray 62291 N Inject for spine disk x-ray 62292 T Injection into disk lesion 0212 3.53 $183.59 $84.45 $36.72 62294 T Injection into spinal artery 0212 3.53 $183.59 $84.45 $36.72 62310 T Inject spine c/t 0206 4.89 $254.32 $75.55 $50.86 62311 T Inject spine l/s (cd) 0206 4.89 $254.32 $75.55 $50.86 62318 T Inject spine w/cath, c/t 0206 4.89 $254.32 $75.55 $50.86 62319 T Inject spine w/cath l/s (cd) 0206 4.89 $254.32 $75.55 $50.86 62350 T Implant spinal canal cath 0223 20.30 $1,055.78 $211.16 62351 T Implant spinal canal cath 0208 39.95 $2,077.76 $415.55 62355 T Remove spinal canal catheter 0203 10.96 $570.02 $256.51 $114.00 62360 T Insert spine infusion device 0226 44.20 $2,298.80 $459.76 62361 T Implant spine infusion pump 0227 128.03 $6,658.71 $1,331.74 62362 T Implant spine infusion pump 0227 128.03 $6,658.71 $1,331.74 62365 T Remove spine infusion device 0203 10.96 $570.02 $256.51 $114.00 62367 S Analyze spine infusion pump 0691 3.14 $163.31 $89.02 $32.66 62368 S Analyze spine infusion pump 0691 3.14 $163.31 $89.02 $32.66 63001 T Removal of spinal lamina 0208 39.95 $2,077.76 $415.55 63003 T Removal of spinal lamina 0208 39.95 $2,077.76 $415.55 63005 T Removal of spinal lamina 0208 39.95 $2,077.76 $415.55 63011 T Removal of spinal lamina 0208 39.95 $2,077.76 $415.55 63012 T Removal of spinal lamina 0208 39.95 $2,077.76 $415.55 63015 T Removal of spinal lamina 0208 39.95 $2,077.76 $415.55 63016 T Removal of spinal lamina 0208 39.95 $2,077.76 $415.55 63017 T Removal of spinal lamina 0208 39.95 $2,077.76 $415.55 63020 T Neck spine disk surgery 0208 39.95 $2,077.76 $415.55 63030 T Low back disk surgery 0208 39.95 $2,077.76 $415.55 63035 T Spinal disk surgery add-on 0208 39.95 $2,077.76 $415.55 63040 T Laminotomy, single cervical 0208 39.95 $2,077.76 $415.55 63042 T Laminotomy, single lumbar 0208 39.95 $2,077.76 $415.55 Start Printed Page 52232 63043 C Laminotomy, addl cervical 63044 C Laminotomy, addl lumbar 63045 T Removal of spinal lamina 0208 39.95 $2,077.76 $415.55 63046 T Removal of spinal lamina 0208 39.95 $2,077.76 $415.55 63047 T Removal of spinal lamina 0208 39.95 $2,077.76 $415.55 63048 T Remove spinal lamina add-on 0208 39.95 $2,077.76 $415.55 63055 T Decompress spinal cord 0208 39.95 $2,077.76 $415.55 63056 T Decompress spinal cord 0208 39.95 $2,077.76 $415.55 63057 T Decompress spine cord add-on 0208 39.95 $2,077.76 $415.55 63064 T Decompress spinal cord 0208 39.95 $2,077.76 $415.55 63066 T Decompress spine cord add-on 0208 39.95 $2,077.76 $415.55 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 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 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 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 Start Printed Page 52233 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 16.66 $866.47 $173.29 63610 T Stimulation of spinal cord 0220 16.66 $866.47 $173.29 63615 T Remove lesion of spinal cord 0220 16.66 $866.47 $173.29 63650 T Implant neuroelectrodes 0225 44.47 $2,312.84 $462.57 63655 T Implant neuroelectrodes 0225 44.47 $2,312.84 $462.57 63660 T Revise/remove neuroelectrode 0687 19.50 $1,014.18 $466.52 $202.84 63685 T Implant neuroreceiver 0222 140.56 $7,310.39 $1,462.08 63688 T Revise/remove neuroreceiver 0688 30.58 $1,590.44 $779.32 $318.09 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 55.05 $2,863.10 $696.46 $572.62 63744 T Revision of spinal shunt 0228 55.05 $2,863.10 $696.46 $572.62 63746 T Removal of spinal shunt 0109 7.68 $399.43 $131.49 $79.89 64400 T Injection for nerve block 0204 2.13 $110.78 $42.10 $22.16 64402 T Injection for nerve block 0204 2.13 $110.78 $42.10 $22.16 64405 T Injection for nerve block 0204 2.13 $110.78 $42.10 $22.16 64408 T Injection for nerve block 0204 2.13 $110.78 $42.10 $22.16 64410 T Injection for nerve block 0204 2.13 $110.78 $42.10 $22.16 64412 T Injection for nerve block 0204 2.13 $110.78 $42.10 $22.16 64413 T Injection for nerve block 0204 2.13 $110.78 $42.10 $22.16 64415 T Injection for nerve block 0204 2.13 $110.78 $42.10 $22.16 64417 T Injection for nerve block 0204 2.13 $110.78 $42.10 $22.16 64418 T Injection for nerve block 0204 2.13 $110.78 $42.10 $22.16 64420 T Injection for nerve block 0207 5.97 $310.49 $123.69 $62.10 64421 T Injection for nerve block 0207 5.97 $310.49 $123.69 $62.10 64425 T Injection for nerve block 0204 2.13 $110.78 $42.10 $22.16 64430 T Injection for nerve block 0204 2.13 $110.78 $42.10 $22.16 64435 T Injection for nerve block 0204 2.13 $110.78 $42.10 $22.16 64445 T Injection for nerve block 0204 2.13 $110.78 $42.10 $22.16 64450 T Injection for nerve block 0204 2.13 $110.78 $42.10 $22.16 64470 T Inj paravertebral c/t 0207 5.97 $310.49 $123.69 $62.10 64472 T Inj paravertebral c/t add-on 0207 5.97 $310.49 $123.69 $62.10 64475 T Inj paravertebral l/s 0207 5.97 $310.49 $123.69 $62.10 64476 T Inj paravertebral l/s add-on 0207 5.97 $310.49 $123.69 $62.10 64479 T Inj foramen epidural c/t 0207 5.97 $310.49 $123.69 $62.10 64480 T Inj foramen epidural add-on 0207 5.97 $310.49 $123.69 $62.10 64483 T Inj foramen epidural l/s 0207 5.97 $310.49 $123.69 $62.10 64484 T Inj foramen epidural add-on 0207 5.97 $310.49 $123.69 $62.10 64505 T Injection for nerve block 0204 2.13 $110.78 $42.10 $22.16 64508 T Injection for nerve block 0204 2.13 $110.78 $42.10 $22.16 64510 T Injection for nerve block 0207 5.97 $310.49 $123.69 $62.10 64520 T Injection for nerve block 0207 5.97 $310.49 $123.69 $62.10 64530 T Injection for nerve block 0207 5.97 $310.49 $123.69 $62.10 64550 A Apply neurostimulator 64553 T Implant neuroelectrodes 0225 44.47 $2,312.84 $462.57 64555 T Implant neuroelectrodes 0225 44.47 $2,312.84 $462.57 64560 T Implant neuroelectrodes 0225 44.47 $2,312.84 $462.57 64561 T Implant neuroelectrodes 0225 44.47 $2,312.84 $462.57 64565 T Implant neuroelectrodes 0225 44.47 $2,312.84 $462.57 64573 T Implant neuroelectrodes 0225 44.47 $2,312.84 $462.57 64575 T Implant neuroelectrodes 0225 44.47 $2,312.84 $462.57 64577 T Implant neuroelectrodes 0225 44.47 $2,312.84 $462.57 64580 T Implant neuroelectrodes 0225 44.47 $2,312.84 $462.57 64581 T Implant neuroelectrodes 0225 44.47 $2,312.84 $462.57 64585 T Revise/remove neuroelectrode 0687 19.50 $1,014.18 $466.52 $202.84 64590 T Implant neuroreceiver 0222 140.56 $7,310.39 $1,462.08 Start Printed Page 52234 64595 T Revise/remove neuroreceiver 0688 30.58 $1,590.44 $779.32 $318.09 64600 T Injection treatment of nerve 0203 10.96 $570.02 $256.51 $114.00 64605 T Injection treatment of nerve 0203 10.96 $570.02 $256.51 $114.00 64610 T Injection treatment of nerve 0203 10.96 $570.02 $256.51 $114.00 64612 T Destroy nerve, face muscle 0204 2.13 $110.78 $42.10 $22.16 64613 T Destroy nerve, spine muscle 0204 2.13 $110.78 $42.10 $22.16 64614 T Destroy nerve, extrem musc 0204 2.13 $110.78 $42.10 $22.16 64620 T Injection treatment of nerve 0203 10.96 $570.02 $256.51 $114.00 64622 T Destr paravertebrl nerve l/s 0203 10.96 $570.02 $256.51 $114.00 64623 T Destr paravertebral n add-on 0203 10.96 $570.02 $256.51 $114.00 64626 T Destr paravertebrl nerve c/t 0203 10.96 $570.02 $256.51 $114.00 64627 T Destr paravertebral n add-on 0203 10.96 $570.02 $256.51 $114.00 64630 T Injection treatment of nerve 0207 5.97 $310.49 $123.69 $62.10 64640 T Injection treatment of nerve 0207 5.97 $310.49 $123.69 $62.10 64680 T Injection treatment of nerve 0203 10.96 $570.02 $256.51 $114.00 64702 T Revise finger/toe nerve 0220 16.66 $866.47 $173.29 64704 T Revise hand/foot nerve 0220 16.66 $866.47 $173.29 64708 T Revise arm/leg nerve 0220 16.66 $866.47 $173.29 64712 T Revision of sciatic nerve 0220 16.66 $866.47 $173.29 64713 T Revision of arm nerve(s) 0220 16.66 $866.47 $173.29 64714 T Revise low back nerve(s) 0220 16.66 $866.47 $173.29 64716 T Revision of cranial nerve 0220 16.66 $866.47 $173.29 64718 T Revise ulnar nerve at elbow 0220 16.66 $866.47 $173.29 64719 T Revise ulnar nerve at wrist 0220 16.66 $866.47 $173.29 64721 T Carpal tunnel surgery 0220 16.66 $866.47 $173.29 64722 T Relieve pressure on nerve(s) 0220 16.66 $866.47 $173.29 64726 T Release foot/toe nerve 0220 16.66 $866.47 $173.29 64727 T Internal nerve revision 0220 16.66 $866.47 $173.29 64732 T Incision of brow nerve 0220 16.66 $866.47 $173.29 64734 T Incision of cheek nerve 0220 16.66 $866.47 $173.29 64736 T Incision of chin nerve 0220 16.66 $866.47 $173.29 64738 T Incision of jaw nerve 0220 16.66 $866.47 $173.29 64740 T Incision of tongue nerve 0220 16.66 $866.47 $173.29 64742 T Incision of facial nerve 0220 16.66 $866.47 $173.29 64744 T Incise nerve, back of head 0220 16.66 $866.47 $173.29 64746 T Incise diaphragm nerve 0220 16.66 $866.47 $173.29 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 16.66 $866.47 $173.29 64763 C Incise hip/thigh nerve 64766 C Incise hip/thigh nerve 64771 T Sever cranial nerve 0220 16.66 $866.47 $173.29 64772 T Incision of spinal nerve 0220 16.66 $866.47 $173.29 64774 T Remove skin nerve lesion 0220 16.66 $866.47 $173.29 64776 T Remove digit nerve lesion 0220 16.66 $866.47 $173.29 64778 T Digit nerve surgery add-on 0220 16.66 $866.47 $173.29 64782 T Remove limb nerve lesion 0220 16.66 $866.47 $173.29 64783 T Limb nerve surgery add-on 0220 16.66 $866.47 $173.29 64784 T Remove nerve lesion 0220 16.66 $866.47 $173.29 64786 T Remove sciatic nerve lesion 0221 25.35 $1,318.43 $463.62 $263.69 64787 T Implant nerve end 0220 16.66 $866.47 $173.29 64788 T Remove skin nerve lesion 0220 16.66 $866.47 $173.29 64790 T Removal of nerve lesion 0220 16.66 $866.47 $173.29 64792 T Removal of nerve lesion 0221 25.35 $1,318.43 $463.62 $263.69 64795 T Biopsy of nerve 0220 16.66 $866.47 $173.29 64802 T Remove sympathetic nerves 0220 16.66 $866.47 $173.29 64804 C Remove sympathetic nerves 64809 C Remove sympathetic nerves 64818 C Remove sympathetic nerves 64820 T Remove sympathetic nerves 0220 16.66 $866.47 $173.29 64821 T Remove sympathetic nerves 0054 23.50 $1,222.21 $472.33 $244.44 64822 T Remove sympathetic nerves 0054 23.50 $1,222.21 $472.33 $244.44 64823 T Remove sympathetic nerves 0054 23.50 $1,222.21 $472.33 $244.44 64831 T Repair of digit nerve 0221 25.35 $1,318.43 $463.62 $263.69 64832 T Repair nerve add-on 0221 25.35 $1,318.43 $463.62 $263.69 Start Printed Page 52235 64834 T Repair of hand or foot nerve 0221 25.35 $1,318.43 $463.62 $263.69 64835 T Repair of hand or foot nerve 0221 25.35 $1,318.43 $463.62 $263.69 64836 T Repair of hand or foot nerve 0221 25.35 $1,318.43 $463.62 $263.69 64837 T Repair nerve add-on 0221 25.35 $1,318.43 $463.62 $263.69 64840 T Repair of leg nerve 0221 25.35 $1,318.43 $463.62 $263.69 64856 T Repair/transpose nerve 0221 25.35 $1,318.43 $463.62 $263.69 64857 T Repair arm/leg nerve 0221 25.35 $1,318.43 $463.62 $263.69 64858 T Repair sciatic nerve 0221 25.35 $1,318.43 $463.62 $263.69 64859 T Nerve surgery 0221 25.35 $1,318.43 $463.62 $263.69 64861 T Repair of arm nerves 0221 25.35 $1,318.43 $463.62 $263.69 64862 T Repair of low back nerves 0221 25.35 $1,318.43 $463.62 $263.69 64864 T Repair of facial nerve 0221 25.35 $1,318.43 $463.62 $263.69 64865 T Repair of facial nerve 0221 25.35 $1,318.43 $463.62 $263.69 64866 C Fusion of facial/other nerve 64868 C Fusion of facial/other nerve 64870 T Fusion of facial/other nerve 0221 25.35 $1,318.43 $463.62 $263.69 64872 T Subsequent repair of nerve 0221 25.35 $1,318.43 $463.62 $263.69 64874 T Repair & revise nerve add-on 0221 25.35 $1,318.43 $463.62 $263.69 64876 T Repair nerve/shorten bone 0221 25.35 $1,318.43 $463.62 $263.69 64885 T Nerve graft, head or neck 0221 25.35 $1,318.43 $463.62 $263.69 64886 T Nerve graft, head or neck 0221 25.35 $1,318.43 $463.62 $263.69 64890 T Nerve graft, hand or foot 0221 25.35 $1,318.43 $463.62 $263.69 64891 T Nerve graft, hand or foot 0221 25.35 $1,318.43 $463.62 $263.69 64892 T Nerve graft, arm or leg 0221 25.35 $1,318.43 $463.62 $263.69 64893 T Nerve graft, arm or leg 0221 25.35 $1,318.43 $463.62 $263.69 64895 T Nerve graft, hand or foot 0221 25.35 $1,318.43 $463.62 $263.69 64896 T Nerve graft, hand or foot 0221 25.35 $1,318.43 $463.62 $263.69 64897 T Nerve graft, arm or leg 0221 25.35 $1,318.43 $463.62 $263.69 64898 T Nerve graft, arm or leg 0221 25.35 $1,318.43 $463.62 $263.69 64901 T Nerve graft add-on 0221 25.35 $1,318.43 $463.62 $263.69 64902 T Nerve graft add-on 0221 25.35 $1,318.43 $463.62 $263.69 64905 T Nerve pedicle transfer 0221 25.35 $1,318.43 $463.62 $263.69 64907 T Nerve pedicle transfer 0221 25.35 $1,318.43 $463.62 $263.69 64999 T Nervous system surgery 0204 2.13 $110.78 $42.10 $22.16 65091 T Revise eye 0242 28.87 $1,501.50 $597.36 $300.30 65093 T Revise eye with implant 0241 21.89 $1,138.48 $384.47 $227.70 65101 T Removal of eye 0242 28.87 $1,501.50 $597.36 $300.30 65103 T Remove eye/insert implant 0242 28.87 $1,501.50 $597.36 $300.30 65105 T Remove eye/attach implant 0242 28.87 $1,501.50 $597.36 $300.30 65110 T Removal of eye 0242 28.87 $1,501.50 $597.36 $300.30 65112 T Remove eye/revise socket 0242 28.87 $1,501.50 $597.36 $300.30 65114 T Remove eye/revise socket 0242 28.87 $1,501.50 $597.36 $300.30 65125 T Revise ocular implant 0240 16.99 $883.63 $315.31 $176.73 65130 T Insert ocular implant 0241 21.89 $1,138.48 $384.47 $227.70 65135 T Insert ocular implant 0241 21.89 $1,138.48 $384.47 $227.70 65140 T Attach ocular implant 0242 28.87 $1,501.50 $597.36 $300.30 65150 T Revise ocular implant 0241 21.89 $1,138.48 $384.47 $227.70 65155 T Reinsert ocular implant 0242 28.87 $1,501.50 $597.36 $300.30 65175 T Removal of ocular implant 0240 16.99 $883.63 $315.31 $176.73 65205 S Remove foreign body from eye 0698 1.01 $52.53 $20.49 $10.51 65210 S Remove foreign body from eye 0231 2.24 $116.50 $52.43 $23.30 65220 S Remove foreign body from eye 0231 2.24 $116.50 $52.43 $23.30 65222 S Remove foreign body from eye 0231 2.24 $116.50 $52.43 $23.30 65235 T Remove foreign body from eye 0233 13.43 $698.48 $266.33 $139.70 65260 T Remove foreign body from eye 0236 20.62 $1,072.43 $214.49 65265 T Remove foreign body from eye 0236 20.62 $1,072.43 $214.49 65270 T Repair of eye wound 0240 16.99 $883.63 $315.31 $176.73 65272 T Repair of eye wound 0233 13.43 $698.48 $266.33 $139.70 65273 C Repair of eye wound 65275 T Repair of eye wound 0233 13.43 $698.48 $266.33 $139.70 65280 T Repair of eye wound 0234 21.45 $1,115.59 $535.48 $223.12 65285 T Repair of eye wound 0234 21.45 $1,115.59 $535.48 $223.12 65286 T Repair of eye wound 0233 13.43 $698.48 $266.33 $139.70 65290 T Repair of eye socket wound 0243 20.94 $1,089.07 $431.39 $217.81 65400 T Removal of eye lesion 0233 13.43 $698.48 $266.33 $139.70 65410 T Biopsy of cornea 0233 13.43 $698.48 $266.33 $139.70 Start Printed Page 52236 65420 T Removal of eye lesion 0233 13.43 $698.48 $266.33 $139.70 65426 T Removal of eye lesion 0234 21.45 $1,115.59 $535.48 $223.12 65430 S Corneal smear 0230 0.78 $40.57 $15.82 $8.11 65435 T Curette/treat cornea 0239 6.91 $359.38 $115.94 $71.88 65436 T Curette/treat cornea 0233 13.43 $698.48 $266.33 $139.70 65450 S Treatment of corneal lesion 0231 2.24 $116.50 $52.43 $23.30 65600 T Revision of cornea 0240 16.99 $883.63 $315.31 $176.73 65710 T Corneal transplant 0244 38.14 $1,983.62 $851.42 $396.72 65730 T Corneal transplant 0244 38.14 $1,983.62 $851.42 $396.72 65750 T Corneal transplant 0244 38.14 $1,983.62 $851.42 $396.72 65755 T Corneal transplant 0244 38.14 $1,983.62 $851.42 $396.72 65760 E Revision of cornea 65765 E Revision of cornea 65767 E Corneal tissue transplant 65770 T Revise cornea with implant 0244 38.14 $1,983.62 $851.42 $396.72 65771 E Radial keratotomy 65772 T Correction of astigmatism 0233 13.43 $698.48 $266.33 $139.70 65775 T Correction of astigmatism 0233 13.43 $698.48 $266.33 $139.70 65800 T Drainage of eye 0233 13.43 $698.48 $266.33 $139.70 65805 T Drainage of eye 0233 13.43 $698.48 $266.33 $139.70 65810 T Drainage of eye 0234 21.45 $1,115.59 $535.48 $223.12 65815 T Drainage of eye 0234 21.45 $1,115.59 $535.48 $223.12 65820 T Relieve inner eye pressure 0232 4.91 $255.36 $112.36 $51.07 65850 T Incision of eye 0234 21.45 $1,115.59 $535.48 $223.12 65855 T Laser surgery of eye 0247 4.97 $258.48 $108.56 $51.70 65860 T Incise inner eye adhesions 0247 4.97 $258.48 $108.56 $51.70 65865 T Incise inner eye adhesions 0233 13.43 $698.48 $266.33 $139.70 65870 T Incise inner eye adhesions 0234 21.45 $1,115.59 $535.48 $223.12 65875 T Incise inner eye adhesions 0234 21.45 $1,115.59 $535.48 $223.12 65880 T Incise inner eye adhesions 0233 13.43 $698.48 $266.33 $139.70 65900 T Remove eye lesion 0233 13.43 $698.48 $266.33 $139.70 65920 T Remove implant of eye 0233 13.43 $698.48 $266.33 $139.70 65930 T Remove blood clot from eye 0234 21.45 $1,115.59 $535.48 $223.12 66020 T Injection treatment of eye 0233 13.43 $698.48 $266.33 $139.70 66030 T Injection treatment of eye 0233 13.43 $698.48 $266.33 $139.70 66130 T Remove eye lesion 0234 21.45 $1,115.59 $535.48 $223.12 66150 T Glaucoma surgery 0233 13.43 $698.48 $266.33 $139.70 66155 T Glaucoma surgery 0234 21.45 $1,115.59 $535.48 $223.12 66160 T Glaucoma surgery 0234 21.45 $1,115.59 $535.48 $223.12 66165 T Glaucoma surgery 0234 21.45 $1,115.59 $535.48 $223.12 66170 T Glaucoma surgery 0234 21.45 $1,115.59 $535.48 $223.12 66172 T Incision of eye 0673 27.47 $1,428.69 $685.77 $285.74 66180 T Implant eye shunt 0673 27.47 $1,428.69 $685.77 $285.74 66185 T Revise eye shunt 0673 27.47 $1,428.69 $685.77 $285.74 66220 T Repair eye lesion 0236 20.62 $1,072.43 $214.49 66225 T Repair/graft eye lesion 0673 27.47 $1,428.69 $685.77 $285.74 66250 T Follow-up surgery of eye 0233 13.43 $698.48 $266.33 $139.70 66500 T Incision of iris 0232 4.91 $255.36 $112.36 $51.07 66505 T Incision of iris 0232 4.91 $255.36 $112.36 $51.07 66600 T Remove iris and lesion 0233 13.43 $698.48 $266.33 $139.70 66605 T Removal of iris 0234 21.45 $1,115.59 $535.48 $223.12 66625 T Removal of iris 0233 13.43 $698.48 $266.33 $139.70 66630 T Removal of iris 0233 13.43 $698.48 $266.33 $139.70 66635 T Removal of iris 0234 21.45 $1,115.59 $535.48 $223.12 66680 T Repair iris & ciliary body 0234 21.45 $1,115.59 $535.48 $223.12 66682 T Repair iris & ciliary body 0234 21.45 $1,115.59 $535.48 $223.12 66700 T Destruction, ciliary body 0233 13.43 $698.48 $266.33 $139.70 66710 T Destruction, ciliary body 0233 13.43 $698.48 $266.33 $139.70 66720 T Destruction, ciliary body 0233 13.43 $698.48 $266.33 $139.70 66740 T Destruction, ciliary body 0233 13.43 $698.48 $266.33 $139.70 66761 T Revision of iris 0247 4.97 $258.48 $108.56 $51.70 66762 T Revision of iris 0247 4.97 $258.48 $108.56 $51.70 66770 T Removal of inner eye lesion 0247 4.97 $258.48 $108.56 $51.70 66820 T Incision, secondary cataract 0232 4.91 $255.36 $112.36 $51.07 66821 T After cataract laser surgery 0247 4.97 $258.48 $108.56 $51.70 66825 T Reposition intraocular lens 0234 21.45 $1,115.59 $535.48 $223.12 Start Printed Page 52237 66830 T Removal of lens lesion 0232 4.91 $255.36 $112.36 $51.07 66840 T Removal of lens material 0245 14.39 $748.41 $251.21 $149.68 66850 T Removal of lens material 0249 27.75 $1,443.25 $524.67 $288.65 66852 T Removal of lens material 0249 27.75 $1,443.25 $524.67 $288.65 66920 T Extraction of lens 0249 27.75 $1,443.25 $524.67 $288.65 66930 T Extraction of lens 0249 27.75 $1,443.25 $524.67 $288.65 66940 T Extraction of lens 0245 14.39 $748.41 $251.21 $149.68 66982 T Cataract surgery, complex 0246 23.59 $1,226.89 $495.96 $245.38 66983 T Cataract surg w/iol, 1 stage 0246 23.59 $1,226.89 $495.96 $245.38 66984 T Cataract surg w/iol, i stage 0246 23.59 $1,226.89 $495.96 $245.38 66985 T Insert lens prosthesis 0246 23.59 $1,226.89 $495.96 $245.38 66986 T Exchange lens prosthesis 0246 23.59 $1,226.89 $495.96 $245.38 66999 T Eye surgery procedure 0232 4.91 $255.36 $112.36 $51.07 67005 T Partial removal of eye fluid 0237 35.09 $1,825.00 $818.54 $365.00 67010 T Partial removal of eye fluid 0237 35.09 $1,825.00 $818.54 $365.00 67015 T Release of eye fluid 0237 35.09 $1,825.00 $818.54 $365.00 67025 T Replace eye fluid 0236 20.62 $1,072.43 $214.49 67027 T Implant eye drug system 0237 35.09 $1,825.00 $818.54 $365.00 67028 T Injection eye drug 0235 5.62 $292.29 $81.84 $58.46 67030 T Incise inner eye strands 0236 20.62 $1,072.43 $214.49 67031 T Laser surgery, eye strands 0247 4.97 $258.48 $108.56 $51.70 67036 T Removal of inner eye fluid 0237 35.09 $1,825.00 $818.54 $365.00 67038 T Strip retinal membrane 0237 35.09 $1,825.00 $818.54 $365.00 67039 T Laser treatment of retina 0237 35.09 $1,825.00 $818.54 $365.00 67040 T Laser treatment of retina 0672 39.95 $2,077.76 $1,038.88 $415.55 67101 T Repair detached retina 0235 5.62 $292.29 $81.84 $58.46 67105 T Repair detached retina 0248 4.44 $230.92 $96.99 $46.18 67107 T Repair detached retina 0672 39.95 $2,077.76 $1,038.88 $415.55 67108 T Repair detached retina 0672 39.95 $2,077.76 $1,038.88 $415.55 67110 T Repair detached retina 0235 5.62 $292.29 $81.84 $58.46 67112 T Rerepair detached retina 0672 39.95 $2,077.76 $1,038.88 $415.55 67115 T Release encircling material 0236 20.62 $1,072.43 $214.49 67120 T Remove eye implant material 0236 20.62 $1,072.43 $214.49 67121 T Remove eye implant material 0237 35.09 $1,825.00 $818.54 $365.00 67141 T Treatment of retina 0235 5.62 $292.29 $81.84 $58.46 67145 T Treatment of retina 0248 4.44 $230.92 $96.99 $46.18 67208 T Treatment of retinal lesion 0235 5.62 $292.29 $81.84 $58.46 67210 T Treatment of retinal lesion 0248 4.44 $230.92 $96.99 $46.18 67218 T Treatment of retinal lesion 0236 20.62 $1,072.43 $214.49 67220 T Treatment of choroid lesion 0235 5.62 $292.29 $81.84 $58.46 67221 T Ocular photodynamic ther 0235 5.62 $292.29 $81.84 $58.46 67225 T Eye photodynamic ther add-on 0235 5.62 $292.29 $81.84 $58.46 67227 T Treatment of retinal lesion 0235 5.62 $292.29 $81.84 $58.46 67228 T Treatment of retinal lesion 0248 4.44 $230.92 $96.99 $46.18 67250 T Reinforce eye wall 0240 16.99 $883.63 $315.31 $176.73 67255 T Reinforce/graft eye wall 0237 35.09 $1,825.00 $818.54 $365.00 67299 T Eye surgery procedure 0235 5.62 $292.29 $81.84 $58.46 67311 T Revise eye muscle 0243 20.94 $1,089.07 $431.39 $217.81 67312 T Revise two eye muscles 0243 20.94 $1,089.07 $431.39 $217.81 67314 T Revise eye muscle 0243 20.94 $1,089.07 $431.39 $217.81 67316 T Revise two eye muscles 0243 20.94 $1,089.07 $431.39 $217.81 67318 T Revise eye muscle(s) 0243 20.94 $1,089.07 $431.39 $217.81 67320 T Revise eye muscle(s) add-on 0243 20.94 $1,089.07 $431.39 $217.81 67331 T Eye surgery follow-up add-on 0243 20.94 $1,089.07 $431.39 $217.81 67332 T Rerevise eye muscles add-on 0243 20.94 $1,089.07 $431.39 $217.81 67334 T Revise eye muscle w/suture 0243 20.94 $1,089.07 $431.39 $217.81 67335 T Eye suture during surgery 0243 20.94 $1,089.07 $431.39 $217.81 67340 T Revise eye muscle add-on 0243 20.94 $1,089.07 $431.39 $217.81 67343 T Release eye tissue 0243 20.94 $1,089.07 $431.39 $217.81 67345 T Destroy nerve of eye muscle 0238 3.04 $158.11 $58.96 $31.62 67350 T Biopsy eye muscle 0699 2.37 $123.26 $55.47 $24.65 67399 T Eye muscle surgery procedure 0243 20.94 $1,089.07 $431.39 $217.81 67400 T Explore/biopsy eye socket 0241 21.89 $1,138.48 $384.47 $227.70 67405 T Explore/drain eye socket 0241 21.89 $1,138.48 $384.47 $227.70 67412 T Explore/treat eye socket 0241 21.89 $1,138.48 $384.47 $227.70 67413 T Explore/treat eye socket 0241 21.89 $1,138.48 $384.47 $227.70 Start Printed Page 52238 67414 T Explr/decompress eye socket 0242 28.87 $1,501.50 $597.36 $300.30 67415 T Aspiration, orbital contents 0239 6.91 $359.38 $115.94 $71.88 67420 T Explore/treat eye socket 0242 28.87 $1,501.50 $597.36 $300.30 67430 T Explore/treat eye socket 0242 28.87 $1,501.50 $597.36 $300.30 67440 T Explore/drain eye socket 0242 28.87 $1,501.50 $597.36 $300.30 67445 T Explr/decompress eye socket 0242 28.87 $1,501.50 $597.36 $300.30 67450 T Explore/biopsy eye socket 0242 28.87 $1,501.50 $597.36 $300.30 67500 S Inject/treat eye socket 0231 2.24 $116.50 $52.43 $23.30 67505 T Inject/treat eye socket 0238 3.04 $158.11 $58.96 $31.62 67515 T Inject/treat eye socket 0239 6.91 $359.38 $115.94 $71.88 67550 T Insert eye socket implant 0242 28.87 $1,501.50 $597.36 $300.30 67560 T Revise eye socket implant 0241 21.89 $1,138.48 $384.47 $227.70 67570 T Decompress optic nerve 0242 28.87 $1,501.50 $597.36 $300.30 67599 T Orbit surgery procedure 0239 6.91 $359.38 $115.94 $71.88 67700 T Drainage of eyelid abscess 0238 3.04 $158.11 $58.96 $31.62 67710 T Incision of eyelid 0239 6.91 $359.38 $115.94 $71.88 67715 T Incision of eyelid fold 0240 16.99 $883.63 $315.31 $176.73 67800 T Remove eyelid lesion 0238 3.04 $158.11 $58.96 $31.62 67801 T Remove eyelid lesions 0239 6.91 $359.38 $115.94 $71.88 67805 T Remove eyelid lesions 0238 3.04 $158.11 $58.96 $31.62 67808 T Remove eyelid lesion(s) 0240 16.99 $883.63 $315.31 $176.73 67810 T Biopsy of eyelid 0238 3.04 $158.11 $58.96 $31.62 67820 S Revise eyelashes 0230 0.78 $40.57 $15.82 $8.11 67825 T Revise eyelashes 0238 3.04 $158.11 $58.96 $31.62 67830 T Revise eyelashes 0239 6.91 $359.38 $115.94 $71.88 67835 T Revise eyelashes 0240 16.99 $883.63 $315.31 $176.73 67840 T Remove eyelid lesion 0239 6.91 $359.38 $115.94 $71.88 67850 T Treat eyelid lesion 0239 6.91 $359.38 $115.94 $71.88 67875 T Closure of eyelid by suture 0239 6.91 $359.38 $115.94 $71.88 67880 T Revision of eyelid 0233 13.43 $698.48 $266.33 $139.70 67882 T Revision of eyelid 0240 16.99 $883.63 $315.31 $176.73 67900 T Repair brow defect 0240 16.99 $883.63 $315.31 $176.73 67901 T Repair eyelid defect 0240 16.99 $883.63 $315.31 $176.73 67902 T Repair eyelid defect 0240 16.99 $883.63 $315.31 $176.73 67903 T Repair eyelid defect 0240 16.99 $883.63 $315.31 $176.73 67904 T Repair eyelid defect 0240 16.99 $883.63 $315.31 $176.73 67906 T Repair eyelid defect 0240 16.99 $883.63 $315.31 $176.73 67908 T Repair eyelid defect 0240 16.99 $883.63 $315.31 $176.73 67909 T Revise eyelid defect 0240 16.99 $883.63 $315.31 $176.73 67911 T Revise eyelid defect 0240 16.99 $883.63 $315.31 $176.73 67914 T Repair eyelid defect 0240 16.99 $883.63 $315.31 $176.73 67915 T Repair eyelid defect 0239 6.91 $359.38 $115.94 $71.88 67916 T Repair eyelid defect 0240 16.99 $883.63 $315.31 $176.73 67917 T Repair eyelid defect 0240 16.99 $883.63 $315.31 $176.73 67921 T Repair eyelid defect 0240 16.99 $883.63 $315.31 $176.73 67922 T Repair eyelid defect 0239 6.91 $359.38 $115.94 $71.88 67923 T Repair eyelid defect 0240 16.99 $883.63 $315.31 $176.73 67924 T Repair eyelid defect 0240 16.99 $883.63 $315.31 $176.73 67930 T Repair eyelid wound 0240 16.99 $883.63 $315.31 $176.73 67935 T Repair eyelid wound 0240 16.99 $883.63 $315.31 $176.73 67938 S Remove eyelid foreign body 0698 1.01 $52.53 $20.49 $10.51 67950 T Revision of eyelid 0240 16.99 $883.63 $315.31 $176.73 67961 T Revision of eyelid 0240 16.99 $883.63 $315.31 $176.73 67966 T Revision of eyelid 0240 16.99 $883.63 $315.31 $176.73 67971 T Reconstruction of eyelid 0241 21.89 $1,138.48 $384.47 $227.70 67973 T Reconstruction of eyelid 0241 21.89 $1,138.48 $384.47 $227.70 67974 T Reconstruction of eyelid 0241 21.89 $1,138.48 $384.47 $227.70 67975 T Reconstruction of eyelid 0240 16.99 $883.63 $315.31 $176.73 67999 T Revision of eyelid 0240 16.99 $883.63 $315.31 $176.73 68020 T Incise/drain eyelid lining 0240 16.99 $883.63 $315.31 $176.73 68040 S Treatment of eyelid lesions 0698 1.01 $52.53 $20.49 $10.51 68100 T Biopsy of eyelid lining 0232 4.91 $255.36 $112.36 $51.07 68110 T Remove eyelid lining lesion 0699 2.37 $123.26 $55.47 $24.65 68115 T Remove eyelid lining lesion 0239 6.91 $359.38 $115.94 $71.88 68130 T Remove eyelid lining lesion 0233 13.43 $698.48 $266.33 $139.70 68135 T Remove eyelid lining lesion 0239 6.91 $359.38 $115.94 $71.88 Start Printed Page 52239 68200 S Treat eyelid by injection 0698 1.01 $52.53 $20.49 $10.51 68320 T Revise/graft eyelid lining 0240 16.99 $883.63 $315.31 $176.73 68325 T Revise/graft eyelid lining 0242 28.87 $1,501.50 $597.36 $300.30 68326 T Revise/graft eyelid lining 0241 21.89 $1,138.48 $384.47 $227.70 68328 T Revise/graft eyelid lining 0241 21.89 $1,138.48 $384.47 $227.70 68330 T Revise eyelid lining 0233 13.43 $698.48 $266.33 $139.70 68335 T Revise/graft eyelid lining 0241 21.89 $1,138.48 $384.47 $227.70 68340 T Separate eyelid adhesions 0240 16.99 $883.63 $315.31 $176.73 68360 T Revise eyelid lining 0234 21.45 $1,115.59 $535.48 $223.12 68362 T Revise eyelid lining 0234 21.45 $1,115.59 $535.48 $223.12 68399 T Eyelid lining surgery 0239 6.91 $359.38 $115.94 $71.88 68400 T Incise/drain tear gland 0238 3.04 $158.11 $58.96 $31.62 68420 T Incise/drain tear sac 0240 16.99 $883.63 $315.31 $176.73 68440 T Incise tear duct opening 0238 3.04 $158.11 $58.96 $31.62 68500 T Removal of tear gland 0241 21.89 $1,138.48 $384.47 $227.70 68505 T Partial removal, tear gland 0241 21.89 $1,138.48 $384.47 $227.70 68510 T Biopsy of tear gland 0240 16.99 $883.63 $315.31 $176.73 68520 T Removal of tear sac 0241 21.89 $1,138.48 $384.47 $227.70 68525 T Biopsy of tear sac 0240 16.99 $883.63 $315.31 $176.73 68530 T Clearance of tear duct 0240 16.99 $883.63 $315.31 $176.73 68540 T Remove tear gland lesion 0241 21.89 $1,138.48 $384.47 $227.70 68550 T Remove tear gland lesion 0242 28.87 $1,501.50 $597.36 $300.30 68700 T Repair tear ducts 0241 21.89 $1,138.48 $384.47 $227.70 68705 T Revise tear duct opening 0238 3.04 $158.11 $58.96 $31.62 68720 T Create tear sac drain 0242 28.87 $1,501.50 $597.36 $300.30 68745 T Create tear duct drain 0241 21.89 $1,138.48 $384.47 $227.70 68750 T Create tear duct drain 0242 28.87 $1,501.50 $597.36 $300.30 68760 S Close tear duct opening 0698 1.01 $52.53 $20.49 $10.51 68761 S Close tear duct opening 0231 2.24 $116.50 $52.43 $23.30 68770 T Close tear system fistula 0240 16.99 $883.63 $315.31 $176.73 68801 S Dilate tear duct opening 0231 2.24 $116.50 $52.43 $23.30 68810 T Probe nasolacrimal duct 0699 2.37 $123.26 $55.47 $24.65 68811 T Probe nasolacrimal duct 0240 16.99 $883.63 $315.31 $176.73 68815 T Probe nasolacrimal duct 0240 16.99 $883.63 $315.31 $176.73 68840 T Explore/irrigate tear ducts 0699 2.37 $123.26 $55.47 $24.65 68850 N Injection for tear sac x-ray 68899 T Tear duct system surgery 0699 2.37 $123.26 $55.47 $24.65 69000 T Drain external ear lesion 0006 1.89 $98.30 $25.56 $19.66 69005 T Drain external ear lesion 0007 9.44 $490.96 $103.10 $98.19 69020 T Drain outer ear canal lesion 0006 1.89 $98.30 $25.56 $19.66 69090 E Pierce earlobes 69100 T Biopsy of external ear 0019 3.94 $204.92 $75.82 $40.98 69105 T Biopsy of external ear canal 0253 14.79 $769.21 $284.61 $153.84 69110 T Remove external ear, partial 0021 14.58 $758.29 $227.49 $151.66 69120 T Removal of external ear 0254 21.89 $1,138.48 $352.93 $227.70 69140 T Remove ear canal lesion(s) 0254 21.89 $1,138.48 $352.93 $227.70 69145 T Remove ear canal lesion(s) 0021 14.58 $758.29 $227.49 $151.66 69150 T Extensive ear canal surgery 0252 6.27 $326.10 $114.24 $65.22 69155 C Extensive ear/neck surgery 69200 X Clear outer ear canal 0340 0.66 $34.33 $6.87 69205 T Clear outer ear canal 0022 18.10 $941.36 $367.13 $188.27 69210 X Remove impacted ear wax 0340 0.66 $34.33 $6.87 69220 T Clean out mastoid cavity 0012 0.76 $39.53 $10.67 $7.91 69222 T Clean out mastoid cavity 0253 14.79 $769.21 $284.61 $153.84 69300 T Revise external ear 0254 21.89 $1,138.48 $352.93 $227.70 69310 T Rebuild outer ear canal 0256 35.51 $1,846.84 $369.37 69320 T Rebuild outer ear canal 0256 35.51 $1,846.84 $369.37 69399 T Outer ear surgery procedure 0251 1.92 $99.86 $19.97 69400 T Inflate middle ear canal 0251 1.92 $99.86 $19.97 69401 T Inflate middle ear canal 0251 1.92 $99.86 $19.97 69405 T Catheterize middle ear canal 0252 6.27 $326.10 $114.24 $65.22 69410 T Inset middle ear (baffle) 0252 6.27 $326.10 $114.24 $65.22 69420 T Incision of eardrum 0251 1.92 $99.86 $19.97 69421 T Incision of eardrum 0253 14.79 $769.21 $284.61 $153.84 69424 T Remove ventilating tube 0252 6.27 $326.10 $114.24 $65.22 69433 T Create eardrum opening 0252 6.27 $326.10 $114.24 $65.22 Start Printed Page 52240 69436 T Create eardrum opening 0253 14.79 $769.21 $284.61 $153.84 69440 T Exploration of middle ear 0254 21.89 $1,138.48 $352.93 $227.70 69450 T Eardrum revision 0256 35.51 $1,846.84 $369.37 69501 T Mastoidectomy 0256 35.51 $1,846.84 $369.37 69502 T Mastoidectomy 0254 21.89 $1,138.48 $352.93 $227.70 69505 T Remove mastoid structures 0256 35.51 $1,846.84 $369.37 69511 T Extensive mastoid surgery 0256 35.51 $1,846.84 $369.37 69530 T Extensive mastoid surgery 0256 35.51 $1,846.84 $369.37 69535 C Remove part of temporal bone 69540 T Remove ear lesion 0253 14.79 $769.21 $284.61 $153.84 69550 T Remove ear lesion 0256 35.51 $1,846.84 $369.37 69552 T Remove ear lesion 0256 35.51 $1,846.84 $369.37 69554 C Remove ear lesion 69601 T Mastoid surgery revision 0256 35.51 $1,846.84 $369.37 69602 T Mastoid surgery revision 0256 35.51 $1,846.84 $369.37 69603 T Mastoid surgery revision 0256 35.51 $1,846.84 $369.37 69604 T Mastoid surgery revision 0256 35.51 $1,846.84 $369.37 69605 T Mastoid surgery revision 0256 35.51 $1,846.84 $369.37 69610 T Repair of eardrum 0254 21.89 $1,138.48 $352.93 $227.70 69620 T Repair of eardrum 0254 21.89 $1,138.48 $352.93 $227.70 69631 T Repair eardrum structures 0256 35.51 $1,846.84 $369.37 69632 T Rebuild eardrum structures 0256 35.51 $1,846.84 $369.37 69633 T Rebuild eardrum structures 0256 35.51 $1,846.84 $369.37 69635 T Repair eardrum structures 0256 35.51 $1,846.84 $369.37 69636 T Rebuild eardrum structures 0256 35.51 $1,846.84 $369.37 69637 T Rebuild eardrum structures 0256 35.51 $1,846.84 $369.37 69641 T Revise middle ear & mastoid 0256 35.51 $1,846.84 $369.37 69642 T Revise middle ear & mastoid 0256 35.51 $1,846.84 $369.37 69643 T Revise middle ear & mastoid 0256 35.51 $1,846.84 $369.37 69644 T Revise middle ear & mastoid 0256 35.51 $1,846.84 $369.37 69645 T Revise middle ear & mastoid 0256 35.51 $1,846.84 $369.37 69646 T Revise middle ear & mastoid 0256 35.51 $1,846.84 $369.37 69650 T Release middle ear bone 0254 21.89 $1,138.48 $352.93 $227.70 69660 T Revise middle ear bone 0256 35.51 $1,846.84 $369.37 69661 T Revise middle ear bone 0256 35.51 $1,846.84 $369.37 69662 T Revise middle ear bone 0256 35.51 $1,846.84 $369.37 69666 T Repair middle ear structures 0256 35.51 $1,846.84 $369.37 69667 T Repair middle ear structures 0256 35.51 $1,846.84 $369.37 69670 T Remove mastoid air cells 0256 35.51 $1,846.84 $369.37 69676 T Remove middle ear nerve 0256 35.51 $1,846.84 $369.37 69700 T Close mastoid fistula 0256 35.51 $1,846.84 $369.37 69710 E Implant/replace hearing aid 69711 T Remove/repair hearing aid 0256 35.51 $1,846.84 $369.37 69714 T Implant temple bone w/stimul 0256 35.51 $1,846.84 $369.37 69715 T Temple bne implnt w/stimulat 0256 35.51 $1,846.84 $369.37 69717 T Temple bone implant revision 0256 35.51 $1,846.84 $369.37 69718 T Revise temple bone implant 0256 35.51 $1,846.84 $369.37 69720 T Release facial nerve 0256 35.51 $1,846.84 $369.37 69725 T Release facial nerve 0256 35.51 $1,846.84 $369.37 69740 T Repair facial nerve 0256 35.51 $1,846.84 $369.37 69745 T Repair facial nerve 0256 35.51 $1,846.84 $369.37 69799 T Middle ear surgery procedure 0253 14.79 $769.21 $284.61 $153.84 69801 T Incise inner ear 0256 35.51 $1,846.84 $369.37 69802 T Incise inner ear 0256 35.51 $1,846.84 $369.37 69805 T Explore inner ear 0256 35.51 $1,846.84 $369.37 69806 T Explore inner ear 0256 35.51 $1,846.84 $369.37 69820 T Establish inner ear window 0256 35.51 $1,846.84 $369.37 69840 T Revise inner ear window 0256 35.51 $1,846.84 $369.37 69905 T Remove inner ear 0256 35.51 $1,846.84 $369.37 69910 T Remove inner ear & mastoid 0256 35.51 $1,846.84 $369.37 69915 T Incise inner ear nerve 0256 35.51 $1,846.84 $369.37 69930 T Implant cochlear device 0259 291.05 $15,137.22 $7,417.24 $3,027.44 69949 T Inner ear surgery procedure 0253 14.79 $769.21 $284.61 $153.84 69950 C Incise inner ear nerve 69955 T Release facial nerve 0256 35.51 $1,846.84 $369.37 69960 T Release inner ear canal 0256 35.51 $1,846.84 $369.37 Start Printed Page 52241 69970 C Remove inner ear lesion 69979 T Temporal bone surgery 0251 1.92 $99.86 $19.97 69990 N Microsurgery add-on 70010 S Contrast x-ray of brain 0274 3.21 $166.95 $80.14 $33.39 70015 S Contrast x-ray of brain 0274 3.21 $166.95 $80.14 $33.39 70030 X X-ray eye for foreign body 0260 0.81 $42.13 $23.17 $8.43 70100 X X-ray exam of jaw 0260 0.81 $42.13 $23.17 $8.43 70110 X X-ray exam of jaw 0260 0.81 $42.13 $23.17 $8.43 70120 X X-ray exam of mastoids 0260 0.81 $42.13 $23.17 $8.43 70130 X X-ray exam of mastoids 0260 0.81 $42.13 $23.17 $8.43 70134 X X-ray exam of middle ear 0261 1.37 $71.25 $34.15 $14.25 70140 X X-ray exam of facial bones 0260 0.81 $42.13 $23.17 $8.43 70150 X X-ray exam of facial bones 0260 0.81 $42.13 $23.17 $8.43 70160 X X-ray exam of nasal bones 0260 0.81 $42.13 $23.17 $8.43 70170 X X-ray exam of tear duct 0263 1.99 $103.50 $45.54 $20.70 70190 X X-ray exam of eye sockets 0260 0.81 $42.13 $23.17 $8.43 70200 X X-ray exam of eye sockets 0260 0.81 $42.13 $23.17 $8.43 70210 X X-ray exam of sinuses 0260 0.81 $42.13 $23.17 $8.43 70220 X X-ray exam of sinuses 0260 0.81 $42.13 $23.17 $8.43 70240 X X-ray exam, pituitary saddle 0260 0.81 $42.13 $23.17 $8.43 70250 X X-ray exam of skull 0260 0.81 $42.13 $23.17 $8.43 70260 X X-ray exam of skull 0261 1.37 $71.25 $34.15 $14.25 70300 X X-ray exam of teeth 0262 0.60 $31.21 $10.30 $6.24 70310 X X-ray exam of teeth 0262 0.60 $31.21 $10.30 $6.24 70320 X Full mouth x-ray of teeth 0262 0.60 $31.21 $10.30 $6.24 70328 X X-ray exam of jaw joint 0260 0.81 $42.13 $23.17 $8.43 70330 X X-ray exam of jaw joints 0260 0.81 $42.13 $23.17 $8.43 70332 S X-ray exam of jaw joint 0275 3.09 $160.71 $69.09 $32.14 70336 S Magnetic image, jaw joint 0335 6.46 $335.98 $151.46 $67.20 70350 X X-ray head for orthodontia 0260 0.81 $42.13 $23.17 $8.43 70355 X Panoramic x-ray of jaws 0260 0.81 $42.13 $23.17 $8.43 70360 X X-ray exam of neck 0260 0.81 $42.13 $23.17 $8.43 70370 X Throat x-ray & fluoroscopy 0272 1.38 $71.77 $38.64 $14.35 70371 X Speech evaluation, complex 0272 1.38 $71.77 $38.64 $14.35 70373 X Contrast x-ray of larynx 0263 1.99 $103.50 $45.54 $20.70 70380 X X-ray exam of salivary gland 0260 0.81 $42.13 $23.17 $8.43 70390 X X-ray exam of salivary duct 0264 2.75 $143.02 $77.23 $28.60 70450 S Ct head/brain w/o dye 0332 3.62 $188.27 $91.27 $37.65 70460 S Ct head/brain w/dye 0283 4.75 $247.04 $49.41 70470 S Ct head/brain w/o&w dye 0333 5.69 $295.93 $146.98 $59.19 70480 S Ct orbit/ear/fossa w/o dye 0332 3.62 $188.27 $91.27 $37.65 70481 S Ct orbit/ear/fossa w/dye 0283 4.75 $247.04 $49.41 70482 S Ct orbit/ear/fossa w/o&w dye 0333 5.69 $295.93 $146.98 $59.19 70486 S Ct maxillofacial w/o dye 0332 3.62 $188.27 $91.27 $37.65 70487 S Ct maxillofacial w/dye 0283 4.75 $247.04 $49.41 70488 S Ct maxillofacial w/o&w dye 0333 5.69 $295.93 $146.98 $59.19 70490 S Ct soft tissue neck w/o dye 0332 3.62 $188.27 $91.27 $37.65 70491 S Ct soft tissue neck w/dye 0283 4.75 $247.04 $49.41 70492 S Ct sft tsue nck w/o & w/dye 0333 5.69 $295.93 $146.98 $59.19 70496 S Ct angiography, head 0662 5.96 $309.97 $170.48 $61.99 70498 S Ct angiography, neck 0662 5.96 $309.97 $170.48 $61.99 70540 S Mri orbit/face/neck w/o dye 0336 7.01 $364.58 $176.94 $72.92 70542 S Mri orbit/face/neck w/dye 0284 7.74 $402.55 $201.02 $80.51 70543 S Mri orbt/fac/nck w/o&w dye 0337 9.86 $512.81 $240.77 $102.56 70544 S Mr angiography head w/o dye 0336 7.01 $364.58 $176.94 $72.92 70545 S Mr angiography head w/dye 0284 7.74 $402.55 $201.02 $80.51 70546 S Mr angiograph head w/o&w dye 0337 9.86 $512.81 $240.77 $102.56 70547 S Mr angiography neck w/o dye 0336 7.01 $364.58 $176.94 $72.92 70548 S Mr angiography neck w/dye 0284 7.74 $402.55 $201.02 $80.51 70549 S Mr angiograph neck w/o&w dye 0337 9.86 $512.81 $240.77 $102.56 70551 S Mri brain w/o dye 0336 7.01 $364.58 $176.94 $72.92 70552 S Mri brain w/dye 0284 7.74 $402.55 $201.02 $80.51 70553 S Mri brain w/o&w dye 0337 9.86 $512.81 $240.77 $102.56 71010 X Chest x-ray 0260 0.81 $42.13 $23.17 $8.43 71015 X Chest x-ray 0260 0.81 $42.13 $23.17 $8.43 71020 X Chest x-ray 0260 0.81 $42.13 $23.17 $8.43 Start Printed Page 52242 71021 X Chest x-ray 0260 0.81 $42.13 $23.17 $8.43 71022 X Chest x-ray 0260 0.81 $42.13 $23.17 $8.43 71023 X Chest x-ray and fluoroscopy 0272 1.38 $71.77 $38.64 $14.35 71030 X Chest x-ray 0260 0.81 $42.13 $23.17 $8.43 71034 X Chest x-ray and fluoroscopy 0272 1.38 $71.77 $38.64 $14.35 71035 X Chest x-ray 0260 0.81 $42.13 $23.17 $8.43 71040 X Contrast x-ray of bronchi 0263 1.99 $103.50 $45.54 $20.70 71060 X Contrast x-ray of bronchi 0264 2.75 $143.02 $77.23 $28.60 71090 X X-ray & pacemaker insertion 0272 1.38 $71.77 $38.64 $14.35 71100 X X-ray exam of ribs 0260 0.81 $42.13 $23.17 $8.43 71101 X X-ray exam of ribs/chest 0260 0.81 $42.13 $23.17 $8.43 71110 X X-ray exam of ribs 0260 0.81 $42.13 $23.17 $8.43 71111 X X-ray exam of ribs/ chest 0261 1.37 $71.25 $34.15 $14.25 71120 X X-ray exam of breastbone 0260 0.81 $42.13 $23.17 $8.43 71130 X X-ray exam of breastbone 0260 0.81 $42.13 $23.17 $8.43 71250 S Ct thorax w/o dye 0332 3.62 $188.27 $91.27 $37.65 71260 S Ct thorax w/dye 0283 4.75 $247.04 $49.41 71270 S Ct thorax w/o&w dye 0333 5.69 $295.93 $146.98 $59.19 71275 S Ct angiography, chest 0662 5.96 $309.97 $170.48 $61.99 71550 S Mri chest w/o dye 0336 7.01 $364.58 $176.94 $72.92 71551 S Mri chest w/dye 0284 7.74 $402.55 $201.02 $80.51 71552 S Mri chest w/o&w dye 0337 9.86 $512.81 $240.77 $102.56 71555 E Mri angio chest w or w/o dye 72010 X X-ray exam of spine 0261 1.37 $71.25 $34.15 $14.25 72020 X X-ray exam of spine 0260 0.81 $42.13 $23.17 $8.43 72040 X X-ray exam of neck spine 0260 0.81 $42.13 $23.17 $8.43 72050 X X-ray exam of neck spine 0261 1.37 $71.25 $34.15 $14.25 72052 X X-ray exam of neck spine 0261 1.37 $71.25 $34.15 $14.25 72069 X X-ray exam of trunk spine 0260 0.81 $42.13 $23.17 $8.43 72070 X X-ray exam of thoracic spine 0260 0.81 $42.13 $23.17 $8.43 72072 X X-ray exam of thoracic spine 0260 0.81 $42.13 $23.17 $8.43 72074 X X-ray exam of thoracic spine 0260 0.81 $42.13 $23.17 $8.43 72080 X X-ray exam of trunk spine 0260 0.81 $42.13 $23.17 $8.43 72090 X X-ray exam of trunk spine 0261 1.37 $71.25 $34.15 $14.25 72100 X X-ray exam of lower spine 0260 0.81 $42.13 $23.17 $8.43 72110 X X-ray exam of lower spine 0261 1.37 $71.25 $34.15 $14.25 72114 X X-ray exam of lower spine 0261 1.37 $71.25 $34.15 $14.25 72120 X X-ray exam of lower spine 0260 0.81 $42.13 $23.17 $8.43 72125 S Ct neck spine w/o dye 0332 3.62 $188.27 $91.27 $37.65 72126 S Ct neck spine w/dye 0283 4.75 $247.04 $49.41 72127 S Ct neck spine w/o&w dye 0333 5.69 $295.93 $146.98 $59.19 72128 S Ct chest spine w/o dye 0332 3.62 $188.27 $91.27 $37.65 72129 S Ct chest spine w/dye 0283 4.75 $247.04 $49.41 72130 S Ct chest spine w/o&w dye 0333 5.69 $295.93 $146.98 $59.19 72131 S Ct lumbar spine w/o dye 0332 3.62 $188.27 $91.27 $37.65 72132 S Ct lumbar spine w/dye 0283 4.75 $247.04 $49.41 72133 S Ct lumbar spine w/o&w dye 0333 5.69 $295.93 $146.98 $59.19 72141 S Mri neck spine w/o dye 0336 7.01 $364.58 $176.94 $72.92 72142 S Mri neck spine w/dye 0284 7.74 $402.55 $201.02 $80.51 72146 S Mri chest spine w/o dye 0336 7.01 $364.58 $176.94 $72.92 72147 S Mri chest spine w/dye 0284 7.74 $402.55 $201.02 $80.51 72148 S Mri lumbar spine w/o dye 0336 7.01 $364.58 $176.94 $72.92 72149 S Mri lumbar spine w/dye 0284 7.74 $402.55 $201.02 $80.51 72156 S Mri neck spine w/o&w dye 0337 9.86 $512.81 $240.77 $102.56 72157 S Mri chest spine w/o&w dye 0337 9.86 $512.81 $240.77 $102.56 72158 S Mri lumbar spine w/o&w dye 0337 9.86 $512.81 $240.77 $102.56 72159 E Mr angio spine w/o&w dye 72170 X X-ray exam of pelvis 0260 0.81 $42.13 $23.17 $8.43 72190 X X-ray exam of pelvis 0260 0.81 $42.13 $23.17 $8.43 72191 S Ct angiograph pelv w/o&w dye 0662 5.96 $309.97 $170.48 $61.99 72192 S Ct pelvis w/o dye 0332 3.62 $188.27 $91.27 $37.65 72193 S Ct pelvis w/dye 0283 4.75 $247.04 $49.41 72194 S Ct pelvis w/o&w dye 0333 5.69 $295.93 $146.98 $59.19 72195 S Mri pelvis w/o dye 0336 7.01 $364.58 $176.94 $72.92 72196 S Mri pelvis w/dye 0284 7.74 $402.55 $201.02 $80.51 72197 S Mri pelvis w/o & w dye 0337 9.86 $512.81 $240.77 $102.56 Start Printed Page 52243 72198 E Mr angio pelvis w/o&w dye 72200 X X-ray exam sacroiliac joints 0260 0.81 $42.13 $23.17 $8.43 72202 X X-ray exam sacroiliac joints 0260 0.81 $42.13 $23.17 $8.43 72220 X X-ray exam of tailbone 0260 0.81 $42.13 $23.17 $8.43 72240 S Contrast x-ray of neck spine 0274 3.21 $166.95 $80.14 $33.39 72255 S Contrast x-ray, thorax spine 0274 3.21 $166.95 $80.14 $33.39 72265 S Contrast x-ray, lower spine 0274 3.21 $166.95 $80.14 $33.39 72270 S Contrast x-ray of spine 0274 3.21 $166.95 $80.14 $33.39 72275 S Epidurography 0274 3.21 $166.95 $80.14 $33.39 72285 S X-ray c/t spine disk 0274 3.21 $166.95 $80.14 $33.39 72295 S X-ray of lower spine disk 0274 3.21 $166.95 $80.14 $33.39 73000 X X-ray exam of collar bone 0260 0.81 $42.13 $23.17 $8.43 73010 X X-ray exam of shoulder blade 0260 0.81 $42.13 $23.17 $8.43 73020 X X-ray exam of shoulder 0260 0.81 $42.13 $23.17 $8.43 73030 X X-ray exam of shoulder 0260 0.81 $42.13 $23.17 $8.43 73040 S Contrast x-ray of shoulder 0275 3.09 $160.71 $69.09 $32.14 73050 X X-ray exam of shoulders 0260 0.81 $42.13 $23.17 $8.43 73060 X X-ray exam of humerus 0260 0.81 $42.13 $23.17 $8.43 73070 X X-ray exam of elbow 0260 0.81 $42.13 $23.17 $8.43 73080 X X-ray exam of elbow 0260 0.81 $42.13 $23.17 $8.43 73085 S Contrast x-ray of elbow 0275 3.09 $160.71 $69.09 $32.14 73090 X X-ray exam of forearm 0260 0.81 $42.13 $23.17 $8.43 73092 X X-ray exam of arm, infant 0260 0.81 $42.13 $23.17 $8.43 73100 X X-ray exam of wrist 0260 0.81 $42.13 $23.17 $8.43 73110 X X-ray exam of wrist 0260 0.81 $42.13 $23.17 $8.43 73115 S Contrast x-ray of wrist 0275 3.09 $160.71 $69.09 $32.14 73120 X X-ray exam of hand 0260 0.81 $42.13 $23.17 $8.43 73130 X X-ray exam of hand 0260 0.81 $42.13 $23.17 $8.43 73140 X X-ray exam of finger(s) 0260 0.81 $42.13 $23.17 $8.43 73200 S Ct upper extremity w/o dye 0332 3.62 $188.27 $91.27 $37.65 73201 S Ct upper extremity w/dye 0283 4.75 $247.04 $49.41 73202 S Ct uppr extremity w/o&w dye 0333 5.69 $295.93 $146.98 $59.19 73206 S Ct angio upr extrm w/o&w dye 0662 5.96 $309.97 $170.48 $61.99 73218 S Mri upper extremity w/o dye 0336 7.01 $364.58 $176.94 $72.92 73219 S Mri upper extremity w/dye 0284 7.74 $402.55 $201.02 $80.51 73220 S Mri uppr extremity w/o&w dye 0337 9.86 $512.81 $240.77 $102.56 73221 S Mri joint upr extrem w/o dye 0336 7.01 $364.58 $176.94 $72.92 73222 S Mri joint upr extrem w/ dye 0284 7.74 $402.55 $201.02 $80.51 73223 S Mri joint upr extr w/o&w dye 0337 9.86 $512.81 $240.77 $102.56 73225 E Mr angio upr extr w/o&w dye 73500 X X-ray exam of hip 0260 0.81 $42.13 $23.17 $8.43 73510 X X-ray exam of hip 0260 0.81 $42.13 $23.17 $8.43 73520 X X-ray exam of hips 0260 0.81 $42.13 $23.17 $8.43 73525 S Contrast x-ray of hip 0275 3.09 $160.71 $69.09 $32.14 73530 X X-ray exam of hip 0261 1.37 $71.25 $34.15 $14.25 73540 X X-ray exam of pelvis & hips 0260 0.81 $42.13 $23.17 $8.43 73542 S X-ray exam, sacroiliac joint 0275 3.09 $160.71 $69.09 $32.14 73550 X X-ray exam of thigh 0260 0.81 $42.13 $23.17 $8.43 73560 X X-ray exam of knee, 1 or 2 0260 0.81 $42.13 $23.17 $8.43 73562 X X-ray exam of knee, 3 0260 0.81 $42.13 $23.17 $8.43 73564 X X-ray exam, knee, 4 or more 0260 0.81 $42.13 $23.17 $8.43 73565 X X-ray exam of knees 0260 0.81 $42.13 $23.17 $8.43 73580 S Contrast x-ray of knee joint 0275 3.09 $160.71 $69.09 $32.14 73590 X X-ray exam of lower leg 0260 0.81 $42.13 $23.17 $8.43 73592 X X-ray exam of leg, infant 0260 0.81 $42.13 $23.17 $8.43 73600 X X-ray exam of ankle 0260 0.81 $42.13 $23.17 $8.43 73610 X X-ray exam of ankle 0260 0.81 $42.13 $23.17 $8.43 73615 S Contrast x-ray of ankle 0275 3.09 $160.71 $69.09 $32.14 73620 X X-ray exam of foot 0260 0.81 $42.13 $23.17 $8.43 73630 X X-ray exam of foot 0260 0.81 $42.13 $23.17 $8.43 73650 X X-ray exam of heel 0260 0.81 $42.13 $23.17 $8.43 73660 X X-ray exam of toe(s) 0260 0.81 $42.13 $23.17 $8.43 73700 S Ct lower extremity w/o dye 0332 3.62 $188.27 $91.27 $37.65 73701 S Ct lower extremity w/dye 0283 4.75 $247.04 $49.41 73702 S Ct lwr extremity w/o&w dye 0333 5.69 $295.93 $146.98 $59.19 73706 S Ct angio lwr extr w/o&w dye 0662 5.96 $309.97 $170.48 $61.99 Start Printed Page 52244 73718 S Mri lower extremity w/o dye 0336 7.01 $364.58 $176.94 $72.92 73719 S Mri lower extremity w/dye 0284 7.74 $402.55 $201.02 $80.51 73720 S Mri lwr extremity w/o&w dye 0337 9.86 $512.81 $240.77 $102.56 73721 S Mri joint of lwr extre w/o d 0336 7.01 $364.58 $176.94 $72.92 73722 S Mri joint of lwr extr w/dye 0284 7.74 $402.55 $201.02 $80.51 73723 S Mri joint lwr extr w/o&w dye 0337 9.86 $512.81 $240.77 $102.56 73725 E Mr ang lwr ext w or w/o dye 74000 X X-ray exam of abdomen 0260 0.81 $42.13 $23.17 $8.43 74010 X X-ray exam of abdomen 0260 0.81 $42.13 $23.17 $8.43 74020 X X-ray exam of abdomen 0260 0.81 $42.13 $23.17 $8.43 74022 X X-ray exam series, abdomen 0261 1.37 $71.25 $34.15 $14.25 74150 S Ct abdomen w/o dye 0332 3.62 $188.27 $91.27 $37.65 74160 S Ct abdomen w/dye 0283 4.75 $247.04 $49.41 74170 S Ct abdomen w/o&w dye 0333 5.69 $295.93 $146.98 $59.19 74175 S Ct angio abdom w/o&w dye 0662 5.96 $309.97 $170.48 $61.99 74181 S Mri abdomen w/o dye 0336 7.01 $364.58 $176.94 $72.92 74182 S Mri abdomen w/dye 0284 7.74 $402.55 $201.02 $80.51 74183 S Mri abdomen w/o&w dye 0337 9.86 $512.81 $240.77 $102.56 74185 E Mri angio, abdom w or w/o dy 74190 X X-ray exam of peritoneum 0263 1.99 $103.50 $45.54 $20.70 74210 S Contrst x-ray exam of throat 0276 1.69 $87.90 $41.72 $17.58 74220 S Contrast x-ray, esophagus 0276 1.69 $87.90 $41.72 $17.58 74230 S Cine/video x-ray, throat/eso 0276 1.69 $87.90 $41.72 $17.58 74235 S Remove esophagus obstruction 0296 2.12 $110.26 $52.92 $22.05 74240 S X-ray exam, upper gi tract 0276 1.69 $87.90 $41.72 $17.58 74241 S X-ray exam, upper gi tract 0276 1.69 $87.90 $41.72 $17.58 74245 S X-ray exam, upper gi tract 0277 2.50 $130.02 $60.47 $26.00 74246 S Contrst x-ray uppr gi tract 0276 1.69 $87.90 $41.72 $17.58 74247 S Contrst x-ray uppr gi tract 0276 1.69 $87.90 $41.72 $17.58 74249 S Contrst x-ray uppr gi tract 0277 2.50 $130.02 $60.47 $26.00 74250 S X-ray exam of small bowel 0276 1.69 $87.90 $41.72 $17.58 74251 S X-ray exam of small bowel 0277 2.50 $130.02 $60.47 $26.00 74260 S X-ray exam of small bowel 0277 2.50 $130.02 $60.47 $26.00 74270 S Contrast x-ray exam of colon 0276 1.69 $87.90 $41.72 $17.58 74280 S Contrast x-ray exam of colon 0277 2.50 $130.02 $60.47 $26.00 74283 S Contrast x-ray exam of colon 0276 1.69 $87.90 $41.72 $17.58 74290 S Contrast x-ray, gallbladder 0276 1.69 $87.90 $41.72 $17.58 74291 S Contrast x-rays, gallbladder 0276 1.69 $87.90 $41.72 $17.58 74300 X X-ray bile ducts/pancreas 0263 1.99 $103.50 $45.54 $20.70 74301 X X-rays at surgery add-on 0263 1.99 $103.50 $45.54 $20.70 74305 X X-ray bile ducts/pancreas 0263 1.99 $103.50 $45.54 $20.70 74320 X Contrast x-ray of bile ducts 0264 2.75 $143.02 $77.23 $28.60 74327 S X-ray bile stone removal 0296 2.12 $110.26 $52.92 $22.05 74328 N Xray 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 1.38 $71.77 $38.64 $14.35 74350 X X-ray guide, stomach tube 0263 1.99 $103.50 $45.54 $20.70 74355 X X-ray guide, intestinal tube 0263 1.99 $103.50 $45.54 $20.70 74360 S X-ray guide, GI dilation 0296 2.12 $110.26 $52.92 $22.05 74363 S X-ray, bile duct dilation 0297 7.80 $405.67 $172.51 $81.13 74400 S Contrst x-ray, urinary tract 0278 2.65 $137.82 $66.07 $27.56 74410 S Contrst x-ray, urinary tract 0278 2.65 $137.82 $66.07 $27.56 74415 S Contrst x-ray, urinary tract 0278 2.65 $137.82 $66.07 $27.56 74420 S Contrst x-ray, urinary tract 0278 2.65 $137.82 $66.07 $27.56 74425 S Contrst x-ray, urinary tract 0278 2.65 $137.82 $66.07 $27.56 74430 S Contrast x-ray, bladder 0278 2.65 $137.82 $66.07 $27.56 74440 S X-ray, male genital tract 0278 2.65 $137.82 $66.07 $27.56 74445 S X-ray exam of penis 0278 2.65 $137.82 $66.07 $27.56 74450 S X-ray, urethra/bladder 0278 2.65 $137.82 $66.07 $27.56 74455 S X-ray, urethra/bladder 0278 2.65 $137.82 $66.07 $27.56 74470 X X-ray exam of kidney lesion 0264 2.75 $143.02 $77.23 $28.60 74475 S X-ray control, cath insert 0297 7.80 $405.67 $172.51 $81.13 74480 S X-ray control, cath insert 0296 2.12 $110.26 $52.92 $22.05 74485 S X-ray guide, GU dilation 0296 2.12 $110.26 $52.92 $22.05 74710 X X-ray measurement of pelvis 0260 0.81 $42.13 $23.17 $8.43 Start Printed Page 52245 74740 X X-ray, female genital tract 0264 2.75 $143.02 $77.23 $28.60 74742 X X-ray, fallopian tube 0263 1.99 $103.50 $45.54 $20.70 74775 S X-ray exam of perineum 0278 2.65 $137.82 $66.07 $27.56 75552 S Heart mri for morph w/o dye 0336 7.01 $364.58 $176.94 $72.92 75553 S Heart mri for morph w/dye 0284 7.74 $402.55 $201.02 $80.51 75554 S Cardiac MRI/function 0335 6.46 $335.98 $151.46 $67.20 75555 S Cardiac MRI/limited study 0335 6.46 $335.98 $151.46 $67.20 75556 E Cardiac MRI/flow mapping 75600 S Contrast x-ray exam of aorta 0280 15.51 $806.66 $353.85 $161.33 75605 S Contrast x-ray exam of aorta 0280 15.51 $806.66 $353.85 $161.33 75625 S Contrast x-ray exam of aorta 0280 15.51 $806.66 $353.85 $161.33 75630 S X-ray aorta, leg arteries 0280 15.51 $806.66 $353.85 $161.33 75635 S Ct angio abdominal arteries 0662 5.96 $309.97 $170.48 $61.99 75650 S Artery x-rays, head & neck 0280 15.51 $806.66 $353.85 $161.33 75658 S Artery x-rays, arm 0280 15.51 $806.66 $353.85 $161.33 75660 S Artery x-rays, head & neck 0279 8.41 $437.40 $174.57 $87.48 75662 S Artery x-rays, head & neck 0279 8.41 $437.40 $174.57 $87.48 75665 S Artery x-rays, head & neck 0280 15.51 $806.66 $353.85 $161.33 75671 S Artery x-rays, head & neck 0280 15.51 $806.66 $353.85 $161.33 75676 S Artery x-rays, neck 0280 15.51 $806.66 $353.85 $161.33 75680 S Artery x-rays, neck 0280 15.51 $806.66 $353.85 $161.33 75685 S Artery x-rays, spine 0279 8.41 $437.40 $174.57 $87.48 75705 S Artery x-rays, spine 0279 8.41 $437.40 $174.57 $87.48 75710 S Artery x-rays, arm/leg 0280 15.51 $806.66 $353.85 $161.33 75716 S Artery x-rays, arms/legs 0280 15.51 $806.66 $353.85 $161.33 75722 S Artery x-rays, kidney 0280 15.51 $806.66 $353.85 $161.33 75724 S Artery x-rays, kidneys 0280 15.51 $806.66 $353.85 $161.33 75726 S Artery x-rays, abdomen 0280 15.51 $806.66 $353.85 $161.33 75731 S Artery x-rays, adrenal gland 0280 15.51 $806.66 $353.85 $161.33 75733 S Artery x-rays, adrenals 0280 15.51 $806.66 $353.85 $161.33 75736 S Artery x-rays, pelvis 0280 15.51 $806.66 $353.85 $161.33 75741 S Artery x-rays, lung 0279 8.41 $437.40 $174.57 $87.48 75743 S Artery x-rays, lungs 0280 15.51 $806.66 $353.85 $161.33 75746 S Artery x-rays, lung 0279 8.41 $437.40 $174.57 $87.48 75756 S Artery x-rays, chest 0279 8.41 $437.40 $174.57 $87.48 75774 S Artery x-ray, each vessel 0668 5.36 $278.77 $122.66 $55.75 75790 S Visualize A-V shunt 0281 5.23 $272.01 $115.16 $54.40 75801 X Lymph vessel x-ray, arm/leg 0264 2.75 $143.02 $77.23 $28.60 75803 X Lymph vessel x-ray,arms/legs 0264 2.75 $143.02 $77.23 $28.60 75805 X Lymph vessel x-ray, trunk 0264 2.75 $143.02 $77.23 $28.60 75807 X Lymph vessel x-ray, trunk 0264 2.75 $143.02 $77.23 $28.60 75809 X Nonvascular shunt, x-ray 0263 1.99 $103.50 $45.54 $20.70 75810 S Vein x-ray, spleen/liver 0279 8.41 $437.40 $174.57 $87.48 75820 S Vein x-ray, arm/leg 0281 5.23 $272.01 $115.16 $54.40 75822 S Vein x-ray, arms/legs 0281 5.23 $272.01 $115.16 $54.40 75825 S Vein x-ray, trunk 0279 8.41 $437.40 $174.57 $87.48 75827 S Vein x-ray, chest 0279 8.41 $437.40 $174.57 $87.48 75831 S Vein x-ray, kidney 0287 7.13 $370.82 $114.51 $74.16 75833 S Vein x-ray, kidneys 0279 8.41 $437.40 $174.57 $87.48 75840 S Vein x-ray, adrenal gland 0287 7.13 $370.82 $114.51 $74.16 75842 S Vein x-ray, adrenal glands 0287 7.13 $370.82 $114.51 $74.16 75860 S Vein x-ray, neck 0287 7.13 $370.82 $114.51 $74.16 75870 S Vein x-ray, skull 0287 7.13 $370.82 $114.51 $74.16 75872 S Vein x-ray, skull 0287 7.13 $370.82 $114.51 $74.16 75880 S Vein x-ray, eye socket 0287 7.13 $370.82 $114.51 $74.16 75885 S Vein x-ray, liver 0279 8.41 $437.40 $174.57 $87.48 75887 S Vein x-ray, liver 0280 15.51 $806.66 $353.85 $161.33 75889 S Vein x-ray, liver 0279 8.41 $437.40 $174.57 $87.48 75891 S Vein x-ray, liver 0279 8.41 $437.40 $174.57 $87.48 75893 N Venous sampling by catheter 75894 S X-rays, transcath therapy 0297 7.80 $405.67 $172.51 $81.13 75896 S X-rays, transcath therapy 0297 7.80 $405.67 $172.51 $81.13 75898 X Follow-up angiography 0264 2.75 $143.02 $77.23 $28.60 75900 C Arterial catheter exchange 75940 X X-ray placement, vein filter 0187 4.19 $217.92 $94.96 $43.58 75945 S Intravascular us 0267 2.58 $134.18 $65.52 $26.84 Start Printed Page 52246 75946 S Intravascular us add-on 0267 2.58 $134.18 $65.52 $26.84 75952 C Endovasc repair abdom aorta 75953 C Abdom aneurysm endovas rpr 75960 S Transcatheter intro, stent 0280 15.51 $806.66 $353.85 $161.33 75961 S Retrieval, broken catheter 0280 15.51 $806.66 $353.85 $161.33 75962 S Repair arterial blockage 0280 15.51 $806.66 $353.85 $161.33 75964 S Repair artery blockage, each 0280 15.51 $806.66 $353.85 $161.33 75966 S Repair arterial blockage 0280 15.51 $806.66 $353.85 $161.33 75968 S Repair artery blockage, each 0280 15.51 $806.66 $353.85 $161.33 75970 S Vascular biopsy 0280 15.51 $806.66 $353.85 $161.33 75978 S Repair venous blockage 0668 5.36 $278.77 $122.66 $55.75 75980 S Contrast xray exam bile duct 0296 2.12 $110.26 $52.92 $22.05 75982 S Contrast xray exam bile duct 0297 7.80 $405.67 $172.51 $81.13 75984 X Xray control catheter change 0264 2.75 $143.02 $77.23 $28.60 75989 N Abscess drainage under x-ray 75992 S Atherectomy, x-ray exam 0280 15.51 $806.66 $353.85 $161.33 75993 S Atherectomy, x-ray exam 0280 15.51 $806.66 $353.85 $161.33 75994 S Atherectomy, x-ray exam 0280 15.51 $806.66 $353.85 $161.33 75995 S Atherectomy, x-ray exam 0280 15.51 $806.66 $353.85 $161.33 75996 S Atherectomy, x-ray exam 0280 15.51 $806.66 $353.85 $161.33 76000 X Fluoroscope examination 0272 1.38 $71.77 $38.64 $14.35 76001 N Fluoroscope exam, extensive 76003 N Needle localization by x-ray 76005 N Fluoroguide for spine inject 76006 X X-ray stress view 0260 0.81 $42.13 $23.17 $8.43 76010 X X-ray, nose to rectum 0260 0.81 $42.13 $23.17 $8.43 76012 S Percut vertebroplasty fluor 0274 3.21 $166.95 $80.14 $33.39 76013 S Percut vertebroplasty, ct 0274 3.21 $166.95 $80.14 $33.39 76020 X X-rays for bone age 0260 0.81 $42.13 $23.17 $8.43 76040 X X-rays, bone evaluation 0260 0.81 $42.13 $23.17 $8.43 76061 X X-rays, bone survey 0261 1.37 $71.25 $34.15 $14.25 76062 X X-rays, bone survey 0261 1.37 $71.25 $34.15 $14.25 76065 X X-rays, bone evaluation 0261 1.37 $71.25 $34.15 $14.25 76066 X Joint survey, single view 0260 0.81 $42.13 $23.17 $8.43 76070 E CT scan, bone density study 76075 S Dual energy x-ray study 0288 1.38 $71.77 $14.35 76076 S Dual energy x-ray study 0665 0.73 $37.97 $7.59 76078 X Radiographic absorptiometry 0261 1.37 $71.25 $34.15 $14.25 76080 X X-ray exam of fistula 0263 1.99 $103.50 $45.54 $20.70 76085 A Computer mammogram add-on 76086 X X-ray of mammary duct 0263 1.99 $103.50 $45.54 $20.70 76088 X X-ray of mammary ducts 0263 1.99 $103.50 $45.54 $20.70 76090 S Mammogram, one breast 0271 0.69 $35.89 $16.80 $7.18 76091 S Mammogram, both breasts 0271 0.69 $35.89 $16.80 $7.18 76092 A Mammogram, screening 76093 E Magnetic image, breast 76094 E Magnetic image, both breasts 76095 X Stereotactic breast biopsy 0187 4.19 $217.92 $94.96 $43.58 76096 X X-ray of needle wire, breast 0289 1.84 $95.70 $44.80 $19.14 76098 X X-ray exam, breast specimen 0260 0.81 $42.13 $23.17 $8.43 76100 X X-ray exam of body section 0261 1.37 $71.25 $34.15 $14.25 76101 X Complex body section x-ray 0264 2.75 $143.02 $77.23 $28.60 76102 X Complex body section x-rays 0264 2.75 $143.02 $77.23 $28.60 76120 X Cine/video x-rays 0260 0.81 $42.13 $23.17 $8.43 76125 X Cine/ video x-rays add-on 0260 0.81 $42.13 $23.17 $8.43 76140 E X-ray consultation 76150 X X-ray exam, dry process 0260 0.81 $42.13 $23.17 $8.43 76350 N Special x-ray contrast study 76355 S CAT scan for localization 0283 4.75 $247.04 $49.41 76360 S CAT scan for needle biopsy 0283 4.75 $247.04 $49.41 76362 N Cat scan for tissue ablation 76370 S CAT scan for therapy guide 0282 1.76 $91.54 $44.51 $18.31 76375 S 3d/holograph reconstr add-on 0282 1.76 $91.54 $44.51 $18.31 76380 S CAT scan follow-up study 0282 1.76 $91.54 $44.51 $18.31 76390 E Mr spectroscopy 76393 N Mr guidance for needle place Start Printed Page 52247 76394 N Mri for tissue ablation 76400 S Magnetic image, bone marrow 0335 6.46 $335.98 $151.46 $67.20 76490 N Us for tissue ablation 76499 X Radiographic procedure 0260 0.81 $42.13 $23.17 $8.43 76506 S Echo exam of head 0266 1.70 $88.42 $48.63 $17.68 76511 S Echo exam of eye 0266 1.70 $88.42 $48.63 $17.68 76512 S Echo exam of eye 0266 1.70 $88.42 $48.63 $17.68 76513 S Echo exam of eye, water bath 0265 1.04 $54.09 $29.75 $10.82 76516 S Echo exam of eye 0266 1.70 $88.42 $48.63 $17.68 76519 S Echo exam of eye 0266 1.70 $88.42 $48.63 $17.68 76529 S Echo exam of eye 0265 1.04 $54.09 $29.75 $10.82 76536 S Us exam of head and neck 0266 1.70 $88.42 $48.63 $17.68 76604 S Us exam, chest, b-scan 0266 1.70 $88.42 $48.63 $17.68 76645 S Us exam, breast(s) 0265 1.04 $54.09 $29.75 $10.82 76700 S Us exam, abdom, complete 0266 1.70 $88.42 $48.63 $17.68 76705 S Us exam, abdom, limited 0266 1.70 $88.42 $48.63 $17.68 76770 S Us exam abdo back wall, comp 0266 1.70 $88.42 $48.63 $17.68 76775 S Us exam abdo back wall, lim 0266 1.70 $88.42 $48.63 $17.68 76778 S Us exam kidney transplant 0266 1.70 $88.42 $48.63 $17.68 76800 S Us exam, spinal canal 0266 1.70 $88.42 $48.63 $17.68 76805 S Us exam, pg uterus, compl 0266 1.70 $88.42 $48.63 $17.68 76810 S Us exam, pg uterus, mult 0265 1.04 $54.09 $29.75 $10.82 76815 S Us exam, pg uterus limit 0265 1.04 $54.09 $29.75 $10.82 76816 S Us exam pg uterus repeat 0265 1.04 $54.09 $29.75 $10.82 76818 S Fetal biophy profile w/nst 0266 1.70 $88.42 $48.63 $17.68 76819 S Fetal biophys profil w/o nst 0266 1.70 $88.42 $48.63 $17.68 76825 S Echo exam of fetal heart 0671 1.68 $87.38 $45.44 $17.48 76826 S Echo exam of fetal heart 0697 1.51 $78.53 $40.84 $15.71 76827 S Echo exam of fetal heart 0671 1.68 $87.38 $45.44 $17.48 76828 S Echo exam of fetal heart 0697 1.51 $78.53 $40.84 $15.71 76830 S Us exam, transvaginal 0266 1.70 $88.42 $48.63 $17.68 76831 S Echo exam, uterus 0266 1.70 $88.42 $48.63 $17.68 76856 S Us exam, pelvic, complete 0266 1.70 $88.42 $48.63 $17.68 76857 S Us exam, pelvic, limited 0265 1.04 $54.09 $29.75 $10.82 76870 S Us exam, scrotum 0266 1.70 $88.42 $48.63 $17.68 76872 S Echo exam, transrectal 0266 1.70 $88.42 $48.63 $17.68 76873 S Echograp trans r, pros study 0266 1.70 $88.42 $48.63 $17.68 76880 S Us exam, extremity 0266 1.70 $88.42 $48.63 $17.68 76885 S Us exam infant hips, dynamic 0266 1.70 $88.42 $48.63 $17.68 76886 S Us exam infant hips, static 0266 1.70 $88.42 $48.63 $17.68 76930 S Echo guide, cardiocentesis 0268 1.48 $76.97 $15.39 76932 S Echo guide for heart biopsy 0268 1.48 $76.97 $15.39 76936 S Echo guide for artery repair 0268 1.48 $76.97 $15.39 76941 S Echo guide for transfusion 0268 1.48 $76.97 $15.39 76942 S Echo guide for biopsy 0268 1.48 $76.97 $15.39 76945 S Echo guide, villus sampling 0268 1.48 $76.97 $15.39 76946 S Echo guide for amniocentesis 0268 1.48 $76.97 $15.39 76948 S Echo guide, ova aspiration 0268 1.48 $76.97 $15.39 76950 S Echo guidance radiotherapy 0268 1.48 $76.97 $15.39 76965 S Echo guidance radiotherapy 0268 1.48 $76.97 $15.39 76970 S Ultrasound exam follow-up 0265 1.04 $54.09 $29.75 $10.82 76975 S GI endoscopic ultrasound 0266 1.70 $88.42 $48.63 $17.68 76977 S Us bone density measure 0265 1.04 $54.09 $29.75 $10.82 76986 S Ultrasound guide intraoper 0266 1.70 $88.42 $48.63 $17.68 76999 S Echo examination procedure 0265 1.04 $54.09 $29.75 $10.82 77261 E Radiation therapy planning 77262 E Radiation therapy planning 77263 E Radiation therapy planning 77280 X Set radiation therapy field 0304 1.69 $87.90 $41.52 $17.58 77285 X Set radiation therapy field 0305 3.87 $201.27 $91.38 $40.25 77290 X Set radiation therapy field 0305 3.87 $201.27 $91.38 $40.25 77295 X Set radiation therapy field 0310 14.38 $747.89 $339.05 $149.58 77299 E Radiation therapy planning 77300 X Radiation therapy dose plan 0304 1.69 $87.90 $41.52 $17.58 77301 S Radioltherapy dos plan, imrt 0712 $875.00 $175.00 77305 X Radiation therapy dose plan 0304 1.69 $87.90 $41.52 $17.58 Start Printed Page 52248 77310 X Radiation therapy dose plan 0304 1.69 $87.90 $41.52 $17.58 77315 X Radiation therapy dose plan 0305 3.87 $201.27 $91.38 $40.25 77321 X Radiation therapy port plan 0305 3.87 $201.27 $91.38 $40.25 77326 X Radiation therapy dose plan 0305 3.87 $201.27 $91.38 $40.25 77327 X Radiation therapy dose plan 0305 3.87 $201.27 $91.38 $40.25 77328 X Radiation therapy dose plan 0305 3.87 $201.27 $91.38 $40.25 77331 X Special radiation dosimetry 0304 1.69 $87.90 $41.52 $17.58 77332 X Radiation treatment aid(s) 0303 2.93 $152.39 $68.58 $30.48 77333 X Radiation treatment aid(s) 0303 2.93 $152.39 $68.58 $30.48 77334 X Radiation treatment aid(s) 0303 2.93 $152.39 $68.58 $30.48 77336 X Radiation physics consult 0304 1.69 $87.90 $41.52 $17.58 77370 X Radiation physics consult 0305 3.87 $201.27 $91.38 $40.25 77399 X External radiation dosimetry 0304 1.69 $87.90 $41.52 $17.58 77401 S Radiation treatment delivery 0300 1.53 $79.57 $15.91 77402 S Radiation treatment delivery 0300 1.53 $79.57 $15.91 77403 S Radiation treatment delivery 0300 1.53 $79.57 $15.91 77404 S Radiation treatment delivery 0300 1.53 $79.57 $15.91 77406 S Radiation treatment delivery 0300 1.53 $79.57 $15.91 77407 S Radiation treatment delivery 0300 1.53 $79.57 $15.91 77408 S Radiation treatment delivery 0300 1.53 $79.57 $15.91 77409 S Radiation treatment delivery 0300 1.53 $79.57 $15.91 77411 S Radiation treatment delivery 0300 1.53 $79.57 $15.91 77412 S Radiation treatment delivery 0301 2.22 $115.46 $23.09 77413 S Radiation treatment delivery 0301 2.22 $115.46 $23.09 77414 S Radiation treatment delivery 0301 2.22 $115.46 $23.09 77416 S Radiation treatment delivery 0301 2.22 $115.46 $23.09 77417 X Radiology port film(s) 0260 0.81 $42.13 $23.17 $8.43 77418 S Radiation tx delivery, imrt 0710 $400.00 $80.00 77427 E Radiation tx management, x5 77431 E Radiation therapy management 77432 E Stereotactic radiation trmt 77470 S Special radiation treatment 0299 6.20 $322.46 $64.49 77499 E Radiation therapy management 77520 S Proton trmt, simple w/o comp 0664 11.03 $573.66 $114.73 77522 S Proton trmt, simple w/comp 0664 11.03 $573.66 $114.73 77523 S Proton trmt, intermediate 0664 11.03 $573.66 $114.73 77525 S Proton treatment, complex 0664 11.03 $573.66 $114.73 77600 S Hyperthermia treatment 0314 4.24 $220.52 $101.77 $44.10 77605 S Hyperthermia treatment 0314 4.24 $220.52 $101.77 $44.10 77610 S Hyperthermia treatment 0314 4.24 $220.52 $101.77 $44.10 77615 S Hyperthermia treatment 0314 4.24 $220.52 $101.77 $44.10 77620 S Hyperthermia treatment 0314 4.24 $220.52 $101.77 $44.10 77750 S Infuse radioactive materials 0300 1.53 $79.57 $15.91 77761 S Apply intrcav radiat simple 0312 4.23 $220.00 $44.00 77762 S Apply intrcav radiat interm 0312 4.23 $220.00 $44.00 77763 S Apply intrcav radiat compl 0312 4.23 $220.00 $44.00 77776 S Apply interstit radiat simpl 0312 4.23 $220.00 $44.00 77777 S Apply interstit radiat inter 0312 4.23 $220.00 $44.00 77778 S Apply iterstit radiat compl 0312 4.23 $220.00 $44.00 77781 S High intensity brachytherapy 0313 13.80 $717.72 $143.54 77782 S High intensity brachytherapy 0313 13.80 $717.72 $143.54 77783 S High intensity brachytherapy 0313 13.80 $717.72 $143.54 77784 S High intensity brachytherapy 0313 13.80 $717.72 $143.54 77789 S Apply surface radiation 0300 1.53 $79.57 $15.91 77790 N Radiation handling 77799 S Radium/radioisotope therapy 0313 13.80 $717.72 $143.54 78000 S Thyroid, single uptake 0290 2.16 $112.34 $56.17 $22.47 78001 S Thyroid, multiple uptakes 0290 2.16 $112.34 $56.17 $22.47 78003 S Thyroid suppress/stimul 0290 2.16 $112.34 $56.17 $22.47 78006 S Thyroid imaging with uptake 0291 4.19 $217.92 $108.96 $43.58 78007 S Thyroid image, mult uptakes 0292 4.53 $235.60 $117.80 $47.12 78010 S Thyroid imaging 0291 4.19 $217.92 $108.96 $43.58 78011 S Thyroid imaging with flow 0292 4.53 $235.60 $117.80 $47.12 78015 S Thyroid met imaging 0291 4.19 $217.92 $108.96 $43.58 78016 S Thyroid met imaging/studies 0292 4.53 $235.60 $117.80 $47.12 78018 S Thyroid met imaging, body 0292 4.53 $235.60 $117.80 $47.12 Start Printed Page 52249 78020 S Thyroid met uptake 0291 4.19 $217.92 $108.96 $43.58 78070 S Parathyroid nuclear imaging 0292 4.53 $235.60 $117.80 $47.12 78075 S Adrenal nuclear imaging 0292 4.53 $235.60 $117.80 $47.12 78099 S Endocrine nuclear procedure 0291 4.19 $217.92 $108.96 $43.58 78102 S Bone marrow imaging, ltd 0291 4.19 $217.92 $108.96 $43.58 78103 S Bone marrow imaging, mult 0291 4.19 $217.92 $108.96 $43.58 78104 S Bone marrow imaging, body 0291 4.19 $217.92 $108.96 $43.58 78110 S Plasma volume, single 0290 2.16 $112.34 $56.17 $22.47 78111 S Plasma volume, multiple 0290 2.16 $112.34 $56.17 $22.47 78120 S Red cell mass, single 0290 2.16 $112.34 $56.17 $22.47 78121 S Red cell mass, multiple 0290 2.16 $112.34 $56.17 $22.47 78122 S Blood volume 0290 2.16 $112.34 $56.17 $22.47 78130 S Red cell survival study 0290 2.16 $112.34 $56.17 $22.47 78135 S Red cell survival kinetics 0290 2.16 $112.34 $56.17 $22.47 78140 S Red cell sequestration 0290 2.16 $112.34 $56.17 $22.47 78160 S Plasma iron turnover 0290 2.16 $112.34 $56.17 $22.47 78162 S Iron absorption exam 0290 2.16 $112.34 $56.17 $22.47 78170 S Red cell iron utilization 0290 2.16 $112.34 $56.17 $22.47 78172 S Total body iron estimation 0290 2.16 $112.34 $56.17 $22.47 78185 S Spleen imaging 0291 4.19 $217.92 $108.96 $43.58 78190 S Platelet survival, kinetics 0290 2.16 $112.34 $56.17 $22.47 78191 S Platelet survival 0292 4.53 $235.60 $117.80 $47.12 78195 S Lymph system imaging 0292 4.53 $235.60 $117.80 $47.12 78199 S Blood/lymph nuclear exam 0291 4.19 $217.92 $108.96 $43.58 78201 S Liver imaging 0291 4.19 $217.92 $108.96 $43.58 78202 S Liver imaging with flow 0291 4.19 $217.92 $108.96 $43.58 78205 S Liver imaging (3D) 0291 4.19 $217.92 $108.96 $43.58 78206 S Liver image (3d) w/flow 0292 4.53 $235.60 $117.80 $47.12 78215 S Liver and spleen imaging 0291 4.19 $217.92 $108.96 $43.58 78216 S Liver & spleen image/flow 0291 4.19 $217.92 $108.96 $43.58 78220 S Liver function study 0291 4.19 $217.92 $108.96 $43.58 78223 S Hepatobiliary imaging 0292 4.53 $235.60 $117.80 $47.12 78230 S Salivary gland imaging 0292 4.53 $235.60 $117.80 $47.12 78231 S Serial salivary imaging 0292 4.53 $235.60 $117.80 $47.12 78232 S Salivary gland function exam 0292 4.53 $235.60 $117.80 $47.12 78258 S Esophageal motility study 0291 4.19 $217.92 $108.96 $43.58 78261 S Gastric mucosa imaging 0291 4.19 $217.92 $108.96 $43.58 78262 S Gastroesophageal reflux exam 0292 4.53 $235.60 $117.80 $47.12 78264 S Gastric emptying study 0292 4.53 $235.60 $117.80 $47.12 78267 A Breath tst attain/anal c-14 78268 A Breath test analysis, c-14 78270 S Vit B-12 absorption exam 0290 2.16 $112.34 $56.17 $22.47 78271 S Vit B-12 absorp exam, IF 0290 2.16 $112.34 $56.17 $22.47 78272 S Vit B-12 absorp, combined 0290 2.16 $112.34 $56.17 $22.47 78278 S Acute GI blood loss imaging 0292 4.53 $235.60 $117.80 $47.12 78282 S GI protein loss exam 0290 2.16 $112.34 $56.17 $22.47 78290 S Meckel's divert exam 0292 4.53 $235.60 $117.80 $47.12 78291 S Leveen/shunt patency exam 0292 4.53 $235.60 $117.80 $47.12 78299 S GI nuclear procedure 0291 4.19 $217.92 $108.96 $43.58 78300 S Bone imaging, limited area 0291 4.19 $217.92 $108.96 $43.58 78305 S Bone imaging, multiple areas 0291 4.19 $217.92 $108.96 $43.58 78306 S Bone imaging, whole body 0291 4.19 $217.92 $108.96 $43.58 78315 S Bone imaging, 3 phase 0292 4.53 $235.60 $117.80 $47.12 78320 S Bone imaging (3D) 0291 4.19 $217.92 $108.96 $43.58 78350 X Bone mineral, single photon 0261 1.37 $71.25 $34.15 $14.25 78351 E Bone mineral, dual photon 78399 S Musculoskeletal nuclear exam 0291 4.19 $217.92 $108.96 $43.58 78414 S Non-imaging heart function 0290 2.16 $112.34 $56.17 $22.47 78428 S Cardiac shunt imaging 0291 4.19 $217.92 $108.96 $43.58 78445 S Vascular flow imaging 0291 4.19 $217.92 $108.96 $43.58 78455 S Venous thrombosis study 0290 2.16 $112.34 $56.17 $22.47 78456 S Acute venous thrombus image 0292 4.53 $235.60 $117.80 $47.12 78457 S Venous thrombosis imaging 0291 4.19 $217.92 $108.96 $43.58 78458 S Ven thrombosis images, bilat 0292 4.53 $235.60 $117.80 $47.12 78459 E Heart muscle imaging (PET) 78460 S Heart muscle blood, single 0286 6.94 $360.94 $198.52 $72.19 Start Printed Page 52250 78461 S Heart muscle blood, multiple 0286 6.94 $360.94 $198.52 $72.19 78464 S Heart image (3d), single 0286 6.94 $360.94 $198.52 $72.19 78465 S Heart image (3d), multiple 0286 6.94 $360.94 $198.52 $72.19 78466 S Heart infarct image 0291 4.19 $217.92 $108.96 $43.58 78468 S Heart infarct image (ef) 0291 4.19 $217.92 $108.96 $43.58 78469 S Heart infarct image (3D) 0291 4.19 $217.92 $108.96 $43.58 78472 S Gated heart, planar, single 0286 6.94 $360.94 $198.52 $72.19 78473 S Gated heart, multiple 0286 6.94 $360.94 $198.52 $72.19 78478 S Heart wall motion add-on 0666 1.59 $82.69 $45.48 $16.54 78480 S Heart function add-on 0666 1.59 $82.69 $45.48 $16.54 78481 S Heart first pass, single 0286 6.94 $360.94 $198.52 $72.19 78483 S Heart first pass, multiple 0286 6.94 $360.94 $198.52 $72.19 78491 E Heart image (pet), single 78492 E Heart image (pet), multiple 78494 S Heart image, spect 0286 6.94 $360.94 $198.52 $72.19 78496 S Heart first pass add-on 0666 1.59 $82.69 $45.48 $16.54 78499 S Cardiovascular nuclear exam 0291 4.19 $217.92 $108.96 $43.58 78580 S Lung perfusion imaging 0291 4.19 $217.92 $108.96 $43.58 78584 S Lung V/Q image single breath 0292 4.53 $235.60 $117.80 $47.12 78585 S Lung V/Q imaging 0292 4.53 $235.60 $117.80 $47.12 78586 S Aerosol lung image, single 0291 4.19 $217.92 $108.96 $43.58 78587 S Aerosol lung image, multiple 0291 4.19 $217.92 $108.96 $43.58 78588 S Perfusion lung image 0292 4.53 $235.60 $117.80 $47.12 78591 S Vent image, 1 breath, 1 proj 0291 4.19 $217.92 $108.96 $43.58 78593 S Vent image, 1 proj, gas 0291 4.19 $217.92 $108.96 $43.58 78594 S Vent image, mult proj, gas 0291 4.19 $217.92 $108.96 $43.58 78596 S Lung differential function 0292 4.53 $235.60 $117.80 $47.12 78599 S Respiratory nuclear exam 0291 4.19 $217.92 $108.96 $43.58 78600 S Brain imaging, ltd static 0291 4.19 $217.92 $108.96 $43.58 78601 S Brain imaging, ltd w/ flow 0291 4.19 $217.92 $108.96 $43.58 78605 S Brain imaging, complete 0291 4.19 $217.92 $108.96 $43.58 78606 S Brain imaging, compl w/flow 0291 4.19 $217.92 $108.96 $43.58 78607 S Brain imaging (3D) 0291 4.19 $217.92 $108.96 $43.58 78608 E Brain imaging (PET) 78609 E Brain imaging (PET) 78610 S Brain flow imaging only 0291 4.19 $217.92 $108.96 $43.58 78615 S Cerebral vascular flow image 0291 4.19 $217.92 $108.96 $43.58 78630 S Cerebrospinal fluid scan 0292 4.53 $235.60 $117.80 $47.12 78635 S CSF ventriculography 0292 4.53 $235.60 $117.80 $47.12 78645 S CSF shunt evaluation 0292 4.53 $235.60 $117.80 $47.12 78647 S Cerebrospinal fluid scan 0292 4.53 $235.60 $117.80 $47.12 78650 S CSF leakage imaging 0292 4.53 $235.60 $117.80 $47.12 78660 S Nuclear exam of tear flow 0291 4.19 $217.92 $108.96 $43.58 78699 S Nervous system nuclear exam 0291 4.19 $217.92 $108.96 $43.58 78700 S Kidney imaging, static 0291 4.19 $217.92 $108.96 $43.58 78701 S Kidney imaging with flow 0291 4.19 $217.92 $108.96 $43.58 78704 S Imaging renogram 0291 4.19 $217.92 $108.96 $43.58 78707 S Kidney flow/function image 0291 4.19 $217.92 $108.96 $43.58 78708 S Kidney flow/function image 0292 4.53 $235.60 $117.80 $47.12 78709 S Kidney flow/function image 0292 4.53 $235.60 $117.80 $47.12 78710 S Kidney imaging (3D) 0291 4.19 $217.92 $108.96 $43.58 78715 S Renal vascular flow exam 0291 4.19 $217.92 $108.96 $43.58 78725 S Kidney function study 0290 2.16 $112.34 $56.17 $22.47 78730 S Urinary bladder retention 0291 4.19 $217.92 $108.96 $43.58 78740 S Ureteral reflux study 0292 4.53 $235.60 $117.80 $47.12 78760 S Testicular imaging 0291 4.19 $217.92 $108.96 $43.58 78761 S Testicular imaging/flow 0291 4.19 $217.92 $108.96 $43.58 78799 S Genitourinary nuclear exam 0291 4.19 $217.92 $108.96 $43.58 78800 S Tumor imaging, limited area 0292 4.53 $235.60 $117.80 $47.12 78801 S Tumor imaging, mult areas 0292 4.53 $235.60 $117.80 $47.12 78802 S Tumor imaging, whole body 0292 4.53 $235.60 $117.80 $47.12 78803 S Tumor imaging (3D) 0292 4.53 $235.60 $117.80 $47.12 78805 S Abscess imaging, ltd area 0292 4.53 $235.60 $117.80 $47.12 78806 S Abscess imaging, whole body 0292 4.53 $235.60 $117.80 $47.12 78807 S Nuclear localization/abscess 0292 4.53 $235.60 $117.80 $47.12 78810 E Tumor imaging (PET) Start Printed Page 52251 78890 N Nuclear medicine data proc 78891 N Nuclear med data proc 78990 N Provide diag radionuclide(s) 78999 S Nuclear diagnostic exam 0291 4.19 $217.92 $108.96 $43.58 79000 S Init hyperthyroid therapy 0294 4.45 $231.44 $127.29 $46.29 79001 S Repeat hyperthyroid therapy 0294 4.45 $231.44 $127.29 $46.29 79020 S Thyroid ablation 0294 4.45 $231.44 $127.29 $46.29 79030 S Thyroid ablation, carcinoma 0294 4.45 $231.44 $127.29 $46.29 79035 S Thyroid metastatic therapy 0295 3.86 $200.75 $110.41 $40.15 79100 S Hematopoetic nuclear therapy 0294 4.45 $231.44 $127.29 $46.29 79200 S Intracavitary nuclear trmt 0295 3.86 $200.75 $110.41 $40.15 79300 S Interstitial nuclear therapy 0294 4.45 $231.44 $127.29 $46.29 79400 S Nonhemato nuclear therapy 0295 3.86 $200.75 $110.41 $40.15 79420 S Intravascular nuclear ther 0295 3.86 $200.75 $110.41 $40.15 79440 S Nuclear joint therapy 0294 4.45 $231.44 $127.29 $46.29 79900 N Provide ther radiopharm(s) 79999 S Nuclear medicine therapy 0294 4.45 $231.44 $127.29 $46.29 80048 A Basic metabolic panel 80050 A General health panel 80051 A Electrolyte panel 80053 A Comprehen metabolic panel 80055 A Obstetric panel 80061 A Lipid panel 80069 A Renal function panel 80074 A Acute hepatitis panel 80076 A Hepatic function panel 80090 A Torch antibody 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 Start Printed Page 52252 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 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 0343 0.47 $24.44 $13.20 $4.89 80502 X Lab pathology consultation 0342 0.23 $11.96 $5.88 $2.39 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 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 Start Printed Page 52253 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 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 Start Printed Page 52254 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 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 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 Start Printed Page 52255 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 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 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 Start Printed Page 52256 83519 A Immunoassay, nonantibody 83520 A Immunoassay, RIA 83525 A Assay of insulin 83527 A Assay of insulin 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 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 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 Start Printed Page 52257 83918 A Organic acids, total, quant 83919 A Organic acids, qual, each 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 Oncorprotein, 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 84160 A Assay of serum protein 84165 A Assay of serum proteins 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 84260 A Assay of serotonin 84270 A Assay of sex hormone globul Start Printed Page 52258 84275 A Assay of sialic acid 84285 A Assay of silica 84295 A Assay of serum sodium 84300 A Assay of urine 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 Reverse assay (t3) 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 84830 A Ovulation tests 84999 A Clinical chemistry test 85002 A Bleeding time test Start Printed Page 52259 85007 A Differential WBC count 85008 A Nondifferential WBC count 85009 A Differential WBC count 85013 A Hematocrit 85014 A Hematocrit 85018 A Hemoglobin 85021 A Automated hemogram 85022 A Automated hemogram 85023 A Automated hemogram 85024 A Automated hemogram 85025 A Automated hemogram 85027 A Automated hemogram 85031 A Manual hemogram, cbc 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 85060 X Blood smear interpretation 0342 0.23 $11.96 $5.88 $2.39 85097 X Bone marrow interpretation 0343 0.47 $24.44 $13.20 $4.89 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 85384 A Fibrinogen 85385 A Fibrinogen 85390 A Fibrinolysins screen 85400 A Fibrinolytic plasmin 85410 A Fibrinolytic antiplasmin 85415 A Fibrinolytic plasminogen 85420 A Fibrinolytic plasminogen 85421 A Fibrinolytic plasminogen 85441 A Heinz bodies, direct Start Printed Page 52260 85445 A Heinz bodies, induced 85460 A Hemoglobin, fetal 85461 A Hemoglobin, fetal 85475 A Hemolysin 85520 A Heparin assay 85525 A Heparin 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 85585 A Blood platelet estimation 85590 A Platelet count, manual 85595 A Platelet count, automated 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 86077 X Physician blood bank service 0343 0.47 $24.44 $13.20 $4.89 86078 X Physician blood bank service 0344 0.66 $34.33 $18.54 $6.87 86079 X Physician blood bank service 0344 0.66 $34.33 $18.54 $6.87 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 86243 A Fc receptor 86255 A Fluorescent antibody, screen Start Printed Page 52261 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 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 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 0.16 $8.32 $3.08 $1.66 86490 X Coccidioidomycosis skin test 0341 0.16 $8.32 $3.08 $1.66 86510 X Histoplasmosis skin test 0341 0.16 $8.32 $3.08 $1.66 86580 X TB intradermal test 0341 0.16 $8.32 $3.08 $1.66 86585 X TB tine test 0341 0.16 $8.32 $3.08 $1.66 86586 X Skin test, unlisted 0341 0.16 $8.32 $3.08 $1.66 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 86632 A Chlamydia igm antibody 86635 A Coccidioides antibody 86638 A Q fever antibody 86641 A Cryptococcus antibody 86644 A CMV antibody Start Printed Page 52262 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 86787 A Varicella-zoster antibody 86790 A Virus antibody nos 86793 A Yersinia antibody 86800 A Thyroglobulin antibody 86803 A Hepatitis c ab test Start Printed Page 52263 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 0.19 $9.88 $3.06 $1.98 86860 X RBC antibody elution 0346 0.42 $21.84 $5.46 $4.37 86870 X RBC antibody identification 0346 0.42 $21.84 $5.46 $4.37 86880 X Coombs test 0341 0.16 $8.32 $3.08 $1.66 86885 X Coombs test 0341 0.16 $8.32 $3.08 $1.66 86886 X Coombs test 0341 0.16 $8.32 $3.08 $1.66 86890 X Autologous blood process 0347 0.98 $50.97 $12.74 $10.19 86891 X Autologous blood, op salvage 0345 0.19 $9.88 $3.06 $1.98 86900 X Blood typing, ABO 0341 0.16 $8.32 $3.08 $1.66 86901 X Blood typing, Rh (D) 0345 0.19 $9.88 $3.06 $1.98 86903 X Blood typing, antigen screen 0345 0.19 $9.88 $3.06 $1.98 86904 X Blood typing, patient serum 0345 0.19 $9.88 $3.06 $1.98 86905 X Blood typing, RBC antigens 0345 0.19 $9.88 $3.06 $1.98 86906 X Blood typing, Rh phenotype 0345 0.19 $9.88 $3.06 $1.98 86910 E Blood typing, paternity test 86911 E Blood typing, antigen system 86915 X Bone marrow/stem cell prep 0346 0.42 $21.84 $5.46 $4.37 86920 X Compatibility test 0346 0.42 $21.84 $5.46 $4.37 86921 X Compatibility test 0345 0.19 $9.88 $3.06 $1.98 86922 X Compatibility test 0346 0.42 $21.84 $5.46 $4.37 86927 X Plasma, fresh frozen 0346 0.42 $21.84 $5.46 $4.37 86930 X Frozen blood prep 0347 0.98 $50.97 $12.74 $10.19 86931 X Frozen blood thaw 0347 0.98 $50.97 $12.74 $10.19 86932 X Frozen blood freeze/thaw 0346 0.42 $21.84 $5.46 $4.37 86940 A Hemolysins/agglutinins, auto 86941 A Hemolysins/agglutinins 86945 X Blood product/irradiation 0346 0.42 $21.84 $5.46 $4.37 86950 X Leukacyte transfusion 0347 0.98 $50.97 $12.74 $10.19 86965 X Pooling blood platelets 0346 0.42 $21.84 $5.46 $4.37 86970 X RBC pretreatment 0345 0.19 $9.88 $3.06 $1.98 86971 X RBC pretreatment 0345 0.19 $9.88 $3.06 $1.98 86972 X RBC pretreatment 0345 0.19 $9.88 $3.06 $1.98 86975 X RBC pretreatment, serum 0345 0.19 $9.88 $3.06 $1.98 86976 X RBC pretreatment, serum 0345 0.19 $9.88 $3.06 $1.98 86977 X RBC pretreatment, serum 0345 0.19 $9.88 $3.06 $1.98 86978 X RBC pretreatment, serum 0345 0.19 $9.88 $3.06 $1.98 86985 X Split blood or products 0347 0.98 $50.97 $12.74 $10.19 86999 X Transfusion procedure 0345 0.19 $9.88 $3.06 $1.98 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 Culture bacteria anaerobic 87076 A Culture anaerobe ident, each 87077 A Culture aerobic identify 87081 A Culture screen only 87084 A Culture of specimen by kit 87086 A Urine culture/colony count 87088 A Urine bacteria culture Start Printed Page 52264 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 Cultur 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 Macacroscopic 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 87198 A Cytomegalovirus antibody dfa 87199 A Enterovirus antibody, dfa 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 87260 A Adenovirus ag, if 87265 A Pertussis ag, if 87270 A Chlamydia trachomatis ag, if 87272 A Cryptosporidum/gardia 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 87301 A Adenovirus ag, eia 87320 A Chylmd trach ag, eia 87324 A Clostridium ag, eia 87327 A Cryptococcus neoform ag, eia 87328 A Cryptospor ag, eia 87332 A Cytomegalovirus ag, eia Start Printed Page 52265 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 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 Start Printed Page 52266 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 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 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 0343 0.47 $24.44 $13.20 $4.89 88106 X Cytopathology, fluids 0343 0.47 $24.44 $13.20 $4.89 88107 X Cytopathology, fluids 0343 0.47 $24.44 $13.20 $4.89 88108 X Cytopath, concentrate tech 0343 0.47 $24.44 $13.20 $4.89 88125 X Forensic cytopathology 0342 0.23 $11.96 $5.88 $2.39 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 lyr redo 88144 A Cytopath, c/v, thin lyr redo 88145 A Cytopath, c/v, thin lyr sel 88147 A Cytopath, c/v, automated Start Printed Page 52267 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 0342 0.23 $11.96 $5.88 $2.39 88161 X Cytopath smear, other source 0343 0.47 $24.44 $13.20 $4.89 88162 X Cytopath smear, other source 0343 0.47 $24.44 $13.20 $4.89 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 0.47 $24.44 $13.20 $4.89 88173 X Cytopath eval, fna, report 0343 0.47 $24.44 $13.20 $4.89 88180 X Cell marker study 0343 0.47 $24.44 $13.20 $4.89 88182 X Cell marker study 0344 0.66 $34.33 $18.54 $6.87 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 0.23 $11.96 $5.88 $2.39 88300 X Surgical path, gross 0342 0.23 $11.96 $5.88 $2.39 88302 X Tissue exam by pathologist 0342 0.23 $11.96 $5.88 $2.39 88304 X Tissue exam by pathologist 0343 0.47 $24.44 $13.20 $4.89 88305 X Tissue exam by pathologist 0343 0.47 $24.44 $13.20 $4.89 88307 X Tissue exam by pathologist 0344 0.66 $34.33 $18.54 $6.87 88309 X Tissue exam by pathologist 0344 0.66 $34.33 $18.54 $6.87 88311 X Decalcify tissue 0342 0.23 $11.96 $5.88 $2.39 88312 X Special stains 0342 0.23 $11.96 $5.88 $2.39 88313 X Special stains 0342 0.23 $11.96 $5.88 $2.39 88314 X Histochemical stain 0342 0.23 $11.96 $5.88 $2.39 88318 X Chemical histochemistry 0342 0.23 $11.96 $5.88 $2.39 88319 X Enzyme histochemistry 0342 0.23 $11.96 $5.88 $2.39 88321 X Microslide consultation 0342 0.23 $11.96 $5.88 $2.39 88323 X Microslide consultation 0343 0.47 $24.44 $13.20 $4.89 88325 X Comprehensive review of data 0344 0.66 $34.33 $18.54 $6.87 88329 X Path consult introp 0342 0.23 $11.96 $5.88 $2.39 88331 X Path consult intraop, 1 bloc 0343 0.47 $24.44 $13.20 $4.89 88332 X Path consult intraop, addl 0342 0.23 $11.96 $5.88 $2.39 88342 X Immunocytochemistry 0344 0.66 $34.33 $18.54 $6.87 88346 X Immunofluorescent study 0343 0.47 $24.44 $13.20 $4.89 88347 X Immunofluorescent study 0344 0.66 $34.33 $18.54 $6.87 Start Printed Page 52268 88348 X Electron microscopy 0661 3.46 $179.95 $98.97 $35.99 88349 X Scanning electron microscopy 0661 3.46 $179.95 $98.97 $35.99 88355 X Analysis, skeletal muscle 0344 0.66 $34.33 $18.54 $6.87 88356 X Analysis, nerve 0344 0.66 $34.33 $18.54 $6.87 88358 X Analysis, tumor 0344 0.66 $34.33 $18.54 $6.87 88362 X Nerve teasing preparations 0343 0.47 $24.44 $13.20 $4.89 88365 X Tissue hybridization 0344 0.66 $34.33 $18.54 $6.87 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 89060 A Exam synovial fluid crystals 89100 X Sample intestinal contents 0360 1.65 $85.81 $42.91 $17.16 89105 X Sample intestinal contents 0360 1.65 $85.81 $42.91 $17.16 89125 A Specimen fat stain 89130 X Sample stomach contents 0360 1.65 $85.81 $42.91 $17.16 89132 X Sample stomach contents 0360 1.65 $85.81 $42.91 $17.16 89135 X Sample stomach contents 0360 1.65 $85.81 $42.91 $17.16 89136 X Sample stomach contents 0360 1.65 $85.81 $42.91 $17.16 89140 X Sample stomach contents 0360 1.65 $85.81 $42.91 $17.16 89141 X Sample stomach contents 0360 1.65 $85.81 $42.91 $17.16 89160 A Exam feces for meat fibers 89190 A Nasal smear for eosinophils 89250 X Fertilization of oocyte 0348 0.83 $43.17 $8.63 89251 X Culture oocyte w/embryos 0348 0.83 $43.17 $8.63 89252 X Assist oocyte fertilization 0348 0.83 $43.17 $8.63 89253 X Embryo hatching 0348 0.83 $43.17 $8.63 89254 X Oocyte identification 0348 0.83 $43.17 $8.63 89255 X Prepare embryo for transfer 0348 0.83 $43.17 $8.63 89256 X Prepare cryopreserved embryo 0348 0.83 $43.17 $8.63 89257 X Sperm identification 0348 0.83 $43.17 $8.63 89258 X Cryopreservation, embryo 0348 0.83 $43.17 $8.63 89259 X Cryopreservation, sperm 0348 0.83 $43.17 $8.63 89260 X Sperm isolation, simple 0348 0.83 $43.17 $8.63 89261 X Sperm isolation, complex 0348 0.83 $43.17 $8.63 89264 X Identify sperm tissue 0348 0.83 $43.17 $8.63 89300 A Semen analysis 89310 A Semen analysis 89320 A Semen analysis 89321 A Semen analysis 89325 A Sperm antibody test 89329 A Sperm evaluation test 89330 A Evaluation, cervical mucus 89350 X Sputum specimen collection 0344 0.66 $34.33 $18.54 $6.87 89355 A Exam feces for starch 89360 X Collect sweat for test 0344 0.66 $34.33 $18.54 $6.87 89365 A Water load test 89399 A Pathology lab procedure 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 K Hep b ig, im 0356 0.69 $35.89 $7.18 90375 K Rabies ig, im/sc 0356 0.69 $35.89 $7.18 90376 K Rabies ig, heat treated 0356 0.69 $35.89 $7.18 90378 N Rsv ig, im, 50mg 90379 N Rsv ig, iv 90384 E Rh ig, full-dose, im 90385 N Rh ig, minidose, im 90386 E Rh ig, iv 90389 N Tetanus ig, im Start Printed Page 52269 90393 N Vaccina ig, im 90396 N Varicella-zoster ig, im 90399 E Immune globulin 90471 N Immunization admin 90472 N Immunization admin, each add 90473 E Immune admin oral/nasal 90474 E Immune admin oral/nasal addl 90476 N Adenovirus vaccine, type 4 90477 N Adenovirus vaccine, type 7 90581 K Anthrax vaccine, sc 0356 0.69 $35.89 $7.18 90585 N Bcg vaccine, percut 90586 N 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 0355 0.24 $12.48 $2.50 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 90657 K Flu vaccine, 6-35 mo, im 0354 0.09 $4.68 90658 K Flu vaccine, 3 yrs, im 0354 0.09 $4.68 90659 K Flu vaccine, whole, im 0354 0.09 $4.68 90660 E Flu vaccine, nasal 90665 N Lyme disease vaccine, im 90669 E Pneumococcal vacc, ped<5 90675 N Rabies vaccine, im 90676 N Rabies vaccine, id 90680 N Rotovirus vaccine, oral 90690 N Typhoid vaccine, oral 90691 N Typhoid vaccine, im 90692 N Typhoid vaccine, h-p, sc/id 90693 K Typhoid vaccine, akd, sc 0356 0.69 $35.89 $7.18 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 N Measles-rubella vaccine, sc 90709 K Rubella & mumps vaccine, sc 0356 0.69 $35.89 $7.18 90710 N Mmrv vaccine, sc 90712 N Oral poliovirus vaccine 90713 N Poliovirus, ipv, sc 90716 N Chicken pox vaccine, sc 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 K Dtap-hep b-ipv vaccine, im 0356 0.69 $35.89 $7.18 90725 N Cholera vaccine, injectable 90727 N Plague vaccine, im 90732 K Pneumococcal vaccine 0354 0.09 $4.68 90733 N Meningococcal vaccine, sc 90735 N Encephalitis vaccine, sc 90740 K Hepb vacc, ill pat 3 dose im 0356 0.69 $35.89 $7.18 90743 K Hep b vacc, adol, 2 dose, im 0356 0.69 $35.89 $7.18 90744 K Hepb vacc ped/adol 3 dose im 0356 0.69 $35.89 $7.18 90746 K Hep b vaccine, adult, im 0356 0.69 $35.89 $7.18 90747 K Hepb vacc, ill pat 4 dose im 0356 0.69 $35.89 $7.18 90748 K Hep b/hib vaccine, im 0355 0.24 $12.48 $2.50 90749 N Vaccine toxoid 90780 E IV infusion therapy, 1 hour Start Printed Page 52270 90781 E IV infusion, additional hour 90782 X Injection, sc/im 0353 0.43 $22.36 $4.47 90783 X Injection, ia 0359 0.83 $43.17 $8.63 90784 X Injection, iv 0359 0.83 $43.17 $8.63 90788 X Injection of antibiotic 0359 0.83 $43.17 $8.63 90799 X Ther/prophylactic/dx inject 0352 0.14 $7.28 $1.46 90801 S Psy dx interview 0323 1.95 $101.42 $21.26 $20.28 90802 S Intac psy dx interview 0323 1.95 $101.42 $21.26 $20.28 90804 S Psytx, office, 20-30 min 0322 1.44 $74.89 $12.40 $14.98 90805 S Psytx, off, 20-30 min w/e&m 0322 1.44 $74.89 $12.40 $14.98 90806 S Psytx, off, 45-50 min 0323 1.95 $101.42 $21.26 $20.28 90807 S Psytx, off, 45-50 min w/e&m 0323 1.95 $101.42 $21.26 $20.28 90808 S Psytx, office, 75-80 min 0323 1.95 $101.42 $21.26 $20.28 90809 S Psytx, off, 75-80, w/e&m 0323 1.95 $101.42 $21.26 $20.28 90810 S Intac psytx, off, 20-30 min 0322 1.44 $74.89 $12.40 $14.98 90811 S Intac psytx, 20-30, w/e&m 0322 1.44 $74.89 $12.40 $14.98 90812 S Intac psytx, off, 45-50 min 0323 1.95 $101.42 $21.26 $20.28 90813 S Intac psytx, 45-50 min w/e&m 0323 1.95 $101.42 $21.26 $20.28 90814 S Intac psytx, off, 75-80 min 0323 1.95 $101.42 $21.26 $20.28 90815 S Intac psytx, 75-80 w/e&m 0323 1.95 $101.42 $21.26 $20.28 90816 S Psytx, hosp, 20-30 min 0322 1.44 $74.89 $12.40 $14.98 90817 S Psytx, hosp, 20-30 min w/e&m 0322 1.44 $74.89 $12.40 $14.98 90818 S Psytx, hosp, 45-50 min 0323 1.95 $101.42 $21.26 $20.28 90819 S Psytx, hosp, 45-50 min w/e&m 0323 1.95 $101.42 $21.26 $20.28 90821 S Psytx, hosp, 75-80 min 0323 1.95 $101.42 $21.26 $20.28 90822 S Psytx, hosp, 75-80 min w/e&m 0323 1.95 $101.42 $21.26 $20.28 90823 S Intac psytx, hosp, 20-30 min 0322 1.44 $74.89 $12.40 $14.98 90824 S Intac psytx, hsp 20-30 w/e&m 0322 1.44 $74.89 $12.40 $14.98 90826 S Intac psytx, hosp, 45-50 min 0323 1.95 $101.42 $21.26 $20.28 90827 S Intac psytx, hsp 45-50 w/e&m 0323 1.95 $101.42 $21.26 $20.28 90828 S Intac psytx, hosp, 75-80 min 0323 1.95 $101.42 $21.26 $20.28 90829 S Intac psytx, hsp 75-80 w/e&m 0323 1.95 $101.42 $21.26 $20.28 90845 S Psychoanalysis 0323 1.95 $101.42 $21.26 $20.28 90846 S Family psytx w/o patient 0324 2.71 $140.94 $28.19 90847 S Family psytx w/patient 0324 2.71 $140.94 $28.19 90849 S Multiple family group psytx 0325 1.55 $80.61 $18.27 $16.12 90853 S Group psychotherapy 0325 1.55 $80.61 $18.27 $16.12 90857 S Intac group psytx 0325 1.55 $80.61 $18.27 $16.12 90862 X Medication management 0374 1.20 $62.41 $12.48 90865 S Narcosynthesis 0323 1.95 $101.42 $21.26 $20.28 90870 S Electroconvulsive therapy 0320 4.46 $231.96 $80.06 $46.39 90871 S Electroconvulsive therapy 0320 4.46 $231.96 $80.06 $46.39 90875 E Psychophysiological therapy 90876 E Psychophysiological therapy 90880 S Hypnotherapy 0323 1.95 $101.42 $21.26 $20.28 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 1.44 $74.89 $12.40 $14.98 90901 S Biofeedback train, any meth 0321 1.27 $66.05 $21.78 $13.21 90911 S Biofeedback peri/uro/rectal 0321 1.27 $66.05 $21.78 $13.21 90918 A ESRD related services, month 90919 A ESRD related services, month 90920 A ESRD related services, month 90921 A ESRD related services, month 90922 A ESRD related services, day 90923 A Esrd related services, day 90924 A Esrd related services, day 90925 A Esrd related services, day 90935 S Hemodialysis, one evaluation 0170 4.79 $249.12 $49.82 90937 E Hemodialysis, repeated eval 90939 N Hemodialysis study, transcut 90940 N Hemodialysis access study 90945 S Dialysis, one evaluation 0170 4.79 $249.12 $49.82 90947 E Dialysis, repeated eval Start Printed Page 52271 90989 E Dialysis training, complete 90993 E Dialysis training, incompl 90997 E Hemoperfusion 90999 E Dialysis procedure 91000 X Esophageal intubation 0361 3.55 $184.63 $83.23 $36.93 91010 X Esophagus motility study 0361 3.55 $184.63 $83.23 $36.93 91011 X Esophagus motility study 0361 3.55 $184.63 $83.23 $36.93 91012 X Esophagus motility study 0361 3.55 $184.63 $83.23 $36.93 91020 X Gastric motility 0361 3.55 $184.63 $83.23 $36.93 91030 X Acid perfusion of esophagus 0361 3.55 $184.63 $83.23 $36.93 91032 X Esophagus, acid reflux test 0361 3.55 $184.63 $83.23 $36.93 91033 X Prolonged acid reflux test 0361 3.55 $184.63 $83.23 $36.93 91052 X Gastric analysis test 0361 3.55 $184.63 $83.23 $36.93 91055 X Gastric intubation for smear 0360 1.65 $85.81 $42.91 $17.16 91060 X Gastric saline load test 0360 1.65 $85.81 $42.91 $17.16 91065 X Breath hydrogen test 0360 1.65 $85.81 $42.91 $17.16 91100 X Pass intestine bleeding tube 0360 1.65 $85.81 $42.91 $17.16 91105 X Gastric intubation treatment 0360 1.65 $85.81 $42.91 $17.16 91122 T Anal pressure record 0156 3.10 $161.23 $48.37 $32.25 91123 N Irrigate fecal impaction 91132 X Electrogastrography 0360 1.65 $85.81 $42.91 $17.16 91133 X Electrogastrography w/test 0360 1.65 $85.81 $42.91 $17.16 91299 X Gastroenterology procedure 0360 1.65 $85.81 $42.91 $17.16 92002 V Eye exam, new patient 0601 1.04 $54.09 $10.82 92004 V Eye exam, new patient 0602 1.57 $81.65 $16.33 92012 V Eye exam established pat 0600 0.91 $47.33 $9.47 92014 V Eye exam & treatment 0602 1.57 $81.65 $16.33 92015 E Refraction 92018 T New eye exam & treatment 0699 2.37 $123.26 $55.47 $24.65 92019 S Eye exam & treatment 0698 1.01 $52.53 $20.49 $10.51 92020 S Special eye evaluation 0230 0.78 $40.57 $15.82 $8.11 92060 S Special eye evaluation 0230 0.78 $40.57 $15.82 $8.11 92065 S Orthoptic/pleoptic training 0230 0.78 $40.57 $15.82 $8.11 92070 N Fitting of contact lens 92081 S Visual field examination(s) 0230 0.78 $40.57 $15.82 $8.11 92082 S Visual field examination(s) 0698 1.01 $52.53 $20.49 $10.51 92083 S Visual field examination(s) 0698 1.01 $52.53 $20.49 $10.51 92100 N Serial tonometry exam(s) 92120 S Tonography & eye evaluation 0230 0.78 $40.57 $15.82 $8.11 92130 S Water provocation tonography 0698 1.01 $52.53 $20.49 $10.51 92135 S Opthalmic dx imaging 0230 0.78 $40.57 $15.82 $8.11 92136 S Ophthalmic biometry 0230 0.78 $40.57 $15.82 $8.11 92140 S Glaucoma provocative tests 0698 1.01 $52.53 $20.49 $10.51 92225 S Special eye exam, initial 0698 1.01 $52.53 $20.49 $10.51 92226 S Special eye exam, subsequent 0698 1.01 $52.53 $20.49 $10.51 92230 T Eye exam with photos 0699 2.37 $123.26 $55.47 $24.65 92235 T Eye exam with photos 0699 2.37 $123.26 $55.47 $24.65 92240 S Icg angiography 0231 2.24 $116.50 $52.43 $23.30 92250 S Eye exam with photos 0230 0.78 $40.57 $15.82 $8.11 92260 S Ophthalmoscopy/dynamometry 0230 0.78 $40.57 $15.82 $8.11 92265 S Eye muscle evaluation 0231 2.24 $116.50 $52.43 $23.30 92270 S Electro-oculography 0698 1.01 $52.53 $20.49 $10.51 92275 S Electroretinography 0231 2.24 $116.50 $52.43 $23.30 92283 S Color vision examination 0230 0.78 $40.57 $15.82 $8.11 92284 S Dark adaptation eye exam 0698 1.01 $52.53 $20.49 $10.51 92285 S Eye photography 0230 0.78 $40.57 $15.82 $8.11 92286 S Internal eye photography 0698 1.01 $52.53 $20.49 $10.51 92287 S Internal eye photography 0231 2.24 $116.50 $52.43 $23.30 92310 E Contact lens fitting 92311 X Contact lens fitting 0362 2.83 $147.19 $29.44 92312 X Contact lens fitting 0362 2.83 $147.19 $29.44 92313 X Contact lens fitting 0362 2.83 $147.19 $29.44 92314 E Prescription of contact lens 92315 X Prescription of contact lens 0362 2.83 $147.19 $29.44 92316 X Prescription of contact lens 0362 2.83 $147.19 $29.44 92317 X Prescription of contact lens 0362 2.83 $147.19 $29.44 Start Printed Page 52272 92325 X Modification of contact lens 0362 2.83 $147.19 $29.44 92326 X Replacement of contact lens 0362 2.83 $147.19 $29.44 92330 S Fitting of artificial eye 0230 0.78 $40.57 $15.82 $8.11 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 2.83 $147.19 $29.44 92353 X Special spectacles fitting 0362 2.83 $147.19 $29.44 92354 X Special spectacles fitting 0362 2.83 $147.19 $29.44 92355 X Special spectacles fitting 0362 2.83 $147.19 $29.44 92358 X Eye prosthesis service 0362 2.83 $147.19 $29.44 92370 E Repair & adjust spectacles 92371 X Repair & adjust spectacles 0362 2.83 $147.19 $29.44 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 0.78 $40.57 $15.82 $8.11 92502 T Ear and throat examination 0251 1.92 $99.86 $19.97 92504 N Ear microscopy examination 92506 A Speech/hearing evaluation 92507 A Speech/hearing therapy 92508 A Speech/hearing therapy 92510 A Rehab for ear implant 92511 T Nasopharyngoscopy 0071 1.01 $52.53 $14.18 $10.51 92512 X Nasal function studies 0363 0.76 $39.53 $14.63 $7.91 92516 X Facial nerve function test 0660 1.65 $85.81 $31.75 $17.16 92520 X Laryngeal function studies 0660 1.65 $85.81 $31.75 $17.16 92525 A Oral function evaluation 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 0.76 $39.53 $14.63 $7.91 92542 X Positional nystagmus test 0363 0.76 $39.53 $14.63 $7.91 92543 X Caloric vestibular test 0660 1.65 $85.81 $31.75 $17.16 92544 X Optokinetic nystagmus test 0363 0.76 $39.53 $14.63 $7.91 92545 X Oscillating tracking test 0363 0.76 $39.53 $14.63 $7.91 92546 X Sinusoidal rotational test 0660 1.65 $85.81 $31.75 $17.16 92547 X Supplemental electrical test 0363 0.76 $39.53 $14.63 $7.91 92548 X Posturography 0660 1.65 $85.81 $31.75 $17.16 92551 E Pure tone hearing test, air 92552 X Pure tone audiometry, air 0364 0.45 $23.40 $9.13 $4.68 92553 X Audiometry, air & bone 0365 1.31 $68.13 $20.16 $13.63 92555 X Speech threshold audiometry 0364 0.45 $23.40 $9.13 $4.68 92556 X Speech audiometry, complete 0364 0.45 $23.40 $9.13 $4.68 92557 X Comprehensive hearing test 0365 1.31 $68.13 $20.16 $13.63 92559 E Group audiometric testing 92560 E Bekesy audiometry, screen 92561 X Bekesy audiometry, diagnosis 0365 1.31 $68.13 $20.16 $13.63 92562 X Loudness balance test 0364 0.45 $23.40 $9.13 $4.68 92563 X Tone decay hearing test 0364 0.45 $23.40 $9.13 $4.68 92564 X Sisi hearing test 0364 0.45 $23.40 $9.13 $4.68 92565 X Stenger test, pure tone 0364 0.45 $23.40 $9.13 $4.68 92567 X Tympanometry 0364 0.45 $23.40 $9.13 $4.68 92568 X Acoustic reflex testing 0364 0.45 $23.40 $9.13 $4.68 92569 X Acoustic reflex decay test 0364 0.45 $23.40 $9.13 $4.68 92571 X Filtered speech hearing test 0364 0.45 $23.40 $9.13 $4.68 92572 X Staggered spondaic word test 0364 0.45 $23.40 $9.13 $4.68 92573 X Lombard test 0364 0.45 $23.40 $9.13 $4.68 92575 X Sensorineural acuity test 0365 1.31 $68.13 $20.16 $13.63 92576 X Synthetic sentence test 0364 0.45 $23.40 $9.13 $4.68 Start Printed Page 52273 92577 X Stenger test, speech 0365 1.31 $68.13 $20.16 $13.63 92579 X Visual audiometry (vra) 0365 1.31 $68.13 $20.16 $13.63 92582 X Conditioning play audiometry 0365 1.31 $68.13 $20.16 $13.63 92583 X Select picture audiometry 0364 0.45 $23.40 $9.13 $4.68 92584 X Electrocochleography 0660 1.65 $85.81 $31.75 $17.16 92585 S Auditor evoke potent, compre 0216 3.06 $159.15 $71.62 $31.83 92586 S Auditor evoke potent, limit 0218 1.06 $55.13 $11.03 92587 X Evoked auditory test 0363 0.76 $39.53 $14.63 $7.91 92588 X Evoked auditory test 0660 1.65 $85.81 $31.75 $17.16 92589 X Auditory function test(s) 0364 0.45 $23.40 $9.13 $4.68 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 0365 1.31 $68.13 $20.16 $13.63 92597 E Voice Prosthetic Evaluation 92598 E Voice Prosthetic Modification 92599 X ENT procedure/service 0364 0.45 $23.40 $9.13 $4.68 92950 S Heart/lung resuscitation cpr 0094 2.68 $139.38 $47.39 $27.88 92953 S Temporary external pacing 0094 2.68 $139.38 $47.39 $27.88 92960 S Cardioversion electric, ext 0679 5.70 $296.45 $100.79 $59.29 92961 S Cardioversion, electric, int 0679 5.70 $296.45 $100.79 $59.29 92970 C Cardioassist, internal 92971 C Cardioassist, external 92973 T Percut coronary thrombectomy 0973 $250.00 $50.00 92974 T Cath place, cardio brachytx 0981 $2,250.00 $450.00 92975 C Dissolve clot, heart vessel 92977 T Dissolve clot, heart vessel 0676 4.62 $240.28 $64.88 $48.06 92978 S Intravasc us, heart add-on 0670 14.78 $768.69 $276.73 $153.74 92979 S Intravasc us, heart add-on 0670 14.78 $768.69 $276.73 $153.74 92980 T Insert intracoronary stent 0104 72.72 $3,782.09 $756.42 92981 T Insert intracoronary stent 0104 72.72 $3,782.09 $756.42 92982 T Coronary artery dilation 0083 47.83 $2,487.59 $497.52 92984 T Coronary artery dilation 0083 47.83 $2,487.59 $497.52 92986 T Revision of aortic valve 0083 47.83 $2,487.59 $497.52 92987 T Revision of mitral valve 0083 47.83 $2,487.59 $497.52 92990 T Revision of pulmonary valve 0083 47.83 $2,487.59 $497.52 92992 C Revision of heart chamber 92993 C Revision of heart chamber 92995 T Coronary atherectomy 0082 75.42 $3,922.52 $1,137.53 $784.50 92996 T Coronary atherectomy add-on 0082 75.42 $3,922.52 $1,137.53 $784.50 92997 T Pul art balloon repr, percut 0081 22.69 $1,180.08 $236.02 92998 T Pul art balloon repr, percut 0081 22.69 $1,180.08 $236.02 93000 E Electrocardiogram, complete 93005 S Electrocardiogram, tracing 0099 0.38 $19.76 $3.95 93010 A Electrocardiogram report 93012 N Transmission of ecg 93014 E Report on transmitted ecg 93015 E Cardiovascular stress test 93016 E Cardiovascular stress test 93017 X Cardiovascular stress test 0100 1.34 $69.69 $38.33 $13.94 93018 E Cardiovascular stress test 93024 X Cardiac drug stress test 0100 1.34 $69.69 $38.33 $13.94 93025 X Microvolt t-wave assess 0100 1.34 $69.69 $38.33 $13.94 93040 E Rhythm ECG with report 93041 S Rhythm ECG, tracing 0099 0.38 $19.76 $3.95 93042 E Rhythm ECG, report 93224 E ECG monitor/report, 24 hrs 93225 X ECG monitor/record, 24 hrs 0100 1.34 $69.69 $38.33 $13.94 93226 X ECG monitor/report, 24 hrs 0100 1.34 $69.69 $38.33 $13.94 93227 E ECG monitor/review, 24 hrs 93230 E ECG monitor/report, 24 hrs 93231 X Ecg monitor/record, 24 hrs 0100 1.34 $69.69 $38.33 $13.94 93232 X ECG monitor/report, 24 hrs 0100 1.34 $69.69 $38.33 $13.94 Start Printed Page 52274 93233 E ECG monitor/review, 24 hrs 93235 E ECG monitor/report, 24 hrs 93236 X ECG monitor/report, 24 hrs 0100 1.34 $69.69 $38.33 $13.94 93237 E ECG monitor/review, 24 hrs 93268 E ECG record/review 93270 X ECG recording 0097 0.84 $43.69 $23.80 $8.74 93271 X Ecg/monitoring and analysis 0097 0.84 $43.69 $23.80 $8.74 93272 E Ecg/review, interpret only 93278 S ECG/signal-averaged 0099 0.38 $19.76 $3.95 93303 S Echo transthoracic 0269 3.42 $177.87 $92.49 $35.57 93304 S Echo transthoracic 0697 1.51 $78.53 $40.84 $15.71 93307 S Echo exam of heart 0269 3.42 $177.87 $92.49 $35.57 93308 S Echo exam of heart 0697 1.51 $78.53 $40.84 $15.71 93312 S Echo transesophageal 0270 5.65 $293.85 $146.79 $58.77 93313 S Echo transesophageal 0270 5.65 $293.85 $146.79 $58.77 93314 N Echo transesophageal 93315 S Echo transesophageal 0270 5.65 $293.85 $146.79 $58.77 93316 S Echo transesophageal 0270 5.65 $293.85 $146.79 $58.77 93317 N Echo transesophageal 93318 S Echo transesophageal intraop 0270 5.65 $293.85 $146.79 $58.77 93320 S Doppler echo exam, heart 0671 1.68 $87.38 $45.44 $17.48 93321 S Doppler echo exam, heart 0697 1.51 $78.53 $40.84 $15.71 93325 S Doppler color flow add-on 0697 1.51 $78.53 $40.84 $15.71 93350 S Echo transthoracic 0269 3.42 $177.87 $92.49 $35.57 93501 T Right heart catheterization 0080 35.64 $1,853.60 $838.92 $370.72 93503 T Insert/place heart catheter 0103 11.26 $585.62 $210.82 $117.12 93505 T Biopsy of heart lining 0103 11.26 $585.62 $210.82 $117.12 93508 T Cath placement, angiography 0080 35.64 $1,853.60 $838.92 $370.72 93510 T Left heart catheterization 0080 35.64 $1,853.60 $838.92 $370.72 93511 T Left heart catheterization 0080 35.64 $1,853.60 $838.92 $370.72 93514 T Left heart catheterization 0080 35.64 $1,853.60 $838.92 $370.72 93524 T Left heart catheterization 0080 35.64 $1,853.60 $838.92 $370.72 93526 T Rt & Lt heart catheters 0080 35.64 $1,853.60 $838.92 $370.72 93527 T Rt & Lt heart catheters 0080 35.64 $1,853.60 $838.92 $370.72 93528 T Rt & Lt heart catheters 0080 35.64 $1,853.60 $838.92 $370.72 93529 T Rt< heart catheterization 0080 35.64 $1,853.60 $838.92 $370.72 93530 T Rt heart cath, congenital 0080 35.64 $1,853.60 $838.92 $370.72 93531 T R & l heart cath, congenital 0080 35.64 $1,853.60 $838.92 $370.72 93532 T R & l heart cath, congenital 0080 35.64 $1,853.60 $838.92 $370.72 93533 T R & l heart cath, congenital 0080 35.64 $1,853.60 $838.92 $370.72 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 N Heart flow reserve measure 93572 N Heart flow reserve measure 93600 T Bundle of His recording 0087 5.81 $302.17 $60.43 93602 T Intra-atrial recording 0087 5.81 $302.17 $60.43 93603 T Right ventricular recording 0087 5.81 $302.17 $60.43 93609 T Map tachycardia, add-on 0087 5.81 $302.17 $60.43 93610 T Intra-atrial pacing 0087 5.81 $302.17 $60.43 93612 T Intraventricular pacing 0087 5.81 $302.17 $60.43 93613 T Electrophys map, 3d, add-on 0087 5.81 $302.17 $60.43 93615 T Esophageal recording 0087 5.81 $302.17 $60.43 93616 T Esophageal recording 0087 5.81 $302.17 $60.43 93618 T Heart rhythm pacing 0087 5.81 $302.17 $60.43 93619 T Electrophysiology evaluation 0085 31.77 $1,652.33 $363.51 $330.47 93620 T Electrophysiology evaluation 0085 31.77 $1,652.33 $363.51 $330.47 93621 T Electrophysiology evaluation 0085 31.77 $1,652.33 $363.51 $330.47 Start Printed Page 52275 93622 T Electrophysiology evaluation 0085 31.77 $1,652.33 $363.51 $330.47 93623 T Stimulation, pacing heart 0087 5.81 $302.17 $60.43 93624 S Electrophysiologic study 0084 9.60 $499.29 $99.86 93631 T Heart pacing, mapping 0087 5.81 $302.17 $60.43 93640 S Evaluation heart device 0084 9.60 $499.29 $99.86 93641 S Electrophysiology evaluation 0084 9.60 $499.29 $99.86 93642 S Electrophysiology evaluation 0084 9.60 $499.29 $99.86 93650 T Ablate heart dysrhythm focus 0086 43.70 $2,272.79 $772.75 $454.56 93651 T Ablate heart dysrhythm focus 0086 43.70 $2,272.79 $772.75 $454.56 93652 T Ablate heart dysrhythm focus 0086 43.70 $2,272.79 $772.75 $454.56 93660 S Tilt table evaluation 0101 4.40 $228.84 $105.27 $45.77 93662 S Intracardiac ecg (ice) 0670 14.78 $768.69 $276.73 $153.74 93668 E Peripheral vascular rehab 93701 S Bioimpedance, thoracic 0099 0.38 $19.76 $3.95 93720 E Total body plethysmography 93721 X Plethysmography tracing 0368 0.96 $49.93 $24.97 $9.99 93722 E Plethysmography report 93724 S Analyze pacemaker system 0690 0.45 $23.40 $10.63 $4.68 93727 S Analyze ilr system 0690 0.45 $23.40 $10.63 $4.68 93731 S Analyze pacemaker system 0690 0.45 $23.40 $10.63 $4.68 93732 S Analyze pacemaker system 0690 0.45 $23.40 $10.63 $4.68 93733 S Telephone analy, pacemaker 0690 0.45 $23.40 $10.63 $4.68 93734 S Analyze pacemaker system 0690 0.45 $23.40 $10.63 $4.68 93735 S Analyze pacemaker system 0690 0.45 $23.40 $10.63 $4.68 93736 S Telephone analy, pacemaker 0690 0.45 $23.40 $10.63 $4.68 93740 X Temperature gradient studies 0367 0.60 $31.21 $15.61 $6.24 93741 S Analyze ht pace device sngl 0689 0.60 $31.21 $12.03 $6.24 93742 S Analyze ht pace device sngl 0689 0.60 $31.21 $12.03 $6.24 93743 S Analyze ht pace device dual 0689 0.60 $31.21 $12.03 $6.24 93744 S Analyze ht pace device dual 0689 0.60 $31.21 $12.03 $6.24 93760 E Cephalic thermogram 93762 E Peripheral thermogram 93770 N Measure venous pressure 93784 E Ambulatory BP monitoring 93786 X Ambulatory BP recording 0097 0.84 $43.69 $23.80 $8.74 93788 E Ambulatory BP analysis 93790 E Review/report BP recording 93797 S Cardiac rehab 0095 0.66 $34.33 $16.73 $6.87 93798 S Cardiac rehab/monitor 0095 0.66 $34.33 $16.73 $6.87 93799 S Cardiovascular procedure 0096 1.82 $94.66 $48.15 $18.93 93875 S Extracranial study 0096 1.82 $94.66 $48.15 $18.93 93880 S Extracranial study 0267 2.58 $134.18 $65.52 $26.84 93882 S Extracranial study 0267 2.58 $134.18 $65.52 $26.84 93886 S Intracranial study 0267 2.58 $134.18 $65.52 $26.84 93888 S Intracranial study 0266 1.70 $88.42 $48.63 $17.68 93922 S Extremity study 0096 1.82 $94.66 $48.15 $18.93 93923 S Extremity study 0096 1.82 $94.66 $48.15 $18.93 93924 S Extremity study 0096 1.82 $94.66 $48.15 $18.93 93925 S Lower extremity study 0267 2.58 $134.18 $65.52 $26.84 93926 S Lower extremity study 0267 2.58 $134.18 $65.52 $26.84 93930 S Upper extremity study 0267 2.58 $134.18 $65.52 $26.84 93931 S Upper extremity study 0266 1.70 $88.42 $48.63 $17.68 93965 S Extremity study 0096 1.82 $94.66 $48.15 $18.93 93970 S Extremity study 0267 2.58 $134.18 $65.52 $26.84 93971 S Extremity study 0267 2.58 $134.18 $65.52 $26.84 93975 S Vascular study 0267 2.58 $134.18 $65.52 $26.84 93976 S Vascular study 0267 2.58 $134.18 $65.52 $26.84 93978 S Vascular study 0267 2.58 $134.18 $65.52 $26.84 93979 S Vascular study 0267 2.58 $134.18 $65.52 $26.84 93980 S Penile vascular study 0267 2.58 $134.18 $65.52 $26.84 93981 S Penile vascular study 0267 2.58 $134.18 $65.52 $26.84 93990 S Doppler flow testing 0267 2.58 $134.18 $65.52 $26.84 94010 X Breathing capacity test 0368 0.96 $49.93 $24.97 $9.99 94014 X Patient recorded spirometry 0367 0.60 $31.21 $15.61 $6.24 94015 X Patient recorded spirometry 0367 0.60 $31.21 $15.61 $6.24 94016 A Review patient spirometry Start Printed Page 52276 94060 X Evaluation of wheezing 0368 0.96 $49.93 $24.97 $9.99 94070 X Evaluation of wheezing 0369 2.39 $124.30 $41.02 $24.86 94150 X Vital capacity test 0367 0.60 $31.21 $15.61 $6.24 94200 X Lung function test (MBC/MVV) 0367 0.60 $31.21 $15.61 $6.24 94240 X Residual lung capacity 0368 0.96 $49.93 $24.97 $9.99 94250 X Expired gas collection 0367 0.60 $31.21 $15.61 $6.24 94260 X Thoracic gas volume 0368 0.96 $49.93 $24.97 $9.99 94350 X Lung nitrogen washout curve 0368 0.96 $49.93 $24.97 $9.99 94360 X Measure airflow resistance 0367 0.60 $31.21 $15.61 $6.24 94370 X Breath airway closing volume 0367 0.60 $31.21 $15.61 $6.24 94375 X Respiratory flow volume loop 0367 0.60 $31.21 $15.61 $6.24 94400 X CO2 breathing response curve 0367 0.60 $31.21 $15.61 $6.24 94450 X Hypoxia response curve 0367 0.60 $31.21 $15.61 $6.24 94620 X Pulmonary stress test/simple 0368 0.96 $49.93 $24.97 $9.99 94621 X Pulm stress test/complex 0369 2.39 $124.30 $41.02 $24.86 94640 S Airway inhalation treatment 0077 0.26 $13.52 $7.44 $2.70 94642 S Aerosol inhalation treatment 0078 0.68 $35.37 $15.21 $7.07 94650 S Pressure breathing (IPPB) 0077 0.26 $13.52 $7.44 $2.70 94651 S Pressure breathing (IPPB) 0077 0.26 $13.52 $7.44 $2.70 94652 C Pressure breathing (IPPB) 94656 S Initial ventilator mgmt 0079 1.63 $84.77 $16.80 $16.95 94657 S Continued ventilator mgmt 0079 1.63 $84.77 $16.80 $16.95 94660 S Pos airway pressure, CPAP 0068 1.59 $82.69 $45.48 $16.54 94662 S Neg press ventilation, cnp 0079 1.63 $84.77 $16.80 $16.95 94664 S Aerosol or vapor inhalations 0077 0.26 $13.52 $7.44 $2.70 94665 S Aerosol or vapor inhalations 0077 0.26 $13.52 $7.44 $2.70 94667 S Chest wall manipulation 0077 0.26 $13.52 $7.44 $2.70 94668 S Chest wall manipulation 0077 0.26 $13.52 $7.44 $2.70 94680 X Exhaled air analysis, o2 0367 0.60 $31.21 $15.61 $6.24 94681 X Exhaled air analysis, o2/co2 0368 0.96 $49.93 $24.97 $9.99 94690 X Exhaled air analysis 0367 0.60 $31.21 $15.61 $6.24 94720 X Monoxide diffusing capacity 0368 0.96 $49.93 $24.97 $9.99 94725 X Membrane diffusion capacity 0368 0.96 $49.93 $24.97 $9.99 94750 X Pulmonary compliance study 0367 0.60 $31.21 $15.61 $6.24 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 0.60 $31.21 $15.61 $6.24 94772 X Breath recording, infant 0369 2.39 $124.30 $41.02 $24.86 94799 X Pulmonary service/procedure 0367 0.60 $31.21 $15.61 $6.24 95004 X Allergy skin tests 0370 0.74 $38.49 $11.16 $7.70 95010 X Sensitivity skin tests 0370 0.74 $38.49 $11.16 $7.70 95015 X Sensitivity skin tests 0370 0.74 $38.49 $11.16 $7.70 95024 X Allergy skin tests 0370 0.74 $38.49 $11.16 $7.70 95027 X Skin end point titration 0370 0.74 $38.49 $11.16 $7.70 95028 X Allergy skin tests 0370 0.74 $38.49 $11.16 $7.70 95044 X Allergy patch tests 0370 0.74 $38.49 $11.16 $7.70 95052 X Photo patch test 0370 0.74 $38.49 $11.16 $7.70 95056 X Photosensitivity tests 0370 0.74 $38.49 $11.16 $7.70 95060 X Eye allergy tests 0370 0.74 $38.49 $11.16 $7.70 95065 X Nose allergy test 0370 0.74 $38.49 $11.16 $7.70 95070 X Bronchial allergy tests 0369 2.39 $124.30 $41.02 $24.86 95071 X Bronchial allergy tests 0369 2.39 $124.30 $41.02 $24.86 95075 X Ingestion challenge test 0361 3.55 $184.63 $83.23 $36.93 95078 X Provocative testing 0370 0.74 $38.49 $11.16 $7.70 95115 X Immunotherapy, one injection 0352 0.14 $7.28 $1.46 95117 X Immunotherapy injections 0353 0.43 $22.36 $4.47 95120 E Immunotherapy, one injection 95125 E Immunotherapy, many antigens 95130 E Immunotherapy, insect venom 95131 E Immunotherapy, insect venoms 95132 E Immunotherapy, insect venoms 95133 E Immunotherapy, insect venoms 95134 E Immunotherapy, insect venoms 95144 X Antigen therapy services 0371 0.50 $26.00 $5.20 95145 X Antigen therapy services 0371 0.50 $26.00 $5.20 Start Printed Page 52277 95146 X Antigen therapy services 0371 0.50 $26.00 $5.20 95147 X Antigen therapy services 0371 0.50 $26.00 $5.20 95148 X Antigen therapy services 0371 0.50 $26.00 $5.20 95149 X Antigen therapy services 0371 0.50 $26.00 $5.20 95165 X Antigen therapy services 0371 0.50 $26.00 $5.20 95170 X Antigen therapy services 0371 0.50 $26.00 $5.20 95180 X Rapid desensitization 0370 0.74 $38.49 $11.16 $7.70 95199 X Allergy immunology services 0370 0.74 $38.49 $11.16 $7.70 95250 T Glucose monitoring, cont 0972 $150.00 $30.00 95805 S Multiple sleep latency test 0209 12.09 $628.79 $280.58 $125.76 95806 S Sleep study, unattended 0213 3.38 $175.79 $70.41 $35.16 95807 S Sleep study, attended 0209 12.09 $628.79 $280.58 $125.76 95808 S Polysomnography, 1-3 0209 12.09 $628.79 $280.58 $125.76 95810 S Polysomnography, 4 or more 0209 12.09 $628.79 $280.58 $125.76 95811 S Polysomnography w/cpap 0209 12.09 $628.79 $280.58 $125.76 95812 S Electroencephalogram (EEG) 0213 3.38 $175.79 $70.41 $35.16 95813 S Electroencephalogram (EEG) 0213 3.38 $175.79 $70.41 $35.16 95816 S Electroencephalogram (EEG) 0214 2.37 $123.26 $61.63 $24.65 95819 S Electroencephalogram (EEG) 0214 2.37 $123.26 $61.63 $24.65 95822 S Sleep electroencephalogram 0214 2.37 $123.26 $61.63 $24.65 95824 S Electroencephalography 0214 2.37 $123.26 $61.63 $24.65 95827 S Night electroencephalogram 0209 12.09 $628.79 $280.58 $125.76 95829 S Surgery electrocorticogram 0214 2.37 $123.26 $61.63 $24.65 95830 E Insert electrodes for EEG 95831 N Limb muscle testing, manual 95832 N Hand muscle testing, manual 95833 N Body muscle testing, manual 95834 N Body muscle testing, manual 95851 N Range of motion measurements 95852 N Range of motion measurements 95857 S Tensilon test 0218 1.06 $55.13 $11.03 95858 S Tensilon test & myogram 0218 1.06 $55.13 $11.03 95860 S Muscle test, one limb 0218 1.06 $55.13 $11.03 95861 S Muscle test, two limbs 0218 1.06 $55.13 $11.03 95863 S Muscle test, 3 limbs 0218 1.06 $55.13 $11.03 95864 S Muscle test, 4 limbs 0218 1.06 $55.13 $11.03 95867 S Muscle test, head or neck 0218 1.06 $55.13 $11.03 95868 S Muscle test, head or neck 0218 1.06 $55.13 $11.03 95869 S Muscle test, thor paraspinal 0215 0.60 $31.21 $6.24 95870 S Muscle test, nonparaspinal 0218 1.06 $55.13 $11.03 95872 S Muscle test, one fiber 0218 1.06 $55.13 $11.03 95875 S Limb exercise test 0215 0.60 $31.21 $6.24 95900 S Motor nerve conduction test 0218 1.06 $55.13 $11.03 95903 S Motor nerve conduction test 0218 1.06 $55.13 $11.03 95904 S Sense nerve conduction test 0215 0.60 $31.21 $6.24 95920 S Intraop nerve test add-on 0216 3.06 $159.15 $71.62 $31.83 95921 S Autonomic nerv function test 0218 1.06 $55.13 $11.03 95922 S Autonomic nerv function test 0218 1.06 $55.13 $11.03 95923 S Autonomic nerv function test 0215 0.60 $31.21 $6.24 95925 S Somatosensory testing 0216 3.06 $159.15 $71.62 $31.83 95926 S Somatosensory testing 0216 3.06 $159.15 $71.62 $31.83 95927 S Somatosensory testing 0216 3.06 $159.15 $71.62 $31.83 95930 S Visual evoked potential test 0218 1.06 $55.13 $11.03 95933 S Blink reflex test 0215 0.60 $31.21 $6.24 95934 S H-reflex test 0215 0.60 $31.21 $6.24 95936 S H-reflex test 0215 0.60 $31.21 $6.24 95937 S Neuromuscular junction test 0218 1.06 $55.13 $11.03 95950 S Ambulatory eeg monitoring 0213 3.38 $175.79 $70.41 $35.16 95951 S EEG monitoring/videorecord 0209 12.09 $628.79 $280.58 $125.76 95953 S EEG monitoring/computer 0209 12.09 $628.79 $280.58 $125.76 95954 S EEG monitoring/giving drugs 0214 2.37 $123.26 $61.63 $24.65 95955 S EEG during surgery 0214 2.37 $123.26 $61.63 $24.65 95956 S Eeg monitoring, cable/radio 0214 2.37 $123.26 $61.63 $24.65 95957 S EEG digital analysis 0214 2.37 $123.26 $61.63 $24.65 95958 S EEG monitoring/function test 0213 3.38 $175.79 $70.41 $35.16 95961 S Electrode stimulation, brain 0216 3.06 $159.15 $71.62 $31.83 Start Printed Page 52278 95962 S Electrode stim, brain add-on 0216 3.06 $159.15 $71.62 $31.83 95965 S Meg, spontaneous 0717 $2,250.00 $450.00 95966 S Meg, evoked, single 0714 $1,375.00 $275.00 95967 S Meg, evoked, each addl 0712 $875.00 $175.00 95970 S Analyze neurostim, no prog 0692 0.85 $44.21 $24.32 $8.84 95971 S Analyze neurostim, simple 0692 0.85 $44.21 $24.32 $8.84 95972 S Analyze neurostim, complex 0692 0.85 $44.21 $24.32 $8.84 95973 S Analyze neurostim, complex 0692 0.85 $44.21 $24.32 $8.84 95974 S Cranial neurostim, complex 0692 0.85 $44.21 $24.32 $8.84 95975 S Cranial neurostim, complex 0692 0.85 $44.21 $24.32 $8.84 95999 S Neurological procedure 0215 0.60 $31.21 $6.24 96000 S Motion analysis, video/3d 0708 $150.00 $30.00 96001 S Motion test w/ft press meas 0708 $150.00 $30.00 96002 S Dynamic surface emg 0708 $150.00 $30.00 96003 S Dynamic fine wire emg 0708 $150.00 $30.00 96004 E Phys review of motion tests 96100 X Psychological testing 0373 2.37 $123.26 $24.65 96105 X Assessment of aphasia 0373 2.37 $123.26 $24.65 96110 X Developmental test, lim 0373 2.37 $123.26 $24.65 96111 X Developmental test, extend 0373 2.37 $123.26 $24.65 96115 X Neurobehavior status exam 0373 2.37 $123.26 $24.65 96117 X Neuropsych test battery 0373 2.37 $123.26 $24.65 96150 S Assess hlth/behave, init 0322 1.44 $74.89 $12.40 $14.98 96151 S Assess hlth/behave, subseq 0322 1.44 $74.89 $12.40 $14.98 96152 S Intervene hlth/behave, indiv 0322 1.44 $74.89 $12.40 $14.98 96153 S Intervene hlth/behave, group 0322 1.44 $74.89 $12.40 $14.98 96154 S Interv hlth/behav, fam w/pt 0322 1.44 $74.89 $12.40 $14.98 96155 S Interv hlth/behav fam no pt 0322 1.44 $74.89 $12.40 $14.98 96400 E Chemotherapy, sc/im 96405 E Intralesional chemo admin 96406 E Intralesional chemo admin 96408 E Chemotherapy, push technique 96410 E Chemotherapy infusion method 96412 E Chemo, infuse method add-on 96414 E Chemo, infuse method add-on 96420 E Chemotherapy, push technique 96422 E Chemotherapy infusion method 96423 E Chemo, infuse method add-on 96425 E Chemotherapy infusion method 96440 E Chemotherapy, intracavitary 96445 E Chemotherapy, intracavitary 96450 E Chemotherapy, into CNS 96520 T Pump refilling, maintenance 0125 1.73 $89.98 $18.00 96530 T Pump refilling, maintenance 0125 1.73 $89.98 $18.00 96542 E Chemotherapy injection 96545 E Provide chemotherapy agent 96549 E Chemotherapy, unspecified 96567 T Photodynamic tx, skin 0972 $150.00 $30.00 96570 T Photodynamic tx, 30 min 0973 $250.00 $50.00 96571 T Photodynamic tx, addl 15 min 0973 $250.00 $50.00 96900 S Ultraviolet light therapy 0001 0.43 $22.36 $7.88 $4.47 96902 N Trichogram 96910 S Photochemotherapy with UV-B 0001 0.43 $22.36 $7.88 $4.47 96912 S Photochemotherapy with UV-A 0001 0.43 $22.36 $7.88 $4.47 96913 S Photochemotherapy, UV-A or B 0683 2.11 $109.74 $39.51 $21.95 96999 T Dermatological procedure 0010 0.70 $36.41 $10.56 $7.28 97001 A Pt evaluation 97002 A Pt re-evaluation 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 A Electric stimulation therapy 97016 A Vasopneumatic device therapy Start Printed Page 52279 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 97601 A Wound(s) care, selective 97602 N Wound(s) care non-selective 97703 A Prosthetic checkout 97750 A Physical performance test 97780 E Acupuncture w/o stimul 97781 E Acupuncture w/stimul 97799 A Physical medicine procedure 97802 A Medical nutrition, indiv, in 97803 A Med nutrition, indiv, subseq 97804 A Medical nutrition, group 98925 S Osteopathic manipulation 0060 0.36 $18.72 $3.74 98926 S Osteopathic manipulation 0060 0.36 $18.72 $3.74 98927 S Osteopathic manipulation 0060 0.36 $18.72 $3.74 98928 S Osteopathic manipulation 0060 0.36 $18.72 $3.74 98929 S Osteopathic manipulation 0060 0.36 $18.72 $3.74 98940 S Chiropractic manipulation 0060 0.36 $18.72 $3.74 98941 S Chiropractic manipulation 0060 0.36 $18.72 $3.74 98942 S Chiropractic manipulation 0060 0.36 $18.72 $3.74 98943 E Chiropractic manipulation 99000 E Specimen handling 99001 E Specimen handling 99002 E Device handling 99024 E Postop follow-up visit 99025 E Initial surgical evaluation 99050 E Medical services after hrs 99052 E Medical services at night 99054 E Medical servcs, unusual hrs 99056 E Non-office medical services 99058 E Office emergency care 99070 E Special supplies 99071 E Patient education materials 99075 E Medical testimony 99078 N Group health education 99080 E Special reports or forms 99082 E Unusual physician travel 99090 E Computer data analysis Start Printed Page 52280 99091 E Collect/review data from pt 99100 E Special anesthesia service 99116 E Anesthesia with hypothermia 99135 E Special anesthesia procedure 99140 E Emergency anesthesia 99141 N Sedation, iv/im or inhalant 99142 N Sedation, oral/rectal/nasal 99170 T Anogenital exam, child 0191 0.22 $11.44 $3.32 $2.29 99172 E Ocular function screen 99173 E Visual acuity screen 99175 N Induction of vomiting 99183 E 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 0.56 $29.13 $10.09 $5.83 99199 E Special service/proc/report 99201 V Office/outpatient visit, new 0600 0.91 $47.33 $9.47 99202 V Office/outpatient visit, new 0600 0.91 $47.33 $9.47 99203 V Office/outpatient visit, new 0601 1.04 $54.09 $10.82 99204 V Office/outpatient visit, new 0602 1.57 $81.65 $16.33 99205 V Office/outpatient visit, new 0602 1.57 $81.65 $16.33 99211 V Office/outpatient visit, est 0600 0.91 $47.33 $9.47 99212 V Office/outpatient visit, est 0600 0.91 $47.33 $9.47 99213 V Office/outpatient visit, est 0601 1.04 $54.09 $10.82 99214 V Office/outpatient visit, est 0602 1.57 $81.65 $16.33 99215 V Office/outpatient visit, est 0602 1.57 $81.65 $16.33 99217 N Observation care discharge 99218 N Observation care 99219 N Observation care 99220 N 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 N Observ/hosp same date 99235 N Observ/hosp same date 99236 N Observ/hosp same date 99238 E Hospital discharge day 99239 E Hospital discharge day 99241 V Office consultation 0600 0.91 $47.33 $9.47 99242 V Office consultation 0600 0.91 $47.33 $9.47 99243 V Office consultation 0601 1.04 $54.09 $10.82 99244 V Office consultation 0602 1.57 $81.65 $16.33 99245 V Office consultation 0602 1.57 $81.65 $16.33 99251 C Initial inpatient consult 99252 C Initial inpatient consult 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 0.91 $47.33 $9.47 99272 V Confirmatory consultation 0600 0.91 $47.33 $9.47 99273 V Confirmatory consultation 0601 1.04 $54.09 $10.82 99274 V Confirmatory consultation 0602 1.57 $81.65 $16.33 99275 V Confirmatory consultation 0602 1.57 $81.65 $16.33 99281 V Emergency dept visit 0610 1.49 $77.49 $19.57 $15.50 99282 V Emergency dept visit 0610 1.49 $77.49 $19.57 $15.50 99283 V Emergency dept visit 0611 2.66 $138.34 $36.47 $27.67 99284 V Emergency dept visit 0612 4.53 $235.60 $54.14 $47.12 Start Printed Page 52281 99285 V Emergency dept visit 0612 4.53 $235.60 $54.14 $47.12 99288 E 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 10.25 $533.09 $150.55 $106.62 99292 N Critical care, addl 30 min 99295 C Neonatal critical care 99296 C Neonatal critical care 99297 C Neonatal critical care 99298 C Neonatal critical care 99301 E Nursing facility care 99302 E Nursing facility care 99303 E Nursing facility care 99311 E Nursing fac care, subseq 99312 E Nursing fac care, subseq 99313 E Nursing fac care, subseq 99315 E Nursing fac discharge day 99316 E Nursing fac discharge day 99321 E Rest home visit, new patient 99322 E Rest home visit, new patient 99323 E Rest home visit, new patient 99331 E Rest home visit, est pat 99332 E Rest home visit, est pat 99333 E Rest home visit, est pat 99341 E Home visit, new patient 99342 E Home visit, new patient 99343 E Home visit, new patient 99344 E Home visit, new patient 99345 E Home visit, new patient 99347 E Home visit, est patient 99348 E Home visit, est patient 99349 E Home visit, est patient 99350 E 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 E Physician standby services 99361 E Physician/team conference 99362 E Physician/team conference 99371 E Physician phone consultation 99372 E Physician phone consultation 99373 E Physician phone consultation 99374 E Home health care supervision 99377 E Hospice care supervision 99379 E Nursing fac care supervision 99380 E 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 Start Printed Page 52282 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 0.91 $47.33 $9.47 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 2.68 $139.38 $47.39 $27.88 99450 E Life/disability evaluation 99455 E Disability examination 99456 E Disability examination 99499 E 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 99508 E Home visit, sleep studies 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, hemodialysis 99539 E Home visit, nos 99551 E Home infus, pain mgmt, iv/sc 99552 E Hm infus pain mgmt, epid/ith 99553 E Home infuse, tocolytic tx 99554 E Home infus, hormone/platelet 99555 E Home infuse, chemotheraphy 99556 E Home infus, antibio/fung/vir 99557 E Home infuse, anticoagulant 99558 E Home infuse, immunotherapy 99559 E Home infus, periton dialysis 99560 E Home infus, entero nutrition 99561 E Home infuse, hydration tx 99562 E Home infus, parent nutrition 99563 E Home admin, pentamidine 99564 E Hme infus, antihemophil agnt 99565 E Home infus, proteinase inhib 99566 E Home infuse, iv therapy 99567 E Home infuse, sympath agent 99568 E Home infus, misc drug, daily 99569 E Home infuse, each addl tx 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 A0384 A Bls defibrillation supplies Start Printed Page 52283 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 A0888 E Noncovered ambulance mileage A0999 A Unlisted ambulance service A4206 A 1 CC sterile syringe&needle A4207 A 2 CC sterile syringe&needle A4208 A 3 CC sterile syringe&needle A4209 E 5+ CC sterile syringe&needle A4210 E Nonneedle injection device A4211 E Supp for self-adm injections A4212 E Non coring needle or stylet A4213 E 20+ CC syringe only A4214 A 30 CC sterile water/saline A4215 E Sterile needle A4220 A Infusion pump refill kit A4221 A Maint drug infus cath per wk A4222 A Drug infusion pump supplies A4230 A Infus insulin pump non needl A4231 A Infusion insulin pump needle A4232 A 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 A4250 E Urine reagent strips/tablets A4253 A Blood glucose/reagent strips A4254 A Battery for glucose monitor A4255 A Glucose monitor platforms A4256 A Calibrator solution/chips A4257 A Replace Lensshield Cartridge A4258 A Lancet device each A4259 A 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 A Paraffin A4270 A Disposable endoscope sheath A4280 A Brst prsths adhsv attchmnt A4290 E Sacral nerve stim test lead A4300 E Cath impl vasc access portal A4301 E 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 Start Printed Page 52284 A4314 A Cath w/drainage 2-way latex A4315 A Cath w/drainage 2-way silcne A4316 A Cath w/drainage 3-way A4319 A Sterile H2O irrigation solut A4320 A Irrigation tray A4321 A Cath therapeutic irrig agent A4322 A Irrigation syringe A4323 A Saline irrigation solution A4324 A Male ext cath w/adh coating A4325 A Male ext cath w/adh strip 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 A4347 A Male external catheter A4348 A Male ext cath extended wear 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 A4360 A Adult incontinence garment A4361 A Ostomy face plate A4362 A Solid skin barrier A4364 A Adhesive, liquid or equal A4365 A Adhesive remover wipes A4367 A Ostomy belt A4368 A Ostomy filter A4369 A Skin barrier liquid per oz A4370 A Skin barrier paste per oz A4371 A Skin barrier powder per oz A4372 A Skin barrier solid 4x4 equiv A4373 A Skin barrier with flange A4374 A Skin barrier extended wear 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 A4385 A Ost skn barrier sld ext wear A4386 A Ost skn barrier w flng ex wr 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 Start Printed Page 52285 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 A4421 A Ostomy supply misc A4454 A Tape all types all sizes A4455 A Adhesive remover per ounce A4460 A Elastic compression bandage A4462 A Abdmnl drssng holder/binder A4464 A Joint support device/garment 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 A4550 E Surgical trays A4554 E Disposable underpads A4556 A Electrodes, pair A4557 A Lead wires, pair A4558 A Conductive paste or gel A4561 N Pessary rubber, any type A4562 N Pessary, non rubber,any type A4565 A Slings A4570 N Splint A4572 A Rib belt A4575 E Hyperbaric o2 chamber disps A4580 N Cast supplies (plaster) A4590 N Special casting material A4595 A TENS suppl 2 lead per month A4608 A Transtracheal oxygen cath A4611 A Heavy duty battery A4612 A Battery cables A4613 A Battery charger A4614 A Hand-held PEFR meter A4615 A Cannula nasal A4616 A Tubing (oxygen) per foot A4617 A Mouth piece A4618 A Breathing circuits A4619 A Face tent A4620 A Variable concentration mask A4621 A Tracheotomy mask or collar A4622 A Tracheostomy or larngectomy A4623 A Tracheostomy inner cannula A4624 A Tracheal suction tube A4625 A Trach care kit for new trach A4626 A Tracheostomy cleaning brush A4627 E Spacer bag/reservoir A4628 A Oropharyngeal suction cath A4629 A Tracheostomy care kit A4630 A Repl bat t.e.n.s. own by pt A4631 A Wheelchair battery A4635 A Underarm crutch pad A4636 A Handgrip for cane etc A4637 A Repl tip cane/crutch/walker A4640 A Alternating pressure pad A4641 N Diagnostic imaging agent A4642 N Satumomab pendetide per dose Start Printed Page 52286 A4643 N High dose contrast MRI A4644 N Contrast 100-199 MGs iodine A4645 N Contrast 200-299 MGs iodine A4646 N Contrast 300-399 MGs iodine A4647 N Supp- paramagnetic contr mat A4649 A Surgical supplies A4651 A Calibrated microcap tube A4652 A Microcapillary tube sealant 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 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 A4712 A Sterile water inj per 10 ml A4714 A Treated water per gallon A4719 A “Y set” tubing 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 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 A4801 A Heparin per 1000 units 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 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 Start Printed Page 52287 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 A5123 A Skin barrier with flange A5126 A Disk/foam pad +or- adhesive A5131 A Appliance cleaner A5200 A Percutaneous catheter anchor A5500 A Diab shoe for density insert A5501 A Diabetic custom molded shoe A5503 A Diabetic shoe w/roller/rockr A5504 A Diabetic shoe with wedge A5505 A Diab shoe w/metatarsal bar A5506 A Diabetic shoe w/off set heel A5507 A Modification diabetic shoe A5508 A Diabetic deluxe shoe A5509 A Direct heat form shoe insert A5510 A Compression form shoe insert A5511 A Custom fab molded shoe inser A6000 A Wound warming wound cover A6010 A Collagen based wound filler 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 Start Printed Page 52288 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 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 A6263 A Non-sterile elastic gauze/yd A6264 A Non-sterile no elastic gauze A6265 A Tape per 18 sq inches 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 A6405 A Sterile elastic gauze /yd A6406 A Sterile non-elastic gauze/yd A7000 A Disposable canister for pump A7001 A Nondisposable pump canister A7002 A Tubing used w suction pump A7003 A Nebulizer administration set A7004 A Disposable nebulizer sml vol A7005 A Nondisposable nebulizer set A7006 A Filtered nebulizer admin set A7007 A Lg vol nebulizer disposable A7008 A Disposable nebulizer prefill A7009 A Nebulizer reservoir bottle A7010 A Disposable corrugated tubing A7011 A Nondispos corrugated tubing A7012 A Nebulizer water collec devic A7013 A Disposable compressor filter A7014 A Compressor nondispos filter A7015 A Aerosol mask used w nebulize A7016 A Nebulizer dome & mouthpiece A7017 A Nebulizer not used w oxygen A7018 A Water distilled w/nebulizer A7019 A Saline solution dispenser A7020 A Sterile H2O or NSS w lgv neb 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 Start Printed Page 52289 A7507 A Integrated filter & holder A7508 A Housing & Integrated Adhesiv A7509 A Heat & moisture exchange sys A9150 E Misc/exper non-prescript dru A9270 E Non-covered item or service A9300 E Exercise equipment A9500 N Technetium TC 99m sestamibi A9502 N Technetium TC99M tetrofosmin A9503 N Technetium TC 99m medronate A9504 N Technetium tc 99m apcitide A9505 N Thallous chloride TL 201/mci A9507 K Indium/111 capromab pendetid 1604 5.91 $307.37 $61.47 A9508 N Iobenguane sulfate I-131 A9510 N Technetium TC99m Disofenin A9511 K Technetium TC 99m depreotide 1095 0.25 $13.00 $2.60 A9600 K Strontium-89 chloride 0701 6.43 $334.42 $66.88 A9605 K Samarium sm153 lexidronamm 0702 15.02 $781.18 $156.24 A9700 G Echocardiography Contrast 9016 $118.75 $17.00 A9900 A Supply/accessory/service A9901 A Delivery/set up/dispensing 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 B4150 A Enteral formulae category i B4151 A Enteral formulae cat1natural B4152 A Enteral formulae category ii B4153 A Enteral formulae categoryIII B4154 A Enteral formulae category IV B4155 A Enteral formulae category v B4156 A Enteral formulae category vi 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 C1010 K Blood, L/R, CMV-NEG 1010 1.67 $86.86 $17.37 C1011 K Platelets, HLA-m, L/R, unit 1011 6.03 $313.61 $62.72 C1012 K PLATELET CONC, L/R, Irrad 0954 1.59 $82.69 $16.54 C1013 K PLATELET CONC, L/R, Unit 1013 0.91 $47.33 $9.47 C1014 K Platelet,Aph/Pher, L/R, unit 9501 5.10 $265.25 $53.05 C1016 K BLOOD,L/R,FROZ/DEGLY/Washed 1016 1.09 $56.69 $11.34 C1017 K Plt, APH/PHER,L/R,CMV-NEG 1017 4.78 $248.60 $49.72 Start Printed Page 52290 C1018 K Blood, L/R, IRRADIATED 1018 1.90 $98.82 $19.76 C1058 G TC 99M oxidronate, per vial 1058 $36.74 $5.26 C1064 G I-131 cap, each add mCi 1064 $5.86 $.75 C1065 G I-131 sol, each add mCi 1065 $15.81 $2.03 C1066 N IN 111 satumomab pendetide C1079 N CO 57/58 per 0.5 uCi C1087 N I-123 per 100 uCi C1088 T LASER OPTIC TR Sys 0980 $1,875.00 $375.00 C1091 K IN111 oxyquinoline,per0.5mCi 1091 4.36 $226.76 $45.35 C1092 K IN 111 pentetate per 0.5 mCi 1092 4.78 $248.60 $49.72 C1094 N TC99Malbumin aggr,per 1.0mCi C1096 K TC 99M EXAMETAZIME, PER Dose 1096 3.35 $174.23 $34.85 C1097 N TC 99M MEBROFENIN, PER Vial C1098 N TC 99M PENTETATE, PER Vial C1099 N TC 99M PYROPHOSPHATE,PER Via C1122 K Tc 99M ARCITUMOMAB PER VIAL 1122 8.33 $433.23 $86.65 C1166 N CYTARABINE LIPOSOMAL, 10 mg C1167 K EPIRUBICIN HCL, 2 mg 1167 0.32 $16.64 $3.33 C1178 K BUSULFAN IV, 6 Mg 1178 0.53 $27.56 $5.51 C1188 N I-131 cap, per 1-5 mCi C1200 N TC 99M Sodium Glucoheptonat C1201 N TC 99M SUCCIMER, PER Vial C1202 N TC 99M SULFUR COLLOID, Vial C1207 K OCTREOTIDE ACETATE DEPOT 1mg 1207 1.22 $63.45 $12.69 C1300 S HYPERBARIC Oxygen 0659 3.12 $162.27 $32.45 C1305 K Apligraf 1305 12.47 $648.55 $129.71 C1348 K I-131 sol, per 1-6 mCi 1348 0.19 $9.88 $1.98 C1713 N Anchor/screw bn/bn,tis/bn C1714 N Cath, trans atherectomy, dir C1715 N Brachytherapy needle C1716 K Brachytx seed, Gold 198 1716 0.35 $18.20 $3.64 C1717 N Brachytx seed, HDR Ir-192 C1718 K Brachytx seed, Iodine 125 1718 0.64 $33.29 $6.66 C1719 K Brachytx seed,Non-HDR Ir-192 1719 0.57 $29.65 $5.93 C1720 K Brachytx seed, Palladium 103 1720 0.89 $46.29 $9.26 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 H Adhesion barrier 1765 C1766 N Intro/sheath,strble,non-peel C1767 N Generator, neurostim, imp Start Printed Page 52291 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 C1774 G Darbepoetin alfa, 1 mcg 0734 $4.74 $.68 C1775 G FDG, per dose (4-40 mCi/ml) 1775 $475.00 $68.00 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 H Ocular imp, aqueous drain dev 1783 C1784 N Ocular dev, intraop, det ret C1785 N Pmkr, dual, rate-resp 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 C1815 N Pros, urinary sph, imp C1816 N Receiver/transmitter, neuro C1817 N Septal defect imp sys 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 C1885 N Cath, translumin angio laser C1887 N Catheter, guiding C1888 H Endovas non-cardiac abl cath 1888 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 H Lead coronary venous 1900 C2615 N Sealant, pulmonary, liquid C2616 N Brachytx seed, Yttrium-90 C2617 N Stent, non-cor, tem w/o del C2618 H Probe, cryoablation 2618 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 C8900 S MRA w/cont, abd 0284 7.74 $402.55 $201.02 $80.51 C8901 S MRA w/o cont, abd 0336 7.01 $364.58 $176.94 $72.92 Start Printed Page 52292 C8902 S MRA w/o fol w/cont, abd 0337 9.86 $512.81 $240.77 $102.56 C8903 S MRI w/cont, breast, uni 0284 7.74 $402.55 $201.02 $80.51 C8904 S MRI w/o cont, breast, uni 0336 7.01 $364.58 $176.94 $72.92 C8905 S MRI w/o fol w/cont, brst, un 0337 9.86 $512.81 $240.77 $102.56 C8906 S MRI w/cont, breast, bi 0284 7.74 $402.55 $201.02 $80.51 C8907 S MRI w/o cont, breast, bi 0336 7.01 $364.58 $176.94 $72.92 C8908 S MRI w/o fol w/cont, breast, 0337 9.86 $512.81 $240.77 $102.56 C8909 S MRA w/cont, chest 0284 7.74 $402.55 $201.02 $80.51 C8910 S MRA w/o cont, chest 0336 7.01 $364.58 $176.94 $72.92 C8911 S MRA w/o fol w/cont, chest 0337 9.86 $512.81 $240.77 $102.56 C8912 S MRA w/cont, lwr ext 0284 7.74 $402.55 $201.02 $80.51 C8913 S MRA w/o cont, lwr ext 0336 7.01 $364.58 $176.94 $72.92 C8914 S MRA w/o fol w/cont, lwr ext 0337 9.86 $512.81 $240.77 $102.56 C9000 N Na chromateCr51, per 0.25mCi C9003 K Palivizumab, per 50 mg 9003 9.34 $485.76 $97.15 C9007 N Baclofen Intrathecal kit-1am C9008 N Baclofen Refill Kit-500mcg C9009 K Baclofen Refill Kit-2000mcg 9009 0.79 $41.09 $8.22 C9010 K Baclofen Refill Kit--4000mcg 9010 0.95 $49.41 $9.88 C9013 N Co 57 cobaltous chloride C9019 G Caspofungin acetate, 5 mg 9019 $34.20 $4.90 C9020 K Sirolimussolution, 1 mg 9020 0.05 $2.60 $.52 C9100 N Iodinated I-131 Albumin C9102 N 51 Na Chromate, 50mCi C9103 N Na Iothalamate I-125, 10 uCi C9105 K Hep B imm glob, per 1 ml 9105 1.58 $82.17 $16.43 C9108 K Thyrotropin alfa, 1.1 mg 9108 8.79 $457.16 $91.43 C9109 K Tirofiban hcl, 6.25 mg 9109 2.32 $120.66 $24.13 C9110 G Alemtuzumab, per 10mg/ml 9110 $486.88 $69.70 C9111 G Inj, bivalirudin, 250mg vial 9111 $397.81 $56.95 C9112 G Perflutren lipid micro, 2ml 9112 $148.20 $21.22 C9113 G Inj pantoprazole sodium, via 9113 $22.80 $3.26 C9114 G Nesiritide, per 1.5 mg vial 9114 $433.20 $62.02 C9115 G Inj, zoledronic acid, 2 mg 9115 $406.78 $58.23 C9200 G Orcel, per 36 cm2 9200 $1,135.25 $162.52 C9201 G Dermagraft, per 37.5 sq cm 9201 $577.60 $82.69 C9503 K Fresh frozen plasma, ea unit 9503 0.77 $40.05 $8.01 C9701 T Stretta System 0980 $1,875.00 $375.00 C9703 T Bard Endoscopic Suturing Sys 0979 $1,625.00 $325.00 C9708 T Preview Tx Planning Software 0973 $250.00 $50.00 C9711 T H.E.L.P. Apheresis System 0978 $1,375.00 $275.00 D0120 E Periodic oral evaluation D0140 E Limit oral eval problm focus D0150 S Comprehensve oral evaluation 0330 0.64 $33.29 $6.66 D0160 E Extensv oral eval prob focus D0170 E Re-eval,est pt,problem focus D0210 E Intraor complete film series D0220 E Intraoral periapical first f D0230 E Intraoral periapical ea add D0240 S Intraoral occlusal film 0330 0.64 $33.29 $6.66 D0250 S Extraoral first film 0330 0.64 $33.29 $6.66 D0260 S Extraoral ea additional film 0330 0.64 $33.29 $6.66 D0270 S Dental bitewing single film 0330 0.64 $33.29 $6.66 D0272 S Dental bitewings two films 0330 0.64 $33.29 $6.66 D0274 S Dental bitewings four films 0330 0.64 $33.29 $6.66 D0277 S Vert bitewings-sev to eight 0330 0.64 $33.29 $6.66 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 D0425 E Caries susceptibility test Start Printed Page 52293 D0460 S Pulp vitality test 0330 0.64 $33.29 $6.66 D0470 E Diagnostic casts D0472 S Gross exam, prep & report 0330 0.64 $33.29 $6.66 D0473 S Micro exam, prep & report 0330 0.64 $33.29 $6.66 D0474 S Micro w exam of surg margins 0330 0.64 $33.29 $6.66 D0480 S Cytopath smear prep & report 0330 0.64 $33.29 $6.66 D0501 S Histopathologic examinations 0330 0.64 $33.29 $6.66 D0502 S Other oral pathology procedu 0330 0.64 $33.29 $6.66 D0999 S Unspecified diagnostic proce 0330 0.64 $33.29 $6.66 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 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 0.64 $33.29 $6.66 D1515 S Fixed bilat space maintainer 0330 0.64 $33.29 $6.66 D1520 S Remove unilat space maintain 0330 0.64 $33.29 $6.66 D1525 S Remove bilat space maintain 0330 0.64 $33.29 $6.66 D1550 S Recement space maintainer 0330 0.64 $33.29 $6.66 D2110 E Amalgam one surface primary D2120 E Amalgam two surfaces primary D2130 E Amalgam three surfaces prima D2131 E Amalgam four/more surf prima 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 D2336 E Composite resin crown D2337 E Compo resin crown ant-perm D2380 E Resin one surf poster primar D2381 E Resin two surf poster primar D2382 E Resin three/more surf post p D2385 E Resin one surf poster perman D2386 E Resin two surf poster perman D2387 E Resin three/more surf post p D2388 E Resin four/more, post perm 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 Start Printed Page 52294 D2710 E Crown resin laboratory 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 D2799 E Provisional crown D2910 E Dental recement inlay D2920 E Dental recement crown 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 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 D2970 S Temporary- fractured tooth 0330 0.64 $33.29 $6.66 D2980 E Crown repair D2999 S Dental unspec restorative pr 0330 0.64 $33.29 $6.66 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 0001T C Endovas repr abdo ao aneurys 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 0.64 $33.29 $6.66 D3470 E Intentional replantation D3910 E Isolation- tooth w rubb dam D3920 E Tooth splitting D3950 E Canal prep/fitting of dowel Start Printed Page 52295 D3999 S Endodontic procedure 0330 0.64 $33.29 $6.66 D4210 E Gingivectomy/plasty per quad D4211 E Gingivectomy/plasty per toot D4220 E Gingival curettage per quadr D4240 E Gingival flap proc w/ planin D4245 E Apically positioned flap D4249 E Crown lengthen hard tissue D4260 S Osseous surgery per quadrant 0330 0.64 $33.29 $6.66 D4263 S Bone replce graft first site 0330 0.64 $33.29 $6.66 D4264 S Bone replce graft each add 0330 0.64 $33.29 $6.66 D4266 E Guided tiss regen resorble D4267 E Guided tiss regen nonresorb D4268 S Surgical revision procedure 0330 0.64 $33.29 $6.66 D4270 S Pedicle soft tissue graft pr 0330 0.64 $33.29 $6.66 D4271 S Free soft tissue graft proc 0330 0.64 $33.29 $6.66 D4273 S Subepithelial tissue graft 0330 0.64 $33.29 $6.66 D4274 E Distal/proximal wedge proc D4320 E Provision splnt intracoronal D4321 E Provisional splint extracoro D4341 E Periodontal scaling & root D4355 S Full mouth debridement 0330 0.64 $33.29 $6.66 D4381 S Localized chemo delivery 0330 0.64 $33.29 $6.66 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 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 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 Start Printed Page 52296 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 0.64 $33.29 $6.66 D5912 S Facial moulage complete 0330 0.64 $33.29 $6.66 D5913 E Nasal prosthesis D5914 E Auricular prosthesis 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 0.64 $33.29 $6.66 D5984 S Radiation shield 0330 0.64 $33.29 $6.66 D5985 S Radiation cone locator 0330 0.64 $33.29 $6.66 D5986 E Fluoride applicator D5987 S Commissure splint 0330 0.64 $33.29 $6.66 D5988 E Surgical splint D5999 E Maxillofacial prosthesis D6010 E Odontics endosteal implant D6020 E Odontics abutment placement D6040 E Odontics eposteal implant D6050 E Odontics transosteal implnt 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 Start Printed Page 52297 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 D6095 E Odontics repr abutment D6100 E Removal of implant D6199 E Implant procedure D6210 E Prosthodont high noble metal D6211 E Bridge base metal cast D6212 E Bridge noble metal cast 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 D6519 E Inlay/onlay porce/ceramic D6520 E Dental retainer two surfaces D6530 E Retainer metallic 3+ surface D6543 E Dental retainr onlay 3 surf D6544 E Dental retainr onlay 4/more D6545 E Dental retainr cast metl D6548 E Porcelain/ceramic retainer 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 D6920 S Dental connector bar 0330 0.64 $33.29 $6.66 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 D6977 E Each addtl prefab post D6980 E Bridge repair D6999 E Fixed prosthodontic proc D7110 S Oral surgery single tooth 0330 0.64 $33.29 $6.66 D7120 S Each add tooth extraction 0330 0.64 $33.29 $6.66 D7130 S Tooth root removal 0330 0.64 $33.29 $6.66 D7210 S Rem imp tooth w mucoper flp 0330 0.64 $33.29 $6.66 D7220 S Impact tooth remov soft tiss 0330 0.64 $33.29 $6.66 D7230 S Impact tooth remov part bony 0330 0.64 $33.29 $6.66 D7240 S Impact tooth remov comp bony 0330 0.64 $33.29 $6.66 D7241 S Impact tooth rem bony w/comp 0330 0.64 $33.29 $6.66 D7250 S Tooth root removal 0330 0.64 $33.29 $6.66 D7260 S Oral antral fistula closure 0330 0.64 $33.29 $6.66 D7270 E Tooth reimplantation D7272 E Tooth transplantation Start Printed Page 52298 D7280 E Exposure impact tooth orthod D7281 E Exposure tooth aid eruption D7285 E Biopsy of oral tissue hard D7286 E Biopsy of oral tissue soft D7290 E Repositioning of teeth D7291 S Transseptal fiberotomy 0330 0.64 $33.29 $6.66 D7310 E Alveoplasty w/ extraction D7320 E Alveoplasty w/o extraction D7340 E Vestibuloplasty ridge extens D7350 E Vestibuloplasty exten graft D7410 E Rad exc lesion up to 1.25 cm D7420 E Lesion > 1.25 cm D7430 E Exc benign tumor to 1.25 cm D7431 E Benign tumor exc > 1.25 cm 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 D7480 E Partial ostectomy D7490 E Mandible resection D7510 E I&d absc intraoral soft tiss D7520 E I&d abscess extraoral 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 D7680 E Reduct simple facial bone fx 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 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 Start Printed Page 52299 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 0.64 $33.29 $6.66 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 D7955 E Repair maxillofacial defects D7960 E Frenulectomy/frenulotomy D7970 E Excision hyperplastic tissue D7971 E Excision pericoronal gingiva 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 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 D9610 E Dent therapeutic drug inject D9630 S Other drugs/medicaments 0330 0.64 $33.29 $6.66 D9910 E Dent appl desensitizing med Start Printed Page 52300 D9911 E Appl desensitizing resin D9920 E Behavior management D9930 S Treatment of complications 0330 0.64 $33.29 $6.66 D9940 S Dental occlusal guard 0330 0.64 $33.29 $6.66 D9941 E Fabrication athletic guard D9950 S Occlusion analysis 0330 0.64 $33.29 $6.66 D9951 S Limited occlusal adjustment 0330 0.64 $33.29 $6.66 D9952 S Complete occlusal adjustment 0330 0.64 $33.29 $6.66 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 A Cane adjust/fixed with tip E0105 A Cane adjust/fixed quad/3 pro E0110 A Crutch forearm pair E0111 A Crutch forearm each E0112 A Crutch underarm pair wood E0113 A Crutch underarm each wood E0114 A Crutch underarm pair no wood E0116 A Crutch underarm each no wood E0130 A Walker rigid adjust/fixed ht E0135 A Walker folding adjust/fixed E0141 A Rigid walker wheeled wo seat E0142 A Walker rigid wheeled with se E0143 A Walker folding wheeled w/o s E0144 A Enclosed walker w rear seat E0145 A Walker whled seat/crutch att E0146 A Folding walker wheels w seat E0147 A Walker variable wheel resist E0148 A Heavyduty walker no wheels E0149 A Heavy duty wheeled walker E0153 A Forearm crutch platform atta E0154 A Walker platform attachment E0155 A Walker wheel attachment,pair E0156 A Walker seat attachment E0157 A Walker crutch attachment E0158 A Walker leg extenders set of4 E0159 A Brake for wheeled walker E0160 A Sitz type bath or equipment E0161 A Sitz bath/equipment w/faucet E0162 A Sitz bath chair E0163 A Commode chair stationry fxd E0164 A Commode chair mobile fixed a E0165 A Commode chair stationry det E0166 A Commode chair mobile detach E0167 A Commode chair pail or pan E0168 A Heavyduty/wide commode chair E0169 A Seatlift incorp commodechair E0175 A Commode chair foot rest E0176 A Air pressre pad/cushion nonp E0177 A Water press pad/cushion nonp E0178 A Gel pressre pad/cushion nonp E0179 A Dry pressre pad/cushion nonp E0180 A Press pad alternating w pump E0181 A Press pad alternating w/ pum E0182 A Pressure pad alternating pum E0184 A Dry pressure mattress E0185 A Gel pressure mattress pad E0186 A Air pressure mattress E0187 A Water pressure mattress E0188 E Synthetic sheepskin pad E0189 E Lambswool sheepskin pad E0191 A Protector heel or elbow E0192 A Pad wheelchr low press/posit Start Printed Page 52301 E0193 A Powered air flotation bed E0194 A Air fluidized bed E0196 A Gel pressure mattress E0197 A Air pressure pad for mattres E0198 A Water pressure pad for mattr E0199 A Dry pressure pad for mattres E0200 A Heat lamp without stand E0202 A Phototherapy light w/ photom E0205 A Heat lamp with stand E0210 A Electric heat pad standard E0215 A Electric heat pad moist E0217 A Water circ heat pad w pump E0218 E Water circ cold pad w pump E0220 A Hot water bottle E0221 A Infrared heating pad system E0225 A Hydrocollator unit E0230 A Ice cap or collar E0231 A Wound warming device E0232 A Warming card for NWT E0235 A Paraffin bath unit portable E0236 A Pump for water circulating p E0238 A Heat pad non-electric moist E0239 A Hydrocollator unit portable 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 E0249 A Pad water circulating heat u E0250 A Hosp bed fixed ht w/ mattres E0251 A Hosp bed fixd ht w/o mattres E0255 A Hospital bed var ht w/ mattr E0256 A Hospital bed var ht w/o matt E0260 A Hosp bed semi-electr w/ matt E0261 A Hosp bed semi-electr w/o mat E0265 A Hosp bed total electr w/ mat E0266 A Hosp bed total elec w/o matt E0270 E Hospital bed institutional t E0271 A Mattress innerspring E0272 A Mattress foam rubber E0273 E Bed board E0274 E Over-bed table E0275 A Bed pan standard E0276 A Bed pan fracture E0277 A Powered pres-redu air mattrs E0280 A Bed cradle E0290 A Hosp bed fx ht w/o rails w/m E0291 A Hosp bed fx ht w/o rail w/o E0292 A Hosp bed var ht w/o rail w/o E0293 A Hosp bed var ht w/o rail w/ E0294 A Hosp bed semi-elect w/ mattr E0295 A Hosp bed semi-elect w/o matt E0296 A Hosp bed total elect w/ matt E0297 A Hosp bed total elect w/o mat E0305 A Rails bed side half length E0310 A Rails bed side full length E0315 E Bed accessory brd/tbl/supprt E0316 A Bed safety enclosure E0325 A Urinal male jug-type E0326 A Urinal female jug-type E0350 E Control unit bowel system E0352 E Disposable pack w/bowel syst E0370 E Air elevator for heel E0371 A Nonpower mattress overlay E0372 A Powered air mattress overlay Start Printed Page 52302 E0373 A Nonpowered pressure mattress E0424 A Stationary compressed gas 02 E0425 E Gas system stationary compre E0430 E Oxygen system gas portable E0431 A Portable gaseous 02 E0434 A Portable liquid 02 E0435 E Oxygen system liquid portabl E0439 A Stationary liquid 02 E0440 E Oxygen system liquid station E0441 A Oxygen contents, gaseous E0442 A Oxygen contents, liquid E0443 A Portable 02 contents, gas E0444 A Portable 02 contents, liquid E0450 A Volume vent stationary/porta E0455 A Oxygen tent excl croup/ped t E0457 A Chest shell E0459 A Chest wrap E0460 A Neg press vent portabl/statn E0462 A Rocking bed w/ or w/o side r E0480 A Percussor elect/pneum home m E0481 A Intrpulmnry percuss vent sys E0482 A Cough stimulating device E0500 A Ippb all types E0550 A Humidif extens supple w ippb E0555 A Humidifier for use w/ regula E0560 A Humidifier supplemental w/ i E0565 A Compressor air power source E0570 A Nebulizer with compression E0571 A Aerosol compressor for svneb E0572 A Aerosol compressor adjust pr E0574 A Ultrasonic generator w svneb E0575 A Nebulizer ultrasonic E0580 A Nebulizer for use w/ regulat E0585 A Nebulizer w/ compressor & he E0590 A Dispensing fee dme neb drug E0600 A Suction pump portab hom modl E0601 A Cont airway pressure device E0602 E Manual breast pump E0603 A Electric breast pump E0604 A Hosp grade elec breast pump E0605 A Vaporizer room type E0606 A Drainage board postural E0607 A Blood glucose monitor home E0608 A Apnea monitor E0610 A Pacemaker monitr audible/vis E0615 A Pacemaker monitr digital/vis E0616 N Cardiac event recorder E0617 A Automatic ext defibrillator E0620 A Cap bld skin piercing laser E0621 A Patient lift sling or seat E0625 E Patient lift bathroom or toi E0627 A Seat lift incorp lift-chair E0628 A Seat lift for pt furn-electr E0629 A Seat lift for pt furn-non-el E0630 A Patient lift hydraulic E0635 A Patient lift electric E0650 A Pneuma compresor non-segment E0651 A Pneum compressor segmental E0652 A Pneum compres w/cal pressure E0655 A Pneumatic appliance half arm E0660 A Pneumatic appliance full leg E0665 A Pneumatic appliance full arm E0666 A Pneumatic appliance half leg E0667 A Seg pneumatic appl full leg E0668 A Seg pneumatic appl full arm E0669 A Seg pneumatic appli half leg Start Printed Page 52303 E0671 A Pressure pneum appl full leg E0672 A Pressure pneum appl full arm E0673 A Pressure pneum appl half leg E0690 A Ultraviolet cabinet E0700 E Safety equipment E0710 E Restraints any type E0720 A Tens two lead E0730 A Tens four lead E0731 A Conductive garment for tens/ E0740 E Incontinence treatment systm E0744 A Neuromuscular stim for scoli E0745 A Neuromuscular stim for shock E0746 E Electromyograph biofeedback E0747 A Elec osteogen stim not spine E0748 A Elec osteogen stim spinal E0749 N Elec osteogen stim implanted E0752 E Neurostimulator electrode E0754 A Pulsegenerator pt programmer E0755 E Electronic salivary reflex s E0756 E Implantable pulse generator E0757 E Implantable RF receiver E0758 A External RF transmitter E0759 A Replace rdfrquncy transmittr E0760 E Osteogen ultrasound stimltor E0765 E Nerve stimulator for tx n&v E0776 A Iv pole E0779 A Amb infusion pump mechanical E0780 A Mech amb infusion pump <8hrs E0781 A External ambulatory infus pu E0782 E Non-programble infusion pump E0783 E Programmable infusion pump E0784 A Ext amb infusn pump insulin E0785 E Replacement impl pump cathet E0786 E Implantable pump replacement E0791 A Parenteral infusion pump sta E0830 N Ambulatory traction device E0840 A Tract frame attach headboard E0850 A Traction stand free standing E0855 A Cervical traction equipment E0860 A Tract equip cervical tract E0870 A Tract frame attach footboard E0880 A Trac stand free stand extrem E0890 A Traction frame attach pelvic E0900 A Trac stand free stand pelvic E0910 A Trapeze bar attached to bed E0920 A Fracture frame attached to b E0930 A Fracture frame free standing E0935 A Exercise device passive moti E0940 A Trapeze bar free standing E0941 A Gravity assisted traction de E0942 A Cervical head harness/halter E0943 A Cervical pillow E0944 A Pelvic belt/harness/boot E0945 A Belt/harness extremity E0946 A Fracture frame dual w cross E0947 A Fracture frame attachmnts pe E0948 A Fracture frame attachmnts ce E0950 E Tray E0951 E Loop heel E0952 E Loop tie E0953 E Pneumatic tire E0954 E Wheelchair semi-pneumatic ca E0958 A Whlchr att- conv 1 arm drive E0959 E Amputee adapter E0961 E Wheelchair brake extension E0962 A Wheelchair 1 inch cushion Start Printed Page 52304 E0963 A Wheelchair 2 inch cushion E0964 A Wheelchair 3 inch cushion E0965 A Wheelchair 4 inch cushion E0966 E Wheelchair head rest extensi E0967 E Wheelchair hand rims E0968 A Wheelchair commode seat E0969 E Wheelchair narrowing device E0970 E Wheelchair no. 2 footplates E0971 E Wheelchair anti-tipping devi E0972 A Transfer board or device E0973 E Wheelchair adjustabl height E0974 E Wheelchair grade-aid E0975 E Wheelchair reinforced seat u E0976 E Wheelchair reinforced back u E0977 E Wheelchair wedge cushion E0978 E Wheelchair belt w/airplane b E0979 E Wheelchair belt with velcro E0980 E Wheelchair safety vest E0990 E Whellchair elevating leg res E0991 E Wheelchair upholstry seat E0992 E Wheelchair solid seat insert E0993 E Wheelchair back upholstery E0994 E Wheelchair arm rest E0995 E Wheelchair calf rest E0996 E Wheelchair tire solid E0997 E Wheelchair caster w/ a fork E0998 E Wheelchair caster w/o a fork E0999 E Wheelchr pneumatic tire w/wh E1000 E Wheelchair tire pneumatic ca E1001 E Wheelchair wheel E1031 A Rollabout chair with casters E1035 E Patient transfer system E1050 A Whelchr fxd full length arms E1060 A Wheelchair detachable arms E1065 E Wheelchair power attachment E1066 E Wheelchair battery charger E1069 E Wheelchair deep cycle batter 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 E1090 A Wheelchair lightweight det a E1091 A Wheelchair youth 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 A Wheelchair standard w/ leg r E1160 A Wheelchair fixed arms 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 A Whlchr moto ful arm leg rest E1211 A Wheelchair motorized w/ det E1212 A Wheelchair motorized w full E1213 A Wheelchair motorized w/ det Start Printed Page 52305 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 A Wheelchair spec sz semi-recl E1226 E Wheelchair spec sz full-recl E1227 E Wheelchair spec sz spec ht a E1228 A Wheelchair spec sz spec ht b E1230 A Power operated vehicle 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 A Wheelchair special seat heig E1297 A Wheelchair special seat dept E1298 A Wheelchair spec seat depth/w E1300 E Whirlpool portable E1310 A Whirlpool non-portable E1340 A Repair for DME, per 15 min E1353 A Oxygen supplies regulator E1355 A Oxygen supplies stand/rack E1372 A Oxy suppl heater for nebuliz E1390 A Oxygen concentrator E1399 A Durable medical equipment mi E1405 A O2/water vapor enrich w/heat E1406 A O2/water vapor enrich w/o he E1500 A Centrifuge E1510 A Kidney dialysate delivry sys E1520 A Heparin infusion pump 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 E1635 A Compact travel hemodialyzer E1636 A Sorbent cartridges per 10 E1637 A Hemostats for dialysis, each E1638 A Peri dialysis heating pad E1639 A Dialysis scale E1699 A Dialysis equipment noc E1700 A Jaw motion rehab system E1701 A Repl cushions for jaw motion E1702 A Repl measr scales jaw motion E1800 A Adjust elbow ext/flex device E1801 A SPS elbow device E1805 A Adjust wrist ext/flex device E1806 A SPS wrist device E1810 A Adjust knee ext/flex device E1811 A SPS knee device Start Printed Page 52306 E1815 A Adjust ankle ext/flex device E1816 A SPS ankle device E1818 A SPS forearm device E1820 A Soft interface material E1821 A Replacement interface SPSD E1825 A Adjust finger ext/flex devc E1830 A Adjust toe ext/flex device E1840 A Adj shoulder ext/flex device E1902 A AAC non-electronic board E2000 A Gastric suction pump hme mdl E2100 A Bld glucose monitor w voice E2101 A Bld glucose monitor w lance G0001 A Drawing blood for specimen G0002 X Temporary urinary catheter 0340 0.66 $34.33 $6.87 G0004 E ECG transm phys review & int G0005 X ECG 24 hour recording 0097 0.84 $43.69 $23.80 $8.74 G0006 X ECG transmission & analysis 0097 0.84 $43.69 $23.80 $8.74 G0007 N ECG phy review & interpret G0008 K Admin influenza virus vac 0354 0.09 $4.68 G0009 K Admin pneumococcal vaccine 0354 0.09 $4.68 G0010 K Admin hepatitis b vaccine 0355 0.24 $12.48 $2.50 G0015 X Post symptom ECG tracing 0097 0.84 $43.69 $23.80 $8.74 G0025 N Collagen skin test kit G0026 A Fecal leukocyte examination G0027 A Semen analysis G0030 S PET imaging prev PET single 0285 16.73 $870.11 $374.15 $174.02 G0031 S PET imaging prev PET multple 0285 16.73 $870.11 $374.15 $174.02 G0032 S PET follow SPECT 78464 singl 0285 16.73 $870.11 $374.15 $174.02 G0033 S PET follow SPECT 78464 mult 0285 16.73 $870.11 $374.15 $174.02 G0034 S PET follow SPECT 76865 singl 0285 16.73 $870.11 $374.15 $174.02 G0035 S PET follow SPECT 78465 mult 0285 16.73 $870.11 $374.15 $174.02 G0036 S PET follow cornry angio sing 0285 16.73 $870.11 $374.15 $174.02 G0037 S PET follow cornry angio mult 0285 16.73 $870.11 $374.15 $174.02 G0038 S PET follow myocard perf sing 0285 16.73 $870.11 $374.15 $174.02 G0039 S PET follow myocard perf mult 0285 16.73 $870.11 $374.15 $174.02 G0040 S PET follow stress echo singl 0285 16.73 $870.11 $374.15 $174.02 G0041 S PET follow stress echo mult 0285 16.73 $870.11 $374.15 $174.02 G0042 S PET follow ventriculogm sing 0285 16.73 $870.11 $374.15 $174.02 G0043 S PET follow ventriculogm mult 0285 16.73 $870.11 $374.15 $174.02 G0044 S PET following rest ECG singl 0285 16.73 $870.11 $374.15 $174.02 G0045 S PET following rest ECG mult 0285 16.73 $870.11 $374.15 $174.02 G0046 S PET follow stress ECG singl 0285 16.73 $870.11 $374.15 $174.02 G0047 S PET follow stress ECG mult 0285 16.73 $870.11 $374.15 $174.02 G0050 S Residual urine by ultrasound 0265 1.04 $54.09 $29.75 $10.82 G0101 V CA screen;pelvic/breast exam 0600 0.91 $47.33 $9.47 G0102 N Prostate ca screening; dre G0103 A Psa, total screening G0104 S CA screen;flexi sigmoidscope 0159 2.48 $128.98 $32.25 G0105 T Colorectal scrn; hi risk ind 0158 7.56 $393.19 $98.30 G0106 S Colon CA screen;barium enema 0157 2.73 $141.98 $22.19 $28.40 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 0.78 $40.57 $15.82 $8.11 G0118 S Glaucoma scrn hgh risk direc 0230 0.78 $40.57 $15.82 $8.11 G0120 S Colon ca scrn; barium enema 0157 2.73 $141.98 $22.19 $28.40 G0121 T Colon ca scrn not hi rsk ind 0158 7.56 $393.19 $98.30 G0122 E Colon ca scrn; barium enema G0123 A Screen cerv/vag thin layer Start Printed Page 52307 G0124 A Screen c/v thin layer by MD G0125 S PET img WhBD sgl pulm ring 0667 18.68 $971.53 $194.31 G0127 T Trim nail(s) 0009 0.68 $35.37 $8.34 $7.07 G0128 E CORF skilled nursing service G0129 P Partial hosp prog service 0033 4.96 $257.96 $51.59 G0130 X Single energy x-ray study 0260 0.81 $42.13 $23.17 $8.43 G0131 S CT scan, bone density study 0288 1.38 $71.77 $14.35 G0132 S CT scan, bone density study 0665 0.73 $37.97 $7.59 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 E HHCP-serv of pt,ea 15 min G0152 E HHCP-serv of ot,ea 15 min G0153 E HHCP-svs of s/l path,ea 15mn G0154 E HHCP-svs of rn,ea 15 min G0155 E HHCP-svs of csw,ea 15 min G0156 E HHCP-svs of aide,ea 15 min G0166 T Extrnl counterpulse, per tx 0678 2.55 $132.62 $26.52 G0167 E Hyperbaric oz tx;no md reqrd G0168 X Wound closure by adhesive 0340 0.66 $34.33 $6.87 G0173 S Stereo radoisurgery,complete 0663 63.69 $3,312.45 $662.49 G0175 V OPPS Service,sched team conf 0602 1.57 $81.65 $16.33 G0176 P OPPS/PHP;activity therapy 0033 4.96 $257.96 $51.59 G0177 P OPPS/PHP; train & educ serv 0033 4.96 $257.96 $51.59 G0179 E MD recertification HHA PT G0180 E MD certification HHA patient G0181 E Home health care supervision G0182 E Hospice care supervision G0185 T Transpuppillary thermotx 0235 5.62 $292.29 $81.84 $58.46 G0186 T Dstry eye lesn,fdr vssl tech 0235 5.62 $292.29 $81.84 $58.46 G0187 T Dstry mclr drusen,photocoag 0235 5.62 $292.29 $81.84 $58.46 G0192 N Immunization oral/intranasal G0193 A Endoscopicstudyswallowfunctn G0194 A Sensorytestingendoscopicstud G0195 A Clinicalevalswallowingfunct G0196 A Evalofswallowingwithradioopa G0197 A Evalofptforprescipspeechdevi G0198 A Patientadapation&trainforspe G0199 A Reevaluationofpatientusespec G0200 A Evalofpatientprescipofvoicep G0201 A Modifortraininginusevoicepro G0202 A Screeningmammographydigital G0204 S Diagnosticmammographydigital 0669 0.95 $49.41 $9.88 G0206 S Diagnosticmammographydigital 0669 0.95 $49.41 $9.88 G0210 S PET img whbd ring dxlung ca 0667 18.68 $971.53 $194.31 G0211 S PET img whbd ring init lung 0667 18.68 $971.53 $194.31 G0212 S PET img whbd ring restag lun 0667 18.68 $971.53 $194.31 G0213 S PET img whbd ring dx colorec 0667 18.68 $971.53 $194.31 G0214 S PET img whbd ring init colre 0667 18.68 $971.53 $194.31 G0215 S PET img whbd restag col 0667 18.68 $971.53 $194.31 G0216 S PET img whbd ring dx melanom 0667 18.68 $971.53 $194.31 G0217 S PET img whbd ring init melan 0667 18.68 $971.53 $194.31 G0218 S PET img whbd ring restag mel 0667 18.68 $971.53 $194.31 G0219 E PET img whbd ring noncov ind G0220 S PET img whbd ring dx lymphom 0667 18.68 $971.53 $194.31 G0221 S PET img whbd ring init lymph 0667 18.68 $971.53 $194.31 G0222 S PET img whbd ring resta lymp 0667 18.68 $971.53 $194.31 G0223 S PET img whbd reg ring dx hea 0667 18.68 $971.53 $194.31 G0224 S PETimg whbd reg ring ini hea 0667 18.68 $971.53 $194.31 G0225 S PET img whbd ring restag hea 0667 18.68 $971.53 $194.31 G0226 S PET img whbd dx esophag 0667 18.68 $971.53 $194.31 G0227 S PET img whbd ring ini esopha 0667 18.68 $971.53 $194.31 G0228 S PET img whbd ring restg esop 0667 18.68 $971.53 $194.31 Start Printed Page 52308 G0229 S PET img metabolic brain ring 0667 18.68 $971.53 $194.31 G0230 S PET myocard viability ring 0667 18.68 $971.53 $194.31 G0231 S PET WhBD colorec; gamma cam 0667 18.68 $971.53 $194.31 G0232 S PET whbd lymphoma; gamma cam 0667 18.68 $971.53 $194.31 G0233 S PET whbd melanoma; gamma cam 0667 18.68 $971.53 $194.31 G0234 S PET WhBD pulm nod; gamma cam 0667 18.68 $971.53 $194.31 G0236 S Digital film convert diag ma 0706 $25.00 $5.00 G0237 T Therapeutic procd strg endur 0970 $25.00 $5.00 G0238 T Oth resp proc, indiv 0970 $25.00 $5.00 G0239 T Oth resp proc, group 0970 $25.00 $5.00 G0240 A Critic care by MD transport G0241 A Each additional 30 minutes G0242 S Multisource photon ster plan 0714 $1,375.00 $275.00 G0243 S Multisour photon stero treat 0721 $5,500.00 $1,100.00 G0244 S Observ care by facility topt 0339 7.60 $395.27 $79.05 G0245 V Initial Foot Exam PTLOPS 0600 0.91 $47.33 $9.47 G0246 V Follow-up Eval of Foot PTLOPS 0600 0.91 $47.33 $9.47 G0247 T Routine footcare w LOPS 0009 0.68 $35.37 $8.34 $7.07 G0248 S Demonstrate use home INR mon 0708 $150.00 $30.00 G0249 S Provide test material,equipm 0708 $150.00 $30.00 G0250 E MD review interpret of test G9001 E MCCD, initial rate G9002 E MCCD,maintenance rate G9003 E MCCD, risk adj hi, initial G9004 E MCCD, risk adj lo, initial G9005 E MCCD, risk adj, maintenance G9006 E MCCD, Home monitoring G9007 E MCCD, sch team conf G9008 E 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 G9016 A Demo-smoking cessation coun H0001 E Alcohol and/or drug assess H0002 E Alcohol and/or drug screenin H0003 E Alcohol and/or drug screenin H0004 E Alcohol and/or drug services H0005 E Alcohol and/or drug services H0006 E Alcohol and/or drug services H0007 E Alcohol and/or drug services H0008 E Alcohol and/or drug services H0009 E Alcohol and/or drug services H0010 E Alcohol and/or drug services H0011 E Alcohol and/or drug services H0012 E Alcohol and/or drug services H0013 E Alcohol and/or drug services H0014 E Alcohol and/or drug services H0015 E Alcohol and/or drug services H0016 E Alcohol and/or drug services H0017 E Alcohol and/or drug services H0018 E Alcohol and/or drug services H0019 E Alcohol and/or drug services H0020 E Alcohol and/or drug services H0021 E Alcohol and/or drug training H0022 E Alcohol and/or drug interven H0023 E Alcohol and/or drug outreach H0024 E Alcohol and/or drug preventi H0025 E Alcohol and/or drug preventi H0026 E Alcohol and/or drug preventi H0027 E Alcohol and/or drug preventi H0028 E Alcohol and/or drug preventi H0029 E Alcohol and/or drug preventi H0030 E Alcohol and/or drug hotline H1000 A Prenatal care atrisk assessm H1001 A Antepartum management Start Printed Page 52309 H1002 A Carecoordination prenatal H1003 A Prenatal at risk education H1004 A Follow up home visit/prental H1005 A Prenatalcare enhanced srv pk J0120 N Tetracyclin injection J0130 K Abciximab injection 1605 5.82 $302.69 $60.54 J0150 N Injection adenosine 6 MG J0151 E Adenosine injection J0170 N Adrenalin epinephrin inject J0190 N Inj biperiden lactate/5 mg J0200 N Alatrofloxacin mesylate J0205 K Alglucerase injection 0900 0.53 $27.56 $5.51 J0207 K Amifostine 7000 4.46 $231.96 $46.39 J0210 N Methyldopate hcl injection J0256 K Alpha 1 proteinase inhibitor 0901 0.02 $1.04 $.21 J0270 E Alprostadil for injection J0275 E Alprostadil urethral suppos J0280 N Aminophyllin 250 MG inj J0282 N Amiodarone HCl J0285 N Amphotericin B J0286 K Amphotericin B lipid complex 7001 2.05 $106.62 $21.32 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 N Arbutamine HCl injection J0456 N Azithromycin J0460 N Atropine sulfate injection J0470 N Dimecaprol injection J0475 N Baclofen 10 MG injection J0476 E 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 N Penicillin g benzathine inj J0585 K Botulinum toxin a per unit 0902 0.05 $2.60 $.52 J0587 G Botulinum toxin type B 9018 $8.79 $1.26 J0600 N Edetate calcium disodium inj J0610 N Calcium gluconate injection J0620 N Calcium glycer & lact/10 ML J0630 N Calcitonin salmon injection J0635 N Calcitriol injection 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 J0698 N Cefotaxime sodium injection J0702 N Betamethasone acet&sod phosp J0704 N Betamethasone sod phosp/4 MG J0706 N Caffeine citrate injection J0710 N Cephapirin sodium injection J0713 N Inj ceftazidime per 500 mg J0715 N Ceftizoxime sodium / 500 MG J0720 N Chloramphenicol sodium injec Start Printed Page 52310 J0725 N Chorionic gonadotropin/1000u J0735 N Clonidine hydrochloride J0740 N Cidofovir injection 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 N Corticotropin injection J0835 N Inj cosyntropin per 0.25 MG J0850 K Cytomegalovirus imm IV /vial 0903 0.34 $17.68 $3.54 J0895 N Deferoxamine mesylate inj 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 J1050 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 J1095 N Inj dexamethasone acetate J1100 N Dexamethasone sodium phos J1110 N Inj dihydroergotamine mesylt J1120 N Acetazolamid sodium injectio J1160 N Digoxin injection J1165 N Phenytoin sodium injection J1170 N Hydromorphone injection J1180 N Dyphylline injection J1190 K Dexrazoxane HCl injection 0726 2.40 $124.82 $24.96 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 N Dolasetron mesylate J1270 N Injection, doxercalciferol J1320 N Amitriptyline injection J1325 N Epoprostenol injection J1327 N Eptifibatide injection J1330 N Ergonovine maleate injection J1364 N Erythro lactobionate /500 MG J1380 N Estradiol valerate 10 MG inj J1390 N Estradiol valerate 20 MG inj J1410 N Inj estrogen conjugate 25 MG J1435 N Injection estrone per 1 MG J1436 N Etidronate disodium inj J1438 N Etanercept injection J1440 K Filgrastim 300 mcg injection 0728 2.24 $116.50 $23.30 J1441 K Filgrastim 480 mcg injection 7049 3.37 $175.27 $35.05 J1450 N Fluconazole J1452 N Intraocular Fomivirsen na J1455 N Foscarnet sodium injection J1460 N Gamma globulin 1 CC inj J1470 E Gamma globulin 2 CC inj J1480 E Gamma globulin 3 CC inj J1490 E Gamma globulin 4 CC inj J1500 E Gamma globulin 5 CC inj J1510 E Gamma globulin 6 CC inj Start Printed Page 52311 J1520 E Gamma globulin 7 CC inj J1530 E Gamma globulin 8 CC inj J1540 E Gamma globulin 9 CC inj J1550 E Gamma globulin 10 CC inj J1560 E Gamma globulin > 10 CC inj J1561 K Immune globulin 500 mg 0905 0.45 $23.40 $4.68 J1563 E IV immune globulin J1565 N RSV-ivig J1570 N Ganciclovir sodium injection J1580 N Garamycin gentamicin inj J1590 N Gatifloxacin injection J1600 N Gold sodium thiomaleate inj J1610 N Glucagon hydrochloride/1 MG J1620 N Gonadorelin hydroch/ 100 mcg J1626 N Granisetron HCl injection 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 E Inj enoxaparin sodium J1655 N Tinzaparin sodium injection J1670 N Tetanus immune globulin inj J1700 N Hydrocortisone acetate inj J1710 N Hydrocortisone sodium ph inj J1720 N Hydrocortisone sodium succ i J1730 N Diazoxide injection J1742 N Ibutilide fumarate injection J1745 K Infliximab injection 7043 0.74 $38.49 $7.70 J1750 N Iron dextran J1755 N Iron sucrose injection J1785 K Injection imiglucerase /unit 0916 0.05 $2.60 $.52 J1790 N Droperidol injection J1800 N Propranolol injection J1810 E Droperidol/fentanyl inj J1820 N Insulin injection J1825 K Interferon beta-1a 0909 2.77 $144.06 $28.81 J1830 N Interferon beta-1b / .25 MG J1835 N Itraconazole injection J1840 N Kanamycin sulfate 500 MG inj J1850 N Kanamycin sulfate 75 MG inj J1885 N Ketorolac tromethamine inj J1890 N Cephalothin sodium injection J1910 N Kutapressin injection J1940 N Furosemide injection J1950 K Leuprolide acetate /3.75 MG 0800 4.15 $215.84 $43.17 J1955 E Inj levocarnitine per 1 gm J1956 N Levofloxacin injection J1960 N Levorphanol tartrate inj J1980 N Hyoscyamine sulfate inj J1990 N Chlordiazepoxide injection J2000 N Lidocaine injection J2010 N Lincomycin injection J2020 N Linezolid injection J2060 N Lorazepam injection J2150 N Mannitol injection J2175 N Meperidine hydrochl /100 MG J2180 N Meperidine/promethazine inj J2210 N Methylergonovin maleate inj J2250 N Inj midazolam hydrochloride J2260 N Inj milrinone lactate / 5 ML J2270 N Morphine sulfate injection J2271 N Morphine so4 injection 100mg J2275 N Morphine sulfate injection J2300 N Inj nalbuphine hydrochloride J2310 N Inj naloxone hydrochloride Start Printed Page 52312 J2320 N Nandrolone decanoate 50 MG J2321 N Nandrolone decanoate 100 MG J2322 N Nandrolone decanoate 200 MG J2352 K Octreotide acetate injection 7031 0.90 $46.81 $9.36 J2355 K Oprelvekin injection 7011 2.52 $131.06 $26.21 J2360 N Orphenadrine injection J2370 N Phenylephrine hcl injection J2400 N Chloroprocaine hcl injection J2405 N Ondansetron hcl injection J2410 N Oxymorphone hcl injection J2430 K Pamidronate disodium /30 MG 0730 3.46 $179.95 $35.99 J2440 N Papaverin hcl injection J2460 N Oxytetracycline injection J2500 N Paricalcitol J2510 N Penicillin g procaine inj J2515 N Pentobarbital sodium inj J2540 N Penicillin g potassium inj J2543 N Piperacillin/tazobactam J2545 A 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 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 N Pralidoxime chloride inj J2760 N Phentolaine mesylate inj J2765 N Metoclopramide hcl injection J2770 N Quinupristin/dalfopristin J2780 N Ranitidine hydrochloride inj J2790 K Rho d immune globulin inj 0884 0.70 $36.41 $7.28 J2792 K Rho(D) immune globulin h, sd 1609 0.22 $11.44 $2.29 J2795 N Ropivacaine HCl injection J2800 N Methocarbamol injection J2810 N Inj theophylline per 40 MG J2820 N Sargramostim injection J2910 N Aurothioglucose injeciton J2912 N Sodium chloride injection J2915 N NA Ferric Gluconate Complex J2920 N Methylprednisolone injection J2930 N Methylprednisolone injection J2940 N Somatrem injection J2941 K Somatropin injection 7034 0.78 $40.57 $8.11 J2950 N Promazine hcl injection J2993 K Reteplase injection 9005 10.84 $563.78 $112.76 J2995 N Inj streptokinase /250000 IU J2997 N Alteplase recombinant J3000 N Streptomycin injection J3010 N Fentanyl citrate injeciton J3030 N Sumatriptan succinate / 6 MG J3070 N Pentazocine hcl injection J3100 K Tenecteplase injection 9002 25.46 $1,324.15 $264.83 J3105 N Terbutaline sulfate inj 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 E Thyrotropin injection J3245 K Tirofiban hydrochloride 7041 4.82 $250.68 $50.14 Start Printed Page 52313 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 1.23 $63.97 $12.79 J3310 N Perphenazine injeciton J3320 N Spectinomycn di-hcl inj J3350 N Urea injection J3360 N Diazepam injection J3364 N Urokinase 5000 IU injection J3365 N Urokinase 250,000 IU inj J3370 N Vancomycin hcl injection J3395 K Verteporfin injection 1203 16.26 $845.67 $169.13 J3400 N Triflupromazine hcl inj J3410 N Hydroxyzine hcl injection J3420 N Vitamin b12 injection J3430 N Vitamin k phytonadione inj J3470 N Hyaluronidase injection J3475 N Inj magnesium sulfate J3480 N Inj potassium chloride J3485 N Zidovudine 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 J7030 N Normal saline solution infus J7040 N Normal saline solution infus J7042 N 5% dextrose/normal saline 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 0.01 $.52 $.10 J7191 K Factor VIII (porcine) 0926 0.02 $1.04 $.21 J7192 K Factor viii recombinant 0927 0.01 $.52 $.10 J7193 K Factor IX non-recombinant 0931 0.01 $.52 $.10 J7194 K Factor ix complex 0928 0.01 $.52 $.10 J7195 K Factor IX recombinant 0932 0.03 $1.56 $.31 J7197 K Antithrombin iii injection 0930 0.01 $.52 $.10 J7198 K Anti-inhibitor 0929 0.01 $.52 $.10 J7199 E Hemophilia clot factor noc J7300 E Intraut copper contraceptive J7302 E Levonorgestrel iu contracept J7308 N Aminolevulinic acid hcl top J7310 N Ganciclovir long act implant J7316 N Sodium hyaluronate injection J7320 K Hylan G-F 20 injection 1611 2.43 $126.38 $25.28 J7330 K Cultured chondrocytes implnt 1059 43.64 $2,269.67 $453.93 J7340 E Metabolic active D/E tissue J7500 N Azathioprine oral 50mg J7501 N Azathioprine parenteral J7502 K Cyclosporine oral 100 mg 0888 0.04 $2.08 $.42 J7504 K Lymphocyte immune globulin 0890 3.64 $189.31 $37.86 J7505 K Monoclonal antibodies 7038 4.43 $230.40 $46.08 J7506 N Prednisone oral J7507 K Tacrolimus oral per 1 MG 0891 0.02 $1.04 $.21 J7508 E Tacrolimus oral per 5 MG J7509 N Methylprednisolone oral Start Printed Page 52314 J7510 N Prednisolone oral per 5 mg J7511 K Antithymocyte globuln rabbit 9104 1.97 $102.46 $20.49 J7513 K Daclizumab, parenteral 1612 3.77 $196.07 $39.21 J7515 N Cyclosporine oral 25 mg J7516 N Cyclosporin parenteral 250mg J7517 G Mycophenolate mofetil oral 9015 $2.40 $.34 J7520 K Sirolimus, oral 9106 0.05 $2.60 $.52 J7525 N Tacrolimus injection J7599 E Immunosuppressive drug noc J7608 A Acetylcysteine inh sol u d J7618 A Albuterol inh sol con J7619 A Albuterol inh sol u d J7622 A Beclomethasone inhalatn sol J7624 A Betamethasone inhalation sol J7626 A Budesonide inhalation sol J7628 A Bitolterol mes inhal sol con J7629 A Bitolterol mes inh sol u d J7631 A Cromolyn sodium inh sol u d J7635 A Atropine inhal sol con J7636 A Atropine inhal sol unit dose J7637 A Dexamethasone inhal sol con J7638 A Dexamethasone inhal sol u d J7639 A Dornase alpha inhal sol u d J7641 A Flunisolide, inhalation sol J7642 A Glycopyrrolate inhal sol con J7643 A Glycopyrrolate inhal sol u d J7644 A Ipratropium brom inh sol u d J7648 A Isoetharine hcl inh sol con J7649 A Isoetharine hcl inh sol u d J7658 A Isoproterenolhcl inh sol con J7659 A Isoproterenol hcl inh sol ud J7668 A Metaproterenol inh sol con J7669 A Metaproterenol inh sol u d J7680 A Terbutaline so4 inh sol con J7681 A Terbutaline so4 inh sol u d J7682 A Tobramycin inhalation sol J7683 A Triamcinolone inh sol con J7684 A Triamcinolone inh sol u d J7699 A Inhalation solution for DME J7799 A Non-inhalation drug for DME J8499 E Oral prescrip drug non chemo J8510 N Oral busulfan J8520 K Capecitabine, oral, 150 mg 7042 0.03 $1.56 $.31 J8521 E Capecitabine, oral, 500 mg J8530 N Cyclophosphamide oral 25 MG J8560 K Etoposide oral 50 MG 0802 0.54 $28.08 $5.62 J8600 N Melphalan oral 2 MG J8610 N Methotrexate oral 2.5 MG J8700 K Temozolmide 1086 0.05 $2.60 $.52 J8999 E Oral prescription drug chemo J9000 N Doxorubic hcl 10 MG vl chemo J9001 K Doxorubicin hcl liposome inj 7046 4.54 $236.12 $47.22 J9015 K Aldesleukin/single use vial 0807 6.09 $316.73 $63.35 J9017 G Arsenic trioxide 9012 $23.75 $3.40 J9020 N Asparaginase injection J9031 N Bcg live intravesical vac J9040 K Bleomycin sulfate injection 0857 3.10 $161.23 $32.25 J9045 K Carboplatin injection 0811 1.58 $82.17 $16.43 J9050 N Carmus bischl nitro inj J9060 K Cisplatin 10 MG injection 0813 0.47 $24.44 $4.89 J9062 E Cisplatin 50 MG injection J9065 K Inj cladribine per 1 MG 0858 0.84 $43.69 $8.74 J9070 N Cyclophosphamide 100 MG inj J9080 E Cyclophosphamide 200 MG inj J9090 E Cyclophosphamide 500 MG inj J9091 E Cyclophosphamide 1.0 grm inj Start Printed Page 52315 J9092 E Cyclophosphamide 2.0 grm inj J9093 N Cyclophosphamide lyophilized J9094 E Cyclophosphamide lyophilized J9095 E Cyclophosphamide lyophilized J9096 E Cyclophosphamide lyophilized J9097 E Cyclophosphamide lyophilized J9100 N Cytarabine hcl 100 MG inj J9110 E Cytarabine hcl 500 MG inj J9120 N Dactinomycin actinomycin d J9130 N Dacarbazine 10 MG inj J9140 E Dacarbazine 200 MG inj J9150 K Daunorubicin 0820 2.27 $118.06 $23.61 J9151 K Daunorubicin citrate liposom 0821 3.17 $164.87 $32.97 J9160 K Denileukin diftitox, 300 mcg 1084 13.94 $725.01 $145.00 J9165 K Diethylstilbestrol injection 0822 2.21 $114.94 $22.99 J9170 K Docetaxel 0823 4.01 $208.56 $41.71 J9180 E Epirubicin HCl injection J9181 N Etoposide 10 MG inj J9182 E Etoposide 100 MG inj J9185 K Fludarabine phosphate inj 0842 3.30 $171.63 $34.33 J9190 N Fluorouracil injection J9200 K Floxuridine injection 0827 2.42 $125.86 $25.17 J9201 K Gemcitabine HCl 0828 1.49 $77.49 $15.50 J9202 K Goserelin acetate implant 0810 5.94 $308.93 $61.79 J9206 K Irinotecan injection 0830 1.86 $96.74 $19.35 J9208 K Ifosfomide injection 0831 2.06 $107.14 $21.43 J9209 K Mesna injection 0732 0.55 $28.60 $5.72 J9211 K Idarubicin hcl injection 0832 4.57 $237.68 $47.54 J9212 N Interferon alfacon-1 J9213 N Interferon alfa-2a inj J9214 N Interferon alfa-2b inj J9215 N Interferon alfa-n3 inj J9216 K Interferon gamma 1-b inj 0838 2.49 $129.50 $25.90 J9217 K Leuprolide acetate suspnsion 9217 6.30 $327.66 $65.53 J9218 K Leuprolide acetate injeciton 0861 0.84 $43.69 $8.74 J9219 G Leuprolide acetate implant 7051 $5,399.80 $773.02 J9230 N Mechlorethamine hcl inj J9245 K Inj melphalan hydrochl 50 MG 0840 4.09 $212.72 $42.54 J9250 N Methotrexate sodium inj J9260 E Methotrexate sodium inj J9265 K Paclitaxel injection 0863 2.50 $130.02 $26.00 J9266 K Pegaspargase/singl dose vial 0843 2.38 $123.78 $24.76 J9268 K Pentostatin injection 0844 21.32 $1,108.83 $221.77 J9270 N Plicamycin (mithramycin) inj J9280 K Mitomycin 5 MG inj 0862 1.18 $61.37 $12.27 J9290 E Mitomycin 20 MG inj J9291 E Mitomycin 40 MG inj J9293 K Mitoxantrone hydrochl / 5 MG 0864 3.02 $157.07 $31.41 J9300 K Gemtuzumab ozogamicin 9004 1.05 $54.61 $10.92 J9310 K Rituximab cancer treatment 0849 5.71 $296.97 $59.39 J9320 N Streptozocin injection J9340 N Thiotepa injection J9350 K Topotecan 0852 7.61 $395.79 $79.16 J9355 K Trastuzumab 1613 0.66 $34.33 $6.87 J9357 K Valrubicin, 200 mg 1614 2.04 $106.10 $21.22 J9360 N Vinblastine sulfate inj J9370 N Vincristine sulfate 1 MG inj J9375 E Vincristine sulfate 2 MG inj J9380 E Vincristine sulfate 5 MG inj J9390 K Vinorelbine tartrate/10 mg 0855 1.10 $57.21 $11.44 J9600 K Porfimer sodium 0856 26.35 $1,370.44 $274.09 J9999 E Chemotherapy drug K0001 A Standard wheelchair K0002 A Stnd hemi (low seat) whlchr K0003 A Lightweight wheelchair K0004 A High strength ltwt whlchr Start Printed Page 52316 K0005 A Ultralightweight wheelchair K0006 A Heavy duty wheelchair K0007 A Extra heavy duty wheelchair K0009 A Other manual wheelchair/base K0010 A Stnd wt frame power whlchr K0011 A Stnd wt pwr whlchr w control K0012 A Ltwt portbl power whlchr K0014 A Other power whlchr base K0015 A Detach non-adjus hght armrst K0016 A Detach adjust armrst cmplete K0017 A Detach adjust armrest base K0018 A Detach adjust armrst upper K0019 A Arm pad each K0020 A Fixed adjust armrest pair K0021 A Anti-tipping device each K0022 A Reinforced back upholstery K0023 A Planr back insrt foam w/strp K0024 A Plnr back insrt foam w/hrdwr K0025 A Hook-on headrest extension K0026 A Back upholst lgtwt whlchr K0027 A Back upholst other whlchr K0028 A Manual fully reclining back K0029 A Reinforced seat upholstery K0030 A Solid plnr seat sngl dnsfoam K0031 A Safety belt/pelvic strap K0032 A Seat uphols lgtwt whlchr K0033 A Seat upholstery other whlchr K0034 A Heel loop each K0035 A Heel loop with ankle strap K0036 A Toe loop each K0037 A High mount flip-up footrest K0038 A Leg strap each K0039 A Leg strap h style each K0040 A Adjustable angle footplate K0041 A Large size footplate each K0042 A Standard size footplate each K0043 A Ftrst lower extension tube K0044 A Ftrst upper hanger bracket K0045 A Footrest complete assembly K0046 A Elevat legrst low extension K0047 A Elevat legrst up hangr brack K0048 A Elevate legrest complete K0049 A Calf pad each K0050 A Ratchet assembly K0051 A Cam relese assem ftrst/lgrst K0052 A Swingaway detach footrest K0053 A Elevate footrest articulate K0054 A Seat wdth 10-12/15/17/20 wc K0055 A Seat dpth 15/17/18 ltwt wc K0056 A Seat ht <17 or> =21 ltwt wc K0057 A Seat wdth 19/20 hvy dty wc K0058 A Seat dpth 17/18 power wc K0059 A Plastic coated handrim each K0060 A Steel handrim each K0061 A Aluminum handrim each K0062 A Handrim 8-10 vert/obliq proj K0063 A Hndrm 12-16 vert/obliq proj K0064 A Zero pressure tube flat free K0065 A Spoke protectors K0066 A Solid tire any size each K0067 A Pneumatic tire any size each K0068 A Pneumatic tire tube each K0069 A Rear whl complete solid tire K0070 A Rear whl compl pneum tire K0071 A Front castr compl pneum tire K0072 A Frnt cstr cmpl sem-pneum tir Start Printed Page 52317 K0073 A Caster pin lock each K0074 A Pneumatic caster tire each K0075 A Semi-pneumatic caster tire K0076 A Solid caster tire each K0077 A Front caster assem complete K0078 A Pneumatic caster tire tube K0079 A Wheel lock extension pair K0080 A Anti-rollback device pair K0081 A Wheel lock assembly complete K0082 A 22 nf deep cycl acid battery K0083 A 22 nf gel cell battery each K0084 A Grp 24 deep cycl acid battry K0085 A Group 24 gel cell battery K0086 A U-1 lead acid battery each K0087 A U-1 gel cell battery each K0088 A Battry chrgr acid/gel cell K0089 A Battery charger dual mode K0090 A Rear tire power wheelchair K0091 A Rear tire tube power whlchr K0092 A Rear assem cmplt powr whlchr K0093 A Rear zero pressure tire tube K0094 A Wheel tire for power base K0095 A Wheel tire tube each base K0096 A Wheel assem powr base complt K0097 A Wheel zero presure tire tube K0098 A Drive belt power wheelchair K0099 A Pwr wheelchair front caster K0100 A Amputee adapter pair K0101 A One-arm drive attachment K0102 A Crutch and cane holder K0103 A Transfer board < 25″ K0104 A Cylinder tank carrier K0105 A Iv hanger K0106 A Arm trough each K0107 A Wheelchair tray K0108 A W/c component-accessory NOS K0112 A Trunk vest supprt innr frame K0113 A Trunk vest suprt w/o inr frm K0114 A Whlchr back suprt inr frame K0115 A Back module orthotic system K0116 A Back & seat modul orthot sys K0183 A Nasal application device K0184 A Nasal pillow or face seal K0185 A Pos airway pressure headgear K0186 A Pos airway prssure chinstrap K0187 A Pos airway pressure tubing K0188 A Pos airway pressure filter K0189 A Filter nondisposable w PAP K0195 A Elevating whlchair leg rests K0268 A Humidifier nonheated w PAP K0415 E RX antiemetic drg, oral NOS K0416 E Rx antiemetic drg,rectal NOS K0452 A Wheelchair bearings K0455 A Pump uninterrupted infusion K0460 A WC power add-on joystick K0461 A WC power add-on tiller cntrl K0462 A Temporary replacement eqpmnt K0531 A Heated humidifier used w pap K0532 A Noninvasive assist wo backup K0533 A Noninvasive assist w backup K0534 A Invasive assist w backup K0538 A Neg pressure wnd thrpy pump K0539 A Neg pres wnd thrpy dsg set K0540 A Neg pres wnd thrp canister K0541 A SGD prerecorded msg <= 8 min K0542 A SGD prerecorded msg > 8 min Start Printed Page 52318 K0543 A SGD msg formed by spelling K0544 A SGD w multi methods msg/accs K0545 A SGD sftwre prgrm for PC/PDA K0546 A SGD accessory,mounting systm K0547 A SGD accessory NOC K0548 A Insulin lispro K0549 A Hosp bed hvy dty xtra wide K0550 A Hosp bed xtra hvy dty x wide K0551 A Residual limb support system L0100 A Cranial orthosis/helmet mold L0110 A Cranial orthosis/helmet nonm 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 L0300 A TLSO flex surgical support L0310 A Tlso flexible custom fabrica L0315 A Tlso flex elas rigid post pa L0317 A Tlso flex hypext elas post p L0320 A Tlso a-p contrl w apron frnt L0321 A Tlso anti-post-cntrl prefab L0330 A Tlso ant-pos-lateral control L0331 A Tlso ant-post-lat cntrl prfb L0340 A Tlso a-p-l-rotary with apron L0350 A Tlso flex compress jacket cu L0360 A Tlso flex compress jacket mo L0370 A Tlso a-p-l-rotary hyperexten L0380 A Tlso a-p-l-rot w/ pos extens L0390 A Tlso a-p-l control molded L0391 A Tlso ant-post-lat-rot cntrl L0400 A Tlso a-p-l w interface mater L0410 A Tlso a-p-l two piece constr L0420 A Tlso a-p-l 2 piece w interfa L0430 A Tlso a-p-l w interface custm L0440 A Tlso a-p-l overlap frnt cust L0500 A Lso flex surgical support L0510 A Lso flexible custom fabricat L0515 A Lso flex elas w/ rig post pa L0520 A Lso a-p-l control with apron L0530 A Lso ant-pos control w apron L0540 A Lso lumbar flexion a-p-l L0550 A Lso a-p-l control molded L0560 A Lso a-p-l w interface L0561 A Prefab lso L0565 A Lso a-p-l control custom L0600 A Sacroiliac flex surg support L0610 A Sacroiliac flexible custm fa L0620 A Sacroiliac semi-rig w apron L0700 A Ctlso a-p-l control molded L0710 A Ctlso a-p-l control w/ inter L0810 A Halo cervical into jckt vest L0820 A Halo cervical into body jack L0830 A Halo cerv into milwaukee typ L0860 A Magnetic resonanc image comp L0900 A Torso/ptosis support L0910 A Torso & ptosis supp custm fa L0920 A Torso/pendulous abd support Start Printed Page 52319 L0930 A Pendulous abdomen supp custm L0940 A Torso/postsurgical support L0950 A Post surg support custom fab L0960 A 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 L0986 A Spinal orth abdm pnl prefab 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 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 L1815 A Elastic with condylar pads Start Printed Page 52320 L1820 A Ko elas w/ condyle pads & jo L1825 A Ko elastic knee cap L1830 A Ko immobilizer canvas longit L1832 A KO adj jnt pos rigid support L1834 A Ko w/0 joint rigid molded to 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 L1885 A Knee upright w/resistance L1900 A Afo sprng wir drsflx calf bd L1902 A Afo ankle gauntlet L1904 A Afo molded ankle gauntlet L1906 A Afo multiligamentus ankle su L1910 A Afo sing bar clasp attach sh L1920 A Afo sing upright w/ adjust s L1930 A Afo plastic L1940 A Afo molded to patient plasti L1945 A Afo molded plas rig ant tib L1950 A Afo spiral molded to pt plas L1960 A Afo pos solid ank plastic mo L1970 A Afo plastic molded w/ankle j L1980 A Afo sing solid stirrup calf L1990 A Afo doub solid stirrup calf L2000 A Kafo sing fre stirr thi/calf 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 L2102 E Afo tibial fx cast plstr mol L2104 E Afo tib fx cast synthetic mo 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 L2122 E Kafo fem fx cast plaster mol L2124 E Kafo fem fx cast synthet mol 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 L2182 A Drop lock knee L2184 A Limited motion knee joint L2186 A Adj motion knee jnt lerman t L2188 A Quadrilateral brim Start Printed Page 52321 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 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 L2435 A Knee joint polycentric joint 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 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 Start Printed Page 52322 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 E Ft insert ucb berkeley shell L3001 E Foot insert remov molded spe L3002 E Foot insert plastazote or eq L3003 E Foot insert silicone gel eac L3010 E Foot longitudinal arch suppo L3020 E Foot longitud/metatarsal sup L3030 E Foot arch support remov prem L3040 E Ft arch suprt premold longit L3050 E Foot arch supp premold metat L3060 E Foot arch supp longitud/meta L3070 E Arch suprt att to sho longit L3080 E Arch supp att to shoe metata L3090 E Arch supp att to shoe long/m L3100 E Hallus-valgus nght dynamic s L3140 E Abduction rotation bar shoe L3150 E Abduct rotation bar w/o shoe L3160 E Shoe styled positioning dev L3170 E Foot plastic heel stabilizer L3201 E Oxford w supinat/pronat inf L3202 E Oxford w/ supinat/pronator c L3203 E Oxford w/ supinator/pronator L3204 E Hightop w/ supp/pronator inf L3206 E Hightop w/ supp/pronator chi L3207 E Hightop w/ supp/pronator jun L3208 E Surgical boot each infant L3209 E Surgical boot each child L3211 E Surgical boot each junior L3212 E Benesch boot pair infant L3213 E Benesch boot pair child L3214 E Benesch boot pair junior L3215 E Orthopedic ftwear ladies oxf L3216 E Orthoped ladies shoes dpth i L3217 E Ladies shoes hightop depth i L3218 E Ladies surgical boot each L3219 E Orthopedic mens shoes oxford L3221 E Orthopedic mens shoes dpth i L3222 E Mens shoes hightop depth inl L3223 E Mens surgical boot each L3224 A Woman's shoe oxford brace L3225 A Man's shoe oxford brace L3230 E Custom shoes depth inlay L3250 E Custom mold shoe remov prost L3251 E Shoe molded to pt silicone s L3252 E Shoe molded plastazote cust L3253 E Shoe molded plastazote cust L3254 E Orth foot non-stndard size/w L3255 E Orth foot non-standard size/ L3257 E Orth foot add charge split s L3260 E Ambulatory surgical boot eac L3265 E Plastazote sandal each L3300 E Sho lift taper to metatarsal L3310 E Shoe lift elev heel/sole neo L3320 E Shoe lift elev heel/sole cor L3330 E Lifts elevation metal extens L3332 E Shoe lifts tapered to one-ha L3334 E Shoe lifts elevation heel /i L3340 E Shoe wedge sach L3350 E Shoe heel wedge L3360 E Shoe sole wedge outside sole Start Printed Page 52323 L3370 E Shoe sole wedge between sole L3380 E Shoe clubfoot wedge L3390 E Shoe outflare wedge L3400 E Shoe metatarsal bar wedge ro L3410 E Shoe metatarsal bar between L3420 E Full sole/heel wedge btween L3430 E Sho heel count plast reinfor L3440 E Heel leather reinforced L3450 E Shoe heel sach cushion type L3455 E Shoe heel new leather standa L3460 E Shoe heel new rubber standar L3465 E Shoe heel thomas with wedge L3470 E Shoe heel thomas extend to b L3480 E Shoe heel pad & depress for L3485 E Shoe heel pad removable for L3500 E Ortho shoe add leather insol L3510 E Orthopedic shoe add rub insl L3520 E O shoe add felt w leath insl L3530 E Ortho shoe add half sole L3540 E Ortho shoe add full sole L3550 E O shoe add standard toe tap L3560 E O shoe add horseshoe toe tap L3570 E O shoe add instep extension L3580 E O shoe add instep velcro clo L3590 E O shoe convert to sof counte L3595 E Ortho shoe add march bar L3600 E Trans shoe calip plate exist L3610 E Trans shoe caliper plate new L3620 E Trans shoe solid stirrup exi L3630 E Trans shoe solid stirrup new L3640 E Shoe dennis browne splint bo L3649 E Orthopedic shoe modifica NOS L3650 A Shlder fig 8 abduct restrain L3660 A Abduct restrainer canvas&web L3670 A Acromio/clavicular canvas&we L3675 A Canvas vest SO L3677 A SO hard plastic stabilizer L3700 A Elbow orthoses elas w stays 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 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 E Torsion mechanism wrist/elbo L3900 A Hinge extension/flex wrist/f L3901 A Hinge ext/flex wrist finger L3902 A 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 L3910 A Whfo swanson design Start Printed Page 52324 L3912 A Flex glove w/elastic finger L3914 A WHO wrist extension cock-up L3916 A Whfo wrist extens w/ outrigg 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 A Seo mobile arm sup att to wc L3965 A Arm supp att to wc rancho ty L3966 A Mobile arm supports reclinin L3968 A Friction dampening arm supp L3969 A Monosuspension arm/hand supp L3970 A Elevat proximal arm support L3972 A Offset/lat rocker arm w/ ela L3974 A 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 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 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 Pneumatic ankle cntrl splint L4360 A Pneumatic walking splint L4370 A Pneumatic full leg splint L4380 A Pneumatic knee splint L4392 A Replace AFO soft interface L4394 A Replace foot drop spint L4396 A Static AFO Start Printed Page 52325 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 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 Start Printed Page 52326 L5644 A Above knee wood socket L5645 A Bk flex inner socket ext fra L5646 A Below knee air cushion socke L5647 A Below knee suction socket L5648 A Above knee air cushion socke 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 L5660 A Sock insrt syme silicone gel L5661 A Multi-durometer symes L5662 A Socket insert bk silicone ge L5663 A Sock knee disartic silicone L5664 A Socket insert ak silicone ge 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 L5674 A Bk suspension sleeve L5675 A Bk heavy duty susp sleeve L5676 A Bk knee joints single axis p L5677 A Bk knee joints polycentric p L5678 A Bk joint covers pair L5680 A Bk thigh lacer non-molded L5682 A Bk thigh lacer glut/ischia m L5684 A Bk fork strap 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 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 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 Start Printed Page 52327 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 L5846 A Knee-shin sys microprocessor L5847 A Microprocessor cntrl feature L5850 A Endo ak/hip knee extens assi L5855 A Mech hip extension assist 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 L5989 A Pylon w elctrnc force sensor L5990 A User adjustable heel height 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 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 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 Start Printed Page 52328 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-friction 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 L6640 A Shoulder abduction joint pai L6641 A Excursion amplifier pulley t L6642 A Excursion amplifier lever ty L6645 A Shoulder flexion-abduction j 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 L6692 A Silicone gel insert or equal L6693 A Lockingelbow forearm cntrbal 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 Start Printed Page 52329 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 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 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 Start Printed Page 52330 L7366 A Battery chrgr 12 volt utah/e 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 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 E Compression stocking BK30-40 L8120 E 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 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 L8490 A Air seal suction reten systm 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 Start Printed Page 52331 L8600 N Implant breast silicone/eq L8603 N Collagen imp urinary 2.5 ml L8606 A Synthetic implnt urinary 1ml L8610 N Ocular implant L8612 N Aqueous shunt prosthesis L8613 N Ossicular implant L8614 N Cochlear device/system L8619 A Replace cochlear processor L8630 N Metacarpophalangeal implant L8641 N Metatarsal joint implant L8642 N Hallux implant L8658 N Interphalangeal joint implnt L8670 N Vascular graft, synthetic L8699 N Prosthetic implant NOS L9900 A O&P supply/accessory/service M0064 X Visit for drug monitoring 0374 1.20 $62.41 $12.48 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 P3000 A Screen pap by tech w md supv P3001 E Screening pap smear by phys P7001 E Culture bacterial urine P9010 K Whole blood for transfusion 0950 1.25 $65.01 $13.00 P9011 E Blood split unit P9012 K Cryoprecipitate each unit 0952 0.53 $27.56 $5.51 P9016 K RBC leukocytes reduced 0954 1.59 $82.69 $16.54 P9017 K One donor fresh frozn plasma 0955 0.71 $36.93 $7.39 P9019 K Platelets, each unit 0957 0.67 $34.85 $6.97 P9020 K Plaelet rich plasma unit 0958 1.12 $58.25 $11.65 P9021 K Red blood cells unit 0959 1.12 $58.25 $11.65 P9022 K Washed red blood cells unit 0960 1.42 $73.85 $14.77 P9023 K Frozen plasma, pooled, sd 0949 1.26 $65.53 $13.11 P9031 K Platelets leukocytes reduced 1013 0.91 $47.33 $9.47 P9032 K Platelets, irradiated 9500 0.92 $47.85 $9.57 P9033 K Platelets leukoreduced irrad 0954 1.59 $82.69 $16.54 P9034 K Platelets, pheresis 9501 5.10 $265.25 $53.05 P9035 K Platelet pheres leukoreduced 9501 5.10 $265.25 $53.05 P9036 K Platelet pheresis irradiated 9502 1.99 $103.50 $20.70 P9037 K Plate pheres leukoredu irrad 1019 6.93 $360.42 $72.08 P9038 K RBC irradiated 9505 1.82 $94.66 $18.93 P9039 K RBC deglycerolized 9504 1.91 $99.34 $19.87 P9040 K RBC leukoreduced irradiated 9504 1.91 $99.34 $19.87 P9041 K Albumin (human),5%, 50ml 0961 0.47 $24.44 $4.89 P9043 K Plasma protein fract,5%,50ml 0956 1.94 $100.90 $20.18 P9044 K Cryoprecipitatereducedplasma 1009 0.66 $34.33 $6.87 P9045 K Albumin (human), 5%, 250 ml 0963 2.37 $123.26 $24.65 P9046 K Albumin (human), 25%, 20 ml 0964 0.50 $26.00 $5.20 P9047 K Albumin (human), 25%, 50ml 0965 1.25 $65.01 $13.00 P9048 K Plasmaprotein fract,5%,250ml 0966 9.71 $505.01 $101.00 P9050 K Granulocytes, pheresis unit 9506 0.45 $23.40 $4.68 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 1.34 $69.69 $38.33 $13.94 Q0081 T Infusion ther other than che 0120 1.81 $94.14 $25.42 $18.83 Q0083 S Chemo by other than infusion 0116 0.85 $44.21 $8.84 Q0084 S Chemotherapy by infusion 0117 3.87 $201.27 $52.33 $40.25 Q0085 S Chemo by both infusion and o 0118 5.68 $295.41 $72.03 $59.08 Start Printed Page 52332 Q0086 A Physical therapy evaluation/ Q0091 T Obtaining screen pap smear 0191 0.22 $11.44 $3.32 $2.29 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 0.19 $9.88 $1.98 Q0163 N Diphenhydramine HCl 50mg Q0164 N Prochlorperazine maleate 5mg Q0165 E Prochlorperazine maleate10mg Q0166 N Granisetron HCl 1 mg oral Q0167 N Dronabinol 2.5mg oral Q0168 E Dronabinol 5mg oral Q0169 N Promethazine HCl 12.5mg oral Q0170 E Promethazine HCl 25 mg oral Q0171 N Chlorpromazine HCl 10mg oral Q0172 E Chlorpromazine HCl 25mg oral Q0173 N Trimethobenzamide HCl 250mg Q0174 N Thiethylperazine maleate10mg Q0175 N Perphenazine 4mg oral Q0176 E Perphenazine 8mg oral Q0177 N Hydroxyzine pamoate 25mg Q0178 E Hydroxyzine pamoate 50mg Q0179 N Ondansetron HCl 8mg oral Q0180 N Dolasetron mesylate oral Q0181 E Unspecified oral anti-emetic Q0183 N Nonmetabolic active tissue Q0184 N Metabolically active tissue Q0187 K Factor viia recombinant 1409 13.53 $703.68 $140.74 Q1001 E Ntiol category 1 Q1002 E Ntiol category 2 Q1003 E Ntiol category 3 Q1004 E Ntiol category 4 Q1005 E Ntiol category 5 Q2001 N Oral cabergoline 0.5 mg Q2002 N Elliotts b solution per ml Q2003 N Aprotinin, 10,000 kiu Q2004 N Bladder calculi irrig sol Q2005 K Corticorelin ovine triflutat 7024 4.62 $240.28 $48.06 Q2006 K Digoxin immune fab (ovine) 7025 2.77 $144.06 $28.81 Q2007 N Ethanolamine oleate 100 mg Q2008 N Fomepizole, 15 mg Q2009 N Fosphenytoin, 50 mg Q2010 N Glatiramer acetate, per dose Q2011 K Hemin, per 1 mg 7030 0.01 $.52 $.10 Q2012 N Pegademase bovine, 25 iu Q2013 N Pentastarch 10% solution Q2014 N Sermorelin acetate, 0.5 mg Q2017 K Teniposide, 50 mg 7035 1.24 $64.49 $12.90 Q2018 N Urofollitropin, 75 iu Q2019 K Basiliximab 1615 9.64 $501.37 $100.27 Q2020 E Histrelin acetate Q2021 N Lepirudin Q2022 K VonWillebrandFactrCmplxperIU 1618 0.01 $.52 $.10 Q3001 N Brachytherapy Radioelements Q3002 N Gallium ga 67 Q3003 K Technetium tc99m bicisate 1620 2.80 $145.63 $29.13 Q3004 N Xenon xe 133 Q3005 N Technetium tc99m mertiatide Q3006 N Technetium tc99m glucepatate Q3007 N Sodium phosphate p32 Q3008 K Indium 111-in pentetreotide 1625 4.57 $237.68 $47.54 Q3009 N Technetium tc99m oxidronate Q3010 N Technetium tc99mlabeledrbcs Start Printed Page 52333 Q3011 K Chromic phosphate p32 1628 1.35 $70.21 $14.04 Q3012 N Cyanocobalamin cobalt co57 Q3014 A Telehealth facility fee Q3017 E ALS assessment Q3019 A ALS emer trans no ALS serv Q3020 A ALS nonemer trans no ALS se Q4001 A Cast sup body cast plaster Q4002 A Cast sup body cast fiberglas Q4003 A Cast sup shoulder cast plstr Q4004 A Cast sup shoulder cast fbrgl Q4005 A Cast sup long arm adult plst Q4006 A Cast sup long arm adult fbrg Q4007 A Cast sup long arm ped plster Q4008 A Cast sup long arm ped fbrgls Q4009 A Cast sup sht arm adult plstr Q4010 A Cast sup sht arm adult fbrgl Q4011 A Cast sup sht arm ped plaster Q4012 A Cast sup sht arm ped fbrglas Q4013 A Cast sup gauntlet plaster Q4014 A Cast sup gauntlet fiberglass Q4015 A Cast sup gauntlet ped plster Q4016 A Cast sup gauntlet ped fbrgls Q4017 A Cast sup lng arm splint plst Q4018 A Cast sup lng arm splint fbrg Q4019 A Cast sup lng arm splnt ped p Q4020 A Cast sup lng arm splnt ped f Q4021 A Cast sup sht arm splint plst Q4022 A Cast sup sht arm splint fbrg Q4023 A Cast sup sht arm splnt ped p Q4024 A Cast sup sht arm splnt ped f Q4025 A Cast sup hip spica plaster Q4026 A Cast sup hip spica fiberglas Q4027 A Cast sup hip spica ped plstr Q4028 A Cast sup hip spica ped fbrgl Q4029 A Cast sup long leg plaster Q4030 A Cast sup long leg fiberglass Q4031 A Cast sup lng leg ped plaster Q4032 A Cast sup lng leg ped fbrgls Q4033 A Cast sup lng leg cylinder pl Q4034 A Cast sup lng leg cylinder fb Q4035 A Cast sup lngleg cylndr ped p Q4036 A Cast sup lngleg cylndr ped f Q4037 A Cast sup shrt leg plaster Q4038 A Cast sup shrt leg fiberglass Q4039 A Cast sup shrt leg ped plster Q4040 A Cast sup shrt leg ped fbrgls Q4041 A Cast sup lng leg splnt plstr Q4042 A Cast sup lng leg splnt fbrgl Q4043 A Cast sup lng leg splnt ped p Q4044 A Cast sup lng leg splnt ped f Q4045 A Cast sup sht leg splnt plstr Q4046 A Cast sup sht leg splnt fbrgl Q4047 A Cast sup sht leg splnt ped p Q4048 A Cast sup sht leg splnt ped f Q4049 A Finger splint, static Q4050 A Cast supplies unlisted Q4051 A Splint supplies misc Q9920 A Epoetin with hct <= 20 Q9921 A Epoetin with hct = 21 Q9922 A Epoetin with hct = 22 Q9923 A Epoetin with hct = 23 Q9924 A Epoetin with hct = 24 Q9925 A Epoetin with hct = 25 Q9926 A Epoetin with hct = 26 Q9927 A Epoetin with hct = 27 Q9928 A Epoetin with hct = 28 Start Printed Page 52334 Q9929 A Epoetin with hct = 29 Q9930 A Epoetin with hct = 30 Q9931 A Epoetin with hct = 31 Q9932 A Epoetin with hct = 32 Q9933 A Epoetin with hct = 33 Q9934 A Epoetin with hct = 34 Q9935 A Epoetin with hct = 35 Q9936 A Epoetin with hct = 36 Q9937 A Epoetin with hct = 37 Q9938 A Epoetin with hct = 38 Q9939 A Epoetin with hct = 39 Q9940 A Epoetin with hct >= 40 R0070 N Transport portable x-ray R0075 N Transport port x-ray multipl R0076 N Transport portable EKG T1015 E Clinic service 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 V2116 A Nonaspheric lens bifocal V2117 A Aspheric lens bifocal V2118 A Lens aniseikonic 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 V2216 A Lens lenticular nonaspheric V2217 A Lens lenticular aspheric bif V2218 A Lens aniseikonic bifocal V2219 A Lens bifocal seg width over V2220 A Lens bifocal add over 3.25d 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 Start Printed Page 52335 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 V2316 A Lens lenticular nonaspheric V2317 A Lens lenticular aspheric tri V2318 A Lens aniseikonic trifocal V2319 A Lens trifocal seg width > 28 V2320 A Lens trifocal add over 3.25d V2399 A Lens trifocal speciality V2410 A Lens variab asphericity sing 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 V2710 A Glass/plastic slab off prism V2715 A Prism lens/es V2718 A Fresnell prism press-on lens V2730 A Special base curve V2740 A Rose tint plastic V2741 A Non-rose tint plastic V2742 A Rose tint glass V2743 A Non-rose tint glass V2744 A Tint photochromatic lens/es V2750 A Anti-reflective coating V2755 A UV lens/es V2760 A Scratch resistant coating V2770 A Occluder lens/es V2780 A Oversize lens/es V2781 E Progressive lens per lens V2785 F Corneal tissue processing V2790 N Amniotic membrane V2799 A Miscellaneous vision service Start Printed Page 52336 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 V5090 E Hearing aid dispensing fee 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 V5299 E Hearing service V5336 E Repair communication device V5362 A Speech screening V5363 A Language screening Start Printed Page 52337 V5364 A Dysphagia screening CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All rights reserved. —————————— CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All rights reserved. Start Printed Page 52337Addendum D.—Payment Status Indicators for the Hospital Outpatient Prospective Payment System
Indicator Service Status A Ambulance Ambulance Fee Schedule. A Clinical Diagnostic Laboratory Services Laboratory Fee Schedule. A Durable Medical Equipment, Prosthetics and Orthotics (excluding implanted DME and prosthetics) DMEPOS Fee Schedule. A EPO for ESRD Patients National Rate. A Physical, Occupational and Speech Therapy Physician Fee Schedule. A Physician Services for ESRD Patients Physician Fee Schedule. A Screening Mammography Physician Fee Schedule. C Inpatient Procedures Not Payable under OPPS; Admit Patient; Bill as Inpatient. D Deleted Code Deleted Effective Beginning of Calendar Year. E Non-Covered Items and Services, Codes not Reportable in Hospital Outpatient Settings Not Paid Under Medicare or When Performed in a Hospital Outpatient Setting. F Acquisition of Corneal Tissue Paid at Reasonable Cost. G Drug/Biological Pass-Through Paid Under OPPS; Separate APC Payment Includes Pass Through Amount. H Device Category Pass-Through Paid Under OPPS; Separate Cost Based Pass Through Payment. K Non Pass-Through Drug/Biological, Certain Brachytherapy seeds Paid Under OPPS; Separate APC. N Items and Services Packaged into APC Rate Paid under OPPS; Payment Is Packaged Into Payment for Other Services. P Partial Hospitalization Paid under OPPS; Per Diem APC. S Significant Procedure, Not Discounted When Multiple Paid Under OPPS; Separate APC. T Significant Procedure, Multiple Procedure Reduction Applies Paid Under OPPS; Separate APC. V Visit to Clinic or Emergency Department Paid Under OPPS; Separate PC. X Ancillary Service Paid Under OPPS; Separate APC Start Printed Page 52363Addendum E.—CPT Codes Which Would Be Paid Only As Inpatient Procedures
[Calender Year 2003]
CPT/HCPCS Status indicator Description 0001T C Endovas repr abdo ao aneurys 0002T C Endovas repr abdo ao aneurys 0005T C Perc cath stent/brain cv art 0006T C Perc cath stent/brain cv art 0007T C Perc cath stent/brain cv art 00174 C Anesth, pharyngeal surgery 00176 C Anesth, pharyngeal surgery 00192 C Anesth, facial bone surgery 00214 C Anesth, skull drainage Start Printed Page 52338 00215 C Anesth, skull repair/fract 0021T C Fetal oximetry, trnsvag/cerv 0024T C Transcath cardiac reduction 00404 C Anesth, surgery of breast 00406 C Anesth, surgery of breast 00452 C Anesth, surgery of shoulder 00474 C Anesth, surgery of rib(s) 00524 C Anesth, chest drainage 00540 C Anesth, chest surgery 00542 C Anesth, release of lung 00544 C Anesth, chest lining removal 00546 C Anesth, lung,chest wall surg 00560 C Anesth, open heart surgery 00562 C Anesth, open heart surgery 00580 C Anesth heart/lung transplant 00604 C Anesth, sitting procedure 00622 C Anesth, removal of nerves 00632 C Anesth, removal of nerves 00634 C Anesth for chemonucleolysis 00670 C Anesth, spine, cord surgery 00792 C Anesth, hemorr/excise liver 00794 C Anesth, pancreas removal 00796 C Anesth, for liver transplant 00802 C Anesth, fat layer removal 00844 C Anesth, pelvis surgery 00846 C Anesth, hysterectomy 00848 C Anesth, pelvic organ surg 00864 C Anesth, removal of bladder 00865 C Anesth, removal of prostate 00866 C Anesth, removal of adrenal 00868 C Anesth, kidney transplant 00882 C Anesth, major vein ligation 00904 C Anesth, perineal surgery 00908 C Anesth, removal of prostate 00928 C Anesth, removal of testis 00932 C Anesth, amputation of penis 00934 C Anesth, penis, nodes removal 00936 C Anesth, penis, nodes removal 00944 C Anesth, vaginal hysterectomy 01140 C Anesth, amputation at pelvis 01150 C Anesth, pelvic tumor surgery 01190 C Anesth, pelvis nerve removal 01212 C Anesth, hip disarticulation 01214 C Anesth, hip arthroplasty 01232 C Anesth, amputation of femur 01234 C Anesth, radical femur surg 01272 C Anesth, femoral artery surg 01274 C Anesth, femoral embolectomy 01402 C Anesth, knee arthroplasty 01404 C Anesth, amputation at knee 01442 C Anesth, knee artery surg 01444 C Anesth, knee artery repair 01486 C Anesth, ankle replacement 01502 C Anesth, lwr leg embolectomy 01632 C Anesth, surgery of shoulder 01634 C Anesth, shoulder joint amput 01636 C Anesth, forequarter amput 01638 C Anesth, shoulder replacement 01652 C Anesth, shoulder vessel surg 01654 C Anesth, shoulder vessel surg 01656 C Anesth, arm-leg vessel surg 01756 C Anesth, radical humerus surg 01990 C Support for organ donor 15756 C Free muscle flap, microvasc 15757 C Free skin flap, microvasc Start Printed Page 52339 15758 C Free fascial flap, microvasc 16035 C Incision of burn scab, initi 16036 C Incise burn scab, addl incis 19200 C Removal of breast 19220 C Removal of breast 19271 C Revision of chest wall 19272 C Extensive chest wall surgery 19361 C Breast reconstruction 19364 C Breast reconstruction 19367 C Breast reconstruction 19368 C Breast reconstruction 19369 C Breast reconstruction 20660 C Apply,remove fixation device 20661 C Application of head brace 20662 C Application of pelvis brace 20663 C Application of thigh brace 20664 C Halo brace application 20802 C Replantation, arm, complete 20805 C Replant, forearm, complete 20808 C Replantation hand, complete 20816 C Replantation digit, complete 20822 C Replantation digit, complete 20824 C Replantation thumb, complete 20827 C Replantation thumb, complete 20838 C Replantation foot, complete 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 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 C Bone/skin graft, metatarsal 20973 C Bone/skin graft, great toe 21045 C Extensive jaw surgery 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 C Reconstruct midface, lefort 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 C Reconstruct orbit/forehead 21179 C Reconstruct entire forehead 21180 C Reconstruct entire forehead 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 C Reconst lwr jaw w/o fixation 21196 C Reconst lwr jaw w/fixation 21247 C Reconstruct lower jaw bone 21255 C Reconstruct lower jaw bone Start Printed Page 52340 21256 C Reconstruction of orbit 21268 C Revise eye sockets 21343 C Treatment of sinus fracture 21344 C Treatment of sinus fracture 21346 C Treat nose/jaw fracture 21347 C Treat nose/jaw fracture 21348 C Treat nose/jaw fracture 21356 C Treat cheek bone fracture 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 21395 C Treat eye socket fracture 21408 C Treat eye socket fracture 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 21495 C Treat hyoid bone fracture 21510 C Drainage of bone lesion 21557 C Remove tumor, neck/chest 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 21632 C Extensive sternum surgery 21705 C Revision of neck muscle/rib 21740 C Reconstruction of sternum 21750 C Repair of sternum separation 21810 C Treatment of rib fracture(s) 21825 C Treat sternum fracture 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 C Revision of thorax spine 22224 C Revision of lumbar spine 22226 C Revise, extra spine segment 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 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 C Lumbar spine fusion Start Printed Page 52341 22614 C Spine fusion, extra segment 22630 C Lumbar spine fusion 22632 C Spine fusion, extra segment 22800 C Fusion of spine 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 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 23332 C Remove shoulder foreign body 23472 C Reconstruct shoulder joint 23900 C Amputation of arm & girdle 23920 C Amputation at shoulder joint 24149 C Radical resection of elbow 24900 C Amputation of upper arm 24920 C Amputation of upper arm 24930 C Amputation follow-up surgery 24931 C Amputate upper arm & implant 24940 C Revision of upper arm 25900 C Amputation of forearm 25905 C Amputation of forearm 25909 C Amputation follow-up surgery 25915 C Amputation of forearm 25920 C Amputate hand at wrist 25924 C Amputation follow-up surgery 25927 C Amputation of hand 25931 C Amputation follow-up surgery 26551 C Great toe-hand transfer 26553 C Single transfer, toe-hand 26554 C Double transfer, toe-hand 26556 C Toe joint transfer 26992 C Drainage of bone lesion 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 27036 C Excision of hip joint/muscle 27054 C Removal of hip joint lining 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 Start Printed Page 52342 27078 C Extensive hip surgery 27079 C Extensive hip surgery 27090 C Removal of hip prosthesis 27091 C Removal of hip prosthesis 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 27215 C Treat pelvic fracture(s) 27217 C Treat pelvic ring fracture 27218 C Treat pelvic ring fracture 27222 C Treat hip socket fracture 27226 C Treat hip wall fracture 27227 C Treat hip fracture(s) 27228 C Treat hip fracture(s) 27232 C Treat thigh fracture 27236 C Treat thigh fracture 27240 C Treat thigh fracture 27244 C Treat thigh fracture 27245 C Treat thigh fracture 27248 C Treat thigh fracture 27253 C Treat hip dislocation 27254 C Treat hip dislocation 27258 C Treat hip dislocation 27259 C Treat hip dislocation 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 27303 C Drainage of bone lesion 27365 C Extensive leg surgery 27445 C Revision of knee joint 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 Start Printed Page 52343 27472 C Repair/graft of thigh 27475 C Surgery to stop leg growth 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 27506 C Treatment of thigh fracture 27507 C Treatment of thigh fracture 27511 C Treatment of thigh fracture 27513 C Treatment of thigh fracture 27514 C Treatment of thigh fracture 27519 C Treat thigh fx growth plate 27535 C Treat knee fracture 27536 C Treat knee fracture 27540 C Treat knee fracture 27556 C Treat knee dislocation 27557 C Treat knee dislocation 27558 C Treat knee dislocation 27580 C Fusion of knee 27590 C Amputate leg at thigh 27591 C Amputate leg at thigh 27592 C Amputate leg at thigh 27596 C Amputation follow-up surgery 27598 C Amputate lower leg at knee 27645 C Extensive lower leg surgery 27646 C Extensive lower leg surgery 27702 C Reconstruct ankle joint 27703 C Reconstruction, ankle joint 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 27880 C Amputation of lower leg 27881 C Amputation of lower leg 27882 C Amputation of lower leg 27886 C Amputation follow-up surgery 27888 C Amputation of foot at ankle 28800 C Amputation of midfoot 28805 C Amputation thru metatarsal 31225 C Removal of upper jaw 31230 C Removal of upper jaw 31290 C Nasal/sinus endoscopy, surg 31291 C Nasal/sinus endoscopy, surg 31292 C Nasal/sinus endoscopy, surg 31293 C Nasal/sinus endoscopy, surg 31294 C Nasal/sinus endoscopy, surg 31360 C Removal of larynx 31365 C Removal of larynx 31367 C Partial removal of larynx 31368 C Partial removal of larynx 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 31584 C Treat larynx fracture 31587 C Revision of larynx 31725 C Clearance of airways Start Printed Page 52344 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 31786 C Remove windpipe lesion 31800 C Repair of windpipe injury 31805 C Repair of windpipe injury 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 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 32402 C Open biopsy chest lining 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 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 Start Printed Page 52345 32852 C Lung transplant with bypass 32853 C Lung transplant, double 32854 C Lung transplant with bypass 32900 C Removal of rib(s) 32905 C Revise & repair chest wall 32906 C Revise & repair chest wall 32940 C Revision of lung 32997 C Total lung lavage 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) 33141 C Heart tmr w/other procedure 33200 C Insertion of heart pacemaker 33201 C Insertion of heart pacemaker 33236 C Remove electrode/thoracotomy 33237 C Remove electrode/thoracotomy 33238 C Remove electrode/thoracotomy 33243 C Remove eltrd/thoracotomy 33245 C Insert epic eltrd pace-defib 33246 C Insert epic eltrd/generator 33250 C Ablate heart dysrhythm focus 33251 C Ablate heart dysrhythm focus 33253 C Reconstruct atria 33261 C Ablate heart dysrhythm focus 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 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 Start Printed Page 52346 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 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 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 Start Printed Page 52347 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 33935 C Transplantation, heart/lung 33940 C Removal of donor heart 33945 C Transplantation of heart 33960 C External circulation assist 33961 C External circulation assist 33967 C Insert ia percut device 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 Start Printed Page 52348 33980 C Remove intracorporeal device 34001 C Removal of artery clot 34051 C Removal of artery clot 34151 C Removal of artery clot 34401 C Removal of vein clot 34451 C Removal of vein clot 34502 C Reconstruct vena cava 34800 C Endovasc abdo repair w/tube 34802 C Endovasc abdo repr w/device 34804 C Endovasc abdo repr w/device 34808 C Endovasc abdo occlud device 34812 C Xpose for endoprosth, aortic 34813 C Xpose for endoprosth, femorl 34820 C Xpose for endoprosth, iliac 34825 C Endovasc extend prosth, init 34826 C Endovasc exten prosth, addl 34830 C Open aortic tube prosth repr 34831 C Open aortoiliac prosth repr 34832 C Open aortofemor prosth repr 35001 C Repair defect of artery 35002 C Repair artery rupture, neck 35005 C Repair defect of artery 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 35141 C Repair defect of artery 35142 C Repair artery rupture, thigh 35151 C Repair defect of artery 35152 C Repair artery rupture, knee 35161 C Repair defect of artery 35162 C Repair artery rupture 35182 C Repair blood vessel lesion 35189 C Repair blood vessel lesion 35211 C Repair blood vessel lesion 35216 C Repair blood vessel lesion 35221 C Repair blood vessel lesion 35241 C Repair blood vessel lesion 35246 C Repair blood vessel lesion 35251 C Repair blood vessel lesion 35271 C Repair blood vessel lesion 35276 C Repair blood vessel lesion 35281 C Repair blood vessel lesion 35301 C Rechanneling of artery 35311 C Rechanneling of artery 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 Start Printed Page 52349 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 35480 C Atherectomy, open 35481 C Atherectomy, open 35482 C Atherectomy, open 35483 C Atherectomy, open 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 35511 C Artery bypass graft 35515 C Artery bypass graft 35516 C Artery bypass graft 35518 C Artery bypass graft 35521 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 35582 C Vein bypass graft 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 Start Printed Page 52350 35681 C Composite bypass graft 35682 C Composite bypass graft 35683 C Composite bypass graft 35691 C Arterial transposition 35693 C Arterial transposition 35694 C Arterial transposition 35695 C Arterial transposition 35700 C Reoperation, bypass graft 35701 C Exploration, carotid artery 35721 C Exploration, femoral artery 35741 C Exploration popliteal artery 35800 C Explore neck vessels 35820 C Explore chest vessels 35840 C Explore abdominal vessels 35870 C Repair vessel graft defect 35901 C Excision, graft, neck 35905 C Excision, graft, thorax 35907 C Excision, graft, abdomen 36510 C Insertion of catheter, vein 36660 C Insertion catheter, artery 36822 C Insertion of cannula(s) 36823 C Insertion of cannula(s) 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 37195 C Thrombolytic therapy, stroke 37616 C Ligation of chest artery 37617 C Ligation of abdomen artery 37618 C Ligation of extremity artery 37660 C Revision of major vein 37788 C Revascularization, penis 38100 C Removal of spleen, total 38101 C Removal of spleen, partial 38102 C Removal of spleen, total 38115 C Repair of ruptured spleen 38380 C Thoracic duct procedure 38381 C Thoracic duct procedure 38382 C Thoracic duct procedure 38562 C Removal, pelvic lymph nodes 38564 C Removal, abdomen lymph nodes 38724 C Removal of lymph nodes, neck 38746 C Remove thoracic lymph nodes 38747 C Remove abdominal lymph nodes 38765 C Remove groin lymph nodes 38770 C Remove pelvis lymph nodes 38780 C Remove abdomen lymph nodes 39000 C Exploration of chest 39010 C Exploration of chest 39200 C Removal chest lesion 39220 C Removal chest lesion 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 39599 C Diaphragm surgery procedure Start Printed Page 52351 41130 C Partial removal of tongue 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 42426 C Excise parotid gland/lesion 42845 C Extensive surgery of throat 42894 C Revision of pharyngeal walls 42953 C Repair throat, esophagus 42961 C Control throat bleeding 42971 C Control nose/throat bleeding 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 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 Parital removal of esophagus 43123 C Partial removal of esophagus 43124 C Removal of esophagus 43135 C Removal of esophagus pouch 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 congential 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 43460 C Pressure treatment esophagus 43496 C Free jejunum flap, microvasc 43500 C Surgical opening of stomach 43501 C Surgical repair of stomach 43502 C Surgical repair of stomach 43510 C Surgical opening of stomach 43520 C Incision of pyloric muscle 43605 C Biopsy of stomach 43610 C Excision of stomach lesion 43611 C Excision of stomach lesion 43620 C Removal of stomach Start Printed Page 52352 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 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 43832 C Place gastrostomy tube 43840 C Repair of stomach lesion 43842 C Gastroplasty for obesity 43843 C Gastroplasty for obesity 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 43880 C Repair stomach-bowel fistula 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 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/taper, cong 44127 C Enterectomy w/o 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 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 44202 C Lap resect s/intestine singl 44203 C Lap resect s/intestine, addl Start Printed Page 52353 44204 C Laparo partial colectomy 44205 C Lap colectomy part w/ileum 44300 C Open bowel to skin 44310 C Ileostomy/jejunostomy 44314 C Revision of ileostomy 44316 C Devise bowel pouch 44320 C Colostomy 44322 C Colostomy with biopsies 44345 C Revision of colostomy 44346 C Revision of colostomy 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 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 C Drain app abscess, percut 44950 C Appendectomy 44955 C Appendectomy add-on 44960 C Appendectomy 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 reservoir 45540 C Correct rectal prolapse 45541 C Correct rectal prolapse 45550 C Repair rectum/remove sigmoid 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 46705 C Repair of anal stricture 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 Start Printed Page 52354 46748 C Repair of cloacal anomaly 46751 C Repair of anal sphincter 47010 C Open drainage, liver lesion 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 47134 C Partial removal, donor liver 47135 C Transplantation of liver 47136 C Transplantation of liver 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 47380 C Open ablate liver tumor rf 47381 C Open ablate liver tumor cryo 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 47550 C Bile duct endoscopy add-on 47570 C Laparo cholecystoenterostomy 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 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 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 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 Start Printed Page 52355 48180 C Fuse pancreas and bowel 48400 C Injection, intraop add-on 48500 C Surgery of pancreatic cyst 48510 C Drain pancreatic pseudocyst 48520 C Fuse pancreas cyst and bowel 48540 C Fuse pancreas cyst and bowel 48545 C Pancreatorrhaphy 48547 C Duodenal exclusion 48556 C Removal, allograft pancreas 49000 C Exploration of abdomen 49002 C Reopening of abdomen 49010 C Exploration behind abdomen 49020 C Drain abdominal abscess 49021 C Drain abdominal abscess 49040 C Drain, open, abdom abscess 49041 C Drain, percut, abdom abscess 49060 C Drain, open, retrop abscess 49061 C Drain, percut, retroper absc 49062 C Drain to peritoneal cavity 49201 C Removal of abdominal lesion 49215 C Excise sacral spine tumor 49220 C Multiple surgery, abdomen 49255 C Removal of omentum 49425 C Insert abdomen-venous drain 49428 C Ligation of shunt 49605 C Repair umbilical lesion 49606 C Repair umbilical lesion 49610 C Repair umbilical lesion 49611 C Repair umbilical lesion 49900 C Repair of abdominal wall 49905 C Omental flap 49906 C Free omental flap, microvasc 50010 C Exploration of kidney 50020 C Renal abscess, open drain 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 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 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 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 50400 C Revision of kidney/ureter 50405 C Revision of kidney/ureter 50500 C Repair of kidney wound 50520 C Close kidney-skin fistula Start Printed Page 52356 50525 C Repair renal-abdomen fistula 50526 C Repair renal-abdomen fistula 50540 C Revision of horseshoe kidney 50545 C Laparo radical nephrectomy 50546 C Laparoscopic nephrectomy 50547 C Laparo removal donor kidney 50548 C Laparo remove k/ureter 50570 C Kidney endoscopy 50572 C Kidney endoscopy 50574 C Kidney endoscopy & biopsy 50575 C Kidney endoscopy 50576 C Kidney endoscopy & treatment 50578 C Renal endoscopy/radiotracer 50580 C Kidney endoscopy & treatment 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 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 51060 C Removal of ureter stone 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 51800 C Revision of bladder/urethra 51820 C Revision of urinary tract Start Printed Page 52357 51840 C Attach bladder/urethra 51841 C Attach bladder/urethra 51845 C Repair bladder neck 51860 C Repair of bladder wound 51865 C Repair of bladder wound 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 53085 C Drainage of urinary leakage 53415 C Reconstruction of urethra 53448 C Remov/replc ur sphinctr comp 54125 C Removal of penis 54130 C Remove penis & nodes 54135 C Remove penis & nodes 54332 C Revise penis/urethra 54336 C Revise penis/urethra 54390 C Repair penis and bladder 54411 C Remv/replc penis pros, comp 54417 C Remv/replc penis pros, compl 54430 C Revision of penis 54535 C Extensive testis surgery 54560 C Exploration for testis 54650 C Orchiopexy (Fowler-Stephens) 55600 C Incise sperm duct pouch 55605 C Incise sperm duct pouch 55650 C Remove sperm duct pouch 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 55845 C Extensive prostate surgery 55862 C Extensive prostate surgery 55865 C Extensive prostate surgery 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 57110 C Remove vagina wall, complete 57111 C Remove vagina tissue, compl 57112 C Vaginectomy w/nodes, compl 57270 C Repair of bowel pouch 57280 C Suspension of vagina 57282 C Repair of vaginal prolapse 57292 C Construct vagina with graft 57305 C Repair rectum-vagina fistula 57307 C Fistula repair & colostomy 57308 C Fistula repair, transperine 57311 C Repair urethrovaginal lesion 57335 C Repair vagina 57531 C Removal of cervix, radical 57540 C Removal of residual cervix 57545 C Remove cervix/repair pelvis 58140 C Removal of uterus lesion 58150 C Total hysterectomy 58152 C Total hysterectomy Start Printed Page 52358 58180 C Partial hysterectomy 58200 C Extensive hysterectomy 58210 C Extensive hysterectomy 58240 C Removal of pelvis contents 58260 C Vaginal hysterectomy 58262 C Vaginal hysterectomy 58263 C Vaginal hysterectomy 58267 C Hysterectomy & vagina repair 58270 C Hysterectomy & vagina repair 58275 C Hysterectomy/revise vagina 58280 C Hysterectomy/revise vagina 58285 C Extensive hysterectomy 58400 C Suspension of uterus 58410 C Suspension of uterus 58520 C Repair of ruptured uterus 58540 C Revision of uterus 58605 C Division of fallopian tube 58611 C Ligate oviduct(s) add-on 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 C Create new tubal opening 58805 C Drainage of ovarian cyst(s) 58822 C Drain ovary abscess, percut 58825 C Transposition, ovary(s) 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 58960 C Exploration of abdomen 59100 C Remove uterus lesion 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 59325 C Revision of cervix 59350 C Repair of uterus 59514 C Cesarean delivery only 59525 C Remove uterus after cesarean 59620 C Attempted vbac delivery only 59830 C Treat uterus infection 59850 C Abortion 59851 C Abortion 59852 C Abortion 59855 C Abortion 59856 C Abortion 59857 C Abortion 60254 C Extensive thyroid surgery 60270 C Removal of thyroid 60271 C Removal of thyroid 60502 C Re-explore parathyroids 60505 C Explore parathyroid glands 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 Start Printed Page 52359 60600 C Remove carotid body lesion 60605 C Remove carotid body lesion 60650 C Laparoscopy adrenalectomy 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 61250 C Pierce skull & explore 61253 C Pierce skull & explore 61304 C Open skull for exploration 61305 C Open skull for exploration 61312 C Open skull for drainage 61313 C Open skull for drainage 61314 C Open skull for drainage 61315 C Open skull for drainage 61320 C Open skull for drainage 61321 C Open skull for drainage 61332 C Explore/biopsy eye socket 61333 C Explore orbit/remove lesion 61334 C Explore orbit/remove object 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 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 61538 C Removal of brain tissue 61539 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 Start Printed Page 52360 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 61570 C Remove foreign body, brain 61571 C Incise skull for brain wound 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 61624 C Occlusion/embolization cath 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 61850 C Implant neuroelectrodes 61860 C Implant neuroelectrodes 61862 C Implant neurostimul, subcort Start Printed Page 52361 61870 C Implant neuroelectrodes 61875 C Implant neuroelectrodes 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 62180 C Establish brain cavity shunt 62190 C Establish brain cavity shunt 62192 C Establish brain cavity shunt 62200 C Establish brain cavity shunt 62201 C Establish brain cavity shunt 62220 C Establish brain cavity shunt 62223 C Establish brain cavity shunt 62256 C Remove brain cavity shunt 62258 C Replace brain cavity shunt 63043 C Laminotomy, addl cervical 63044 C Laminotomy, addl lumbar 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 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 63268 C Excise intraspinal lesion 63270 C Excise intraspinal lesion 63271 C Excise intraspinal lesion Start Printed Page 52362 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 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 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 64752 C Incision of vagus nerve 64755 C Incision of stomach nerves 64760 C Incision of vagus nerve 64763 C Incise hip/thigh nerve 64766 C Incise hip/thigh nerve 64804 C Remove sympathetic nerves 64809 C Remove sympathetic nerves 64818 C Remove sympathetic nerves 64866 C Fusion of facial/other nerve 64868 C Fusion of facial/other nerve 65273 C Repair of eye wound 69155 C Extensive ear/neck surgery 69535 C Remove part of temporal bone 69554 C Remove ear lesion 69950 C Incise inner ear nerve 69970 C Remove inner ear lesion 75900 C Arterial catheter exchange 75952 C Endovasc repair abdom aorta 75953 C Abdom aneurysm endovas rpr 92970 C Cardioassist, internal 92971 C Cardioassist, external 92975 C Dissolve clot, heart vessel 92992 C Revision of heart chamber 92993 C Revision of heart chamber 94652 C Pressure breathing (IPPB) 99190 C Special pump services 99191 C Special pump services 99192 C Special pump services 99251 C Initial inpatient consult 99252 C Initial inpatient consult 99253 C Initial inpatient consult 99254 C Initial inpatient consult 99255 C Initial inpatient consult 99261 C Follow-up inpatient consult Start Printed Page 52363 99262 C Follow-up inpatient consult 99263 C Follow-up inpatient consult 99295 C Neonatal critical care 99296 C Neonatal critical care 99297 C Neonatal critical care 99298 C Neonatal critical care 99356 C Prolonged service, inpatient 99357 C Prolonged service, inpatient 99433 C Normal newborn care/hospital CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Copyright American Dental Association. All rights reserved. Addendum H.—Wage Index for Urban Areas
Urban area (constituent counties) Wage index 0040 Abilene, TX 0.9268 Taylor, TX 0060 Aguadilla, PR 0.4634 Aguada, PR Aguadilla, PR Moca, PR 0080 Akron, OH 0.9685 Portage, OH Summit, OH 0120 Albany, GA 1.0835 Dougherty, GA Lee, GA 0160 2 Albany-Schenectady-Troy, NY 0.8633 Albany, NY Montgomery, NY Rensselaer, NY Saratoga, NY Schenectady, NY Schoharie, NY 0200 Albuquerque, NM 0.9372 Bernalillo, NM Sandoval, NM Valencia, NM 0220 Alexandria, LA 0.7929 Rapides, LA 0240 Allentown-Bethlehem-Easton, PA 0.9833 Carbon, PA Lehigh, PA Northampton, PA 0280 Altoona, PA 0.9300 Blair, PA 0320 Amarillo, TX Potter, TX 0.9051 Randall, TX 0380 Anchorage, AK 1.2610 Anchorage, AK 0440 Ann Arbor, MI 1.1217 Lenawee, MI Livingston, MI Washtenaw, MI 0450 Anniston, AL 0.8126 Calhoun, AL 0460 2 Appleton-Oshkosh-Neenah, WI 0.9229 Calumet, WI Outagamie, WI Winnebago, WI 0470 2 Arecibo, PR 0.4400 Arecibo, PR Camuy, PR Hatillo, PR 0480 Asheville, NC 0.9682 Buncombe, NC Madison, NC 0500 Athens, GA 1.0308 Clarke, GA Madison, GA Oconee, GA 0520 1 Atlanta, GA 1.0091 Barrow, GA Bartow, GA Carroll, GA Cherokee, GA Clayton, GA Cobb, GA Coweta, GA DeKalb, GA Douglas, GA Fayette, GA Forsyth, GA Fulton, GA Gwinnett, GA Henry, GA Newton, GA Paulding, GA Pickens, GA Rockdale, GA Spalding, GA Walton, GA 0560 Atlantic-Cape May, NJ 1.1058 Atlantic, NJ Cape May, NJ 0580 Auburn-Opelika, AL 0.8306 Lee, AL 0600 Augusta-Aiken, GA-SC 1.0364 Columbia, GA McDuffie, GA Richmond, GA Aiken, SC Edgefield, SC 0640 1 Austin-San Marcos, TX 0.9529 Bastrop, TX Caldwell, TX Hays, TX Travis, TX Williamson, TX 0680 Bakersfield, CA 1.0186 Kern, CA 0720 1 Baltimore, MD 0.9757 Anne Arundel, MD Baltimore, MD Baltimore City, MD Carroll, MD Harford, MD Howard, MD Queen Anne's, MD 0733 Bangor, ME 0.9791 Penobscot, ME 0743 Barnstable-Yarmouth, MA 1.3127 Barnstable, MA 0760 Baton Rouge, LA 0.8388 Ascension, LA East Baton Rouge, LA Livingston, LA West Baton Rouge, LA 0840 Beaumont-Port Arthur, TX 0.8389 Hardin, TX Jefferson, TX Orange, TX 0860 Bellingham, WA 1.2407 Whatcom, WA 0870 Benton Harbor, MI 0.9072 Berrien, MI 0875 1 Bergen-Passaic, NJ 1.2100 Bergen, NJ Passaic, NJ 0880 Billings, MT 0.9114 Yellowstone, MT 0920 Biloxi-Gulfport-Pascagoula, MS 0.8830 Hancock, MS Harrison, MS Jackson, MS 0960 2 Binghamton, NY 0.8633 Broome, NY Tioga, NY 1000 Birmingham, AL 0.9301 Blount, AL Jefferson, AL St. Clair, AL Shelby, AL 1010 Bismarck, ND 0.7881 Burleigh, ND Morton, ND 1020 Bloomington, IN 0.8997 Monroe, IN 1040 Bloomington-Normal, IL 0.9202 McLean, IL 1080 Boise City, ID 0.9403 Ada, ID Start Printed Page 52364 Canyon, ID 1123 1 Boston-Worcester-Lawrence-Lowell-Brockton, MA-NH 1.1304 Bristol, MA Essex, MA Middlesex, MA Norfolk, MA Plymouth, MA Suffolk, MA Worcester, MA Hillsborough, NH Merrimack, NH Rockingham, NH Strafford, NH 1125 Boulder-Longmont, CO 0.9688 Boulder, CO 1145 Brazoria, TX 0.8617 Brazoria, TX 1150 Bremerton, WA 1.1056 Kitsap, WA 1240 Brownsville-Harlingen-San Benito, TX 0.8992 Cameron, TX 1260 Bryan-College Station, TX 0.8410 Brazos, TX 1280 1 Buffalo-Niagara Falls, NY 0.9464 Erie, NY Niagara, NY 1303 Burlington, VT 1.0176 Chittenden, VT Franklin, VT Grand Isle, VT 1310 Caguas, PR 0.4453 Caguas, PR Cayey, PR Cidra, PR Gurabo, PR San Lorenzo, PR 1320 Canton-Massillon, OH 0.9026 Carroll, OH Stark, OH 1350 Casper, WY 0.9788 Natrona, WY 1360 Cedar Rapids, IA 0.9149 Linn, IA 1400 Champaign-Urbana, IL 0.9983 Champaign, IL 1440 2 Charleston-North Charleston, SC 0.8607 Berkeley, SC Charleston, SC Dorchester, SC 1480 Charleston, WV 0.8765 Kanawha, WV Putnam, WV 1520 1 Charlotte-Gastonia-Rock Hill, NC-SC 0.9839 Cabarrus, NC Gaston, NC Lincoln, NC Mecklenburg, NC Rowan, NC Stanly, NC Union, NC York, SC 1540 Charlottesville, VA 1.0583 Albemarle, VA Charlottesville City, VA Fluvanna, VA Greene, VA 1560 Chattanooga, TN-GA 0.9069 Catoosa, GA Dade, GA Walker, GA Hamilton, TN Marion, TN 1580 2 Cheyenne, WY 0.8890 Laramie, WY 1600 1 Chicago, IL 1.1088 Cook, IL DeKalb, IL DuPage, IL Grundy, IL Kane, IL Kendall, IL Lake, IL McHenry, IL Will, IL 1620 2 Chico-Paradise, CA 0.9934 Butte, CA 1640 1 Cincinnati, OH-KY-IN 0.9354 Dearborn, IN Ohio, IN Boone, KY Campbell, KY Gallatin, KY Grant, KY Kenton, KY Pendleton, KY Brown, OH Clermont, OH Hamilton, OH Warren, OH 1660 Clarksville-Hopkinsville, TN-KY 0.8386 Christian, KY Montgomery, TN 1680 1 Cleveland-Lorain-Elyria, OH 0.9295 Ashtabula, OH Cuyahoga, OH Geauga, OH Lake, OH Lorain, OH Medina, OH 1720 Colorado Springs, CO 0.9968 El Paso, CO 1740 Columbia, MO 0.8737 Boone, MO 1760 Columbia, SC 0.8990 Lexington, SC Richland, SC 1800 Columbus, GA-ALRussell, AL 0.8450 Chattahoochee, GA Harris, GA Muscogee, GA 1840 1 Columbus, OH 0.9705 Delaware, OH Fairfield, OH Franklin, OH Licking, OH Madison, OH Pickaway, OH 1880 Corpus Christi, TX 0.8154 Nueces, TX San Patricio, TX 1890 Corvallis, OR 1.1569 Benton, OR 1900 2 Cumberland, MD-WV (MD Hospitals) 0.8855 Allegany, MD Mineral, WV 1900 2 Cumberland, MD-WV (WV Hospitals) 0.8053 Allegany, MD Mineral, WV 1920 1 Dallas, TX 0.9831 Collin, TX Dallas, TX Denton, TX Ellis, TX Henderson, TX Hunt, TX Kaufman, TX Rockwall, TX 1950 Danville, VA 0.8785 Danville City, VA Pittsylvania, VA 1960 Davenport-Moline-Rock Island, IA-IL 0.8872 Scott, IA Henry, IL Rock Island, IL 2000 Dayton-Springfield, OH 0.9378 Clark, OH Greene, OH Miami, OH Montgomery, OH 2020 Daytona Beach, FL 0.9133 Flagler, FL Volusia, FL 2030 Decatur, AL 0.9066 Lawrence, AL Morgan, AL 2040 2 Decatur, IL 0.8301 Macon, IL 2080 1 Denver, CO 1.0401 Adams, CO Arapahoe, CO Denver, CO Douglas, CO Jefferson, CO 2120 Des Moines, IA 0.8908 Dallas, IA Polk, IA Warren, IA 2160 1 Detroit, MI 1.0506 Lapeer, MI Macomb, MI Monroe, MI Oakland, MI St. Clair, MI Wayne, MI 2180 Dothan, AL 0.8028 Dale, AL Houston, AL 2190 Dover, DE 0.9452 Kent, DE 2200 Dubuque, IA 0.8801 Dubuque, IA 2240 Duluth-Superior, MN-WI 1.0462 St. Louis, MN Douglas, WI 2281 Dutchess County, NY 1.0793 Dutchess, NY 2290 2 Eau Claire, WI 0.9229 Chippewa, WI Eau Claire, WI Start Printed Page 52365 2320 El Paso, TX 0.9137 El Paso, TX 2330 Elkhart-Goshen, IN 0.9851 Elkhart, IN 2335 2 Elmira, NY 0.8633 Chemung, NY 2340 Enid, OK 0.8387 Garfield, OK 2360 Erie, PA 0.9016 Erie, PA 2400 Eugene-Springfield, OR 1.1077 Lane, OR 2440 2 Evansville-Henderson, IN-KY (IN Hospitals) 0.8796 Posey, IN Vanderburgh, IN Warrick, IN Henderson, KY 2440 Evansville-Henderson, IN-KY (KY Hospitals) 0.8254 Posey, IN Vanderburgh, IN Warrick, IN Henderson, KY 2520 Fargo-Moorhead, ND-MN 0.9783 Clay, MN Cass, ND 2560 Fayetteville, NC 0.9055 Cumberland, NC 2580 Fayetteville-Springdale-Rogers, AR 0.8182 Benton, AR Washington, AR 2620 Flagstaff, AZ-UT 1.0791 Coconino, AZ Kane, UT 2640 Flint, MI 1.1233 Genesee, MI 2650 Florence, AL 0.7960 Colbert, AL Lauderdale, AL 2655 Florence, SC 0.8869 Florence, SC 2670 Fort Collins-Loveland, CO 0.9923 Larimer, CO 2680 1 Ft. Lauderdale, FL 1.0792 Broward, FL 2700 Fort Myers-Cape Coral, FL 0.9456 Lee, FL 2710 Fort Pierce-Port St. Lucie, FL 0.9959 Martin, FL St. Lucie, FL 2720 Fort Smith, AR-OK 0.7811 Crawford, AR Sebastian, AR Sequoyah, OK 2750 Fort Walton Beach, FL 0.9651 Okaloosa, FL 2760 Fort Wayne, IN 0.9499 Adams, IN Allen, IN De Kalb, IN Huntington, IN Wells, IN Whitley, IN 2800 1 Forth Worth-Arlington, TX 0.9620 Hood, TX Johnson, TX Parker, TX Tarrant, TX 2840 Fresno, CA 1.0340 Fresno, CA Madera, CA 2880 Gadsden, AL 0.8684 Etowah, AL 2900 Gainesville, FL 0.9730 Alachua, FL 2920 Galveston-Texas City, TX 0.9603 Galveston, TX 2960 Gary, IN 0.9676 Lake, IN Porter, IN 2975 2 Glens Falls, NY 0.8633 Warren, NY Washington, NY 2980 Goldsboro, NC 0.8982 Wayne, NC 2985 Grand Forks, ND-MN 0.9338 Polk, MN Grand Forks, ND 2995 Grand Junction, CO 0.9824 Mesa, CO 3000 1 Grand Rapids-Muskegon-Holland, MI 0.9664 Allegan, MI Kent, MI Muskegon, MI Ottawa, MI 3040 Great Falls, MT 0.9057 Cascade, MT 3060 Greeley, CO 0.9219 Weld, CO 3080 Green Bay, WI 0.9599 Brown, WI 3120 1 Greensboro-Winston-Salem-High Point, NC 0.9270 Alamance, NC Davidson, NC Davie, NC Forsyth, NCGuilford, NC Randolph, NC Stokes, NC Yadkin, NC 3150 Greenville, NC 0.9257 Pitt, NC 3160 Greenville-Spartanburg-Anderson, SC 0.9177 Anderson, SC Cherokee, SC Greenville, SC Pickens, SC Spartanburg, SC 3180 Hagerstown, MD 0.9362 Washington, MD 3200 Hamilton-Middletown, OH 0.9484 Butler, OH 3240 Harrisburg-Lebanon-Carlisle, PA 0.9315 Cumberland, PA Dauphin, PA Lebanon, PA Perry, PA 3283 \1, 2\ Hartford, CT 1.2520 Hartford, CT Litchfield, CT Middlesex, CT Tolland, CT 3285 2 Hattiesburg, MS 0.7759 Forrest, MS Lamar, MS 3290 Hickory-Morganton-Lenoir, NC 0.8958 Alexander, NC Burke, NC Caldwell, NC Catawba, NC 3320 Honolulu, HI 1.1121 Honolulu, HI 3350 Houma, LA 0.8470 Lafourche, LA Terrebonne, LA 3360 1 Houston, TX 0.9746 Chambers, TX Fort Bend, TX Harris, TX Liberty, TX Montgomery, TX Waller, TX 3400 Huntington-Ashland, WV-KY-OH 0.9744 Boyd, KY Carter, KY Greenup, KY Lawrence, OH Cabell, WV Wayne, WV 3440 Huntsville, AL 0.8901 Limestone, AL Madison, AL 3480 1 Indianapolis, IN 0.9828 Boone, IN Hamilton, IN Hancock, IN Hendricks, IN Johnson, IN Madison, IN Marion, IN Morgan, IN Shelby, IN 3500 Iowa City, IA 1.0025 Johnson, IA 3520 Jackson, MI 0.9591 Jackson, MI 3560 Jackson, MS 0.8713 Hinds, MS Madison, MS Rankin, MS 3580 Jackson, TN 0.9370 Madison, TN Chester, TN 3600 1 Jacksonville, FL 0.9341 Clay, FL Duval, FL Nassau, FL St. Johns, FL 3605 2 Jacksonville, NC 0.8714 Onslow, NC 3610 2 Jamestown, NY 0.8633 Chautauqua, NY 3620 Janesville-Beloit, WI 0.9696 Rock, WI 3640 Jersey City, NJ 1.1200 Hudson, NJ 3660 Johnson City-Kingsport-Bristol, TN-VA (TN Hospitals) 0.8384 Carter, TN Hawkins, TN Sullivan, TN Unicoi, TN Start Printed Page 52366 Washington, TN Bristol City, VA Scott, VA Washington, VA 3660 2 Johnson City-Kingsport-Bristol, TN-VA (VA Hospitals) 0.8494 Carter, TN Hawkins, TN Sullivan, TN Unicoi, TN Washington, TN Bristol City, VA Scott, VA Washington, VA 3680 2 Johnstown, PA 0.8525 Cambria, PA Somerset, PA 3700 Jonesboro, AR 0.7906 Craighead, AR 3710 Joplin, MO 0.8700 Jasper, MO Newton, MO 3720 Kalamazoo-Battlecreek, MI 1.0689 Calhoun, MI Kalamazoo, MI Van Buren, MI 3740 Kankakee, IL 0.9591 Kankakee, IL 3760 1 Kansas City, KS-MO 0.9809 Johnson, KS Leavenworth, KS Miami, KS Wyandotte, KS Cass, MO Clay, MO Clinton, MO Jackson, MO Lafayette, MO Platte, MO Ray, MO 3800 Kenosha, WI 0.9741 Kenosha, WI 3810 Killeen-Temple, TX 0.8447 Bell, TX Coryell, TX 3840 Knoxville, TN 0.9090 Anderson, TN Blount, TN Knox, TN Loudon, TN Sevier, TN Union, TN 3850 Kokomo, IN 0.9031 Howard, IN Tipton, IN 3870 2 La Crosse, WI-MN (WI Hospitals) 0.9229 Houston, MN La Crosse, WI 3870 2 La Crosse, WI-MN (MN Hospitals) 0.9249 Houston, MN La Crosse, WI 3880 Lafayette, LA 0.8550 Acadia, LA Lafayette, LA St. Landry, LA St. Martin, LA 3920 Lafayette, IN 0.9515 Clinton, IN Tippecanoe, IN 3960 Lake Charles, LA 0.8030 Calcasieu, LA 3980 Lakeland-Winter Haven, FL 0.9170 Polk, FL 4000 Lancaster, PA 0.9171 Lancaster, PA 4040 Lansing-East Lansing, MI 0.9827 Clinton, MI Eaton, MI Ingham, MI 4080 Laredo, TX 0.8504 Webb, TX 4100 Las Cruces, NM 0.8888 Dona Ana, NM 4120 1 Las Vegas, NV-AZ 1.1018 Mohave, AZ Clark, NV Nye, NV 4150 Lawrence, KS 0.7964 Douglas, KS 4200 Lawton, OK 0.8251 Comanche, OK 4243 Lewiston-Auburn, ME 0.9249 Androscoggin, ME 4280 Lexington, KY 0.8629 Bourbon, KY Clark, KY Fayette, KY Jessamine, KY Madison, KY Scott, KY Woodford, KY 4320 Lima, OH 0.9515 Allen, OH Auglaize, OH 4360 Lincoln, NE 0.9133 Lancaster, NE 4400 Little Rock-North Little Rock, AR 0.9045 Faulkner, AR Lonoke, AR Pulaski, AR Saline, AR 4420 Longview-Marshall, TX 0.8588 Gregg, TX Harrison, TX Upshur, TX 4480 1 Los Angeles-Long Beach, CA 1.2044 Los Angeles, CA 4520 1 Louisville, KY-IN 0.9517 Clark, IN Floyd, IN Harrison, IN Scott, IN Bullitt, KY Jefferson, KY Oldham, KY 4600 Lubbock, TX 0.7809 Lubbock, TX 4640 Lynchburg, VA 0.9311 Amherst, VA Bedford, VA Bedford City, VA Campbell, VA Lynchburg City, VA 4680 Macon, GA 0.9296 Bibb, GA Houston, GA Jones, GA Peach, GA Twiggs, GA 4720 Madison, WI 1.0188 Dane, WI 4800 Mansfield, OH 0.8989 Crawford, OH Richland, OH 4840 Mayaguez, PR 0.4921 Anasco, PR Cabo Rojo, PR Hormigueros, PR Mayaguez, PR Sabana Grande, PR San German, PR 4880 McAllen-Edinburg-Mission, TX 0.8419 Hidalgo, TX 4890 Medford-Ashland, OR 1.0605 Jackson, OR 4900 Melbourne-Titusville-Palm Bay, FL 1.0782 Brevard, Fl 4920 1 Memphis, TN-AR-MS 0.8839 Crittenden, AR DeSoto, MS Fayette, TN Shelby, TN Tipton, TN 4940 Merced, CA 0.9937 Merced, CA 5000 1 Miami, FL 0.9878 Dade, FL 5015 1 Middlesex-Somerset-Hunterdon, NJ 1.1454 Hunterdon, NJ Middlesex, NJ Somerset, NJ 5080 1 Milwaukee-Waukesha, WI 0.9901 Milwaukee, WI Ozaukee, WI Washington, WI Waukesha, WI 5120 1 Minneapolis-St. Paul, MN-WI 1.0969 Anoka, MN Carver, MN Chisago, MN Dakota, MN Hennepin, MN Isanti, MN Ramsey, MN Scott, MN Sherburne, MN Washington, MN Wright, MN Pierce, WI St. Croix, WI 5140 Missoula, MT 0.9250 Missoula, MT 5160 Mobile, AL 0.8181 Baldwin, AL Mobile, AL 5170 Modesto, CA 1.0606 Stanislaus, CA 5190 1 Monmouth-Ocean, NJ 1.1290 Monmouth, NJ Ocean, NJ 5200 Monroe, LA 0.8191 Ouachita, LA Start Printed Page 52367 5240 2 Montgomery, AL 0.7853 Autauga, AL Elmore, AL Montgomery, AL 5280 Muncie, IN 0.9150 Delaware, IN 5330 Myrtle Beach, SC 0.9141 Horry, SC 5345 Naples, FL 0.9803 Collier, FL 5360 1 Nashville, TN 0.9456 Cheatham, TN Davidson, TN Dickson, TN Robertson, TN Rutherford TN Sumner, TN Williamson, TN Wilson, TN 5380 1 Nassau-Suffolk, NY 1.3441 Nassau, NY Suffolk, NY 5483 \1, 2\ New Haven-Bridgeport-Stamford-Waterbury- 1.2520 Danbury, CT Fairfield, CT New Haven, CT 5523 2 New London-Norwich, CT 1.2520 New London, CT 5560 1 New Orleans, LA 0.9050 Jefferson, LA Orleans, LA Plaquemines, LA St. Bernard, LA St. Charles, LA St. James, LA St. John The Baptist, LA St. Tammany, LA 5600 1 New York, NY 1.4069 Bronx, NY Kings, NY New York, NY Putnam, NY Queens, NY Richmond, NY Rockland, NY Westchester, NY 5640 1 Newark, NJ 1.1546 Essex, NJ Morris, NJ Sussex, NJ Union, NJ Warren, NJ 5660 Newburgh, NY-PA 1.1434 Orange, NY Pike, PA 5720 1 Norfolk-Virginia Beach-Newport News, VA-NC 0.8553 Currituck, NC Chesapeake City, VA Gloucester, VA Hampton City, VA Isle of Wight, VA James City, VA Mathews, VA Newport News City, VA Norfolk City, VA Poquoson City, VA Portsmouth City, VA Suffolk City, VA Virginia Beach City VA Williamsburg City, VA York, VA 5775 1 Oakland, CA 1.5324 Alameda, CA Contra Costa, CA 5790 Ocala, FL 0.9526 Marion, FL 5800 Odessa-Midland, TX 0.9233 Ector, TX Midland, TX 5880 1 Oklahoma City, OK 0.8997 Canadian, OK Cleveland, OK Logan, OK McClain, OK Oklahoma, OK Pottawatomie, OK 5910 Olympia, WA 1.1071 Thurston, WA 5920 Omaha, NE-IA 1.0089 Pottawattamie, IA Cass, NE Douglas, NE Sarpy, NE Washington, NE 5945 1 Orange County, CA 1.1726 Orange, CA 5960 1 Orlando, FL 0.9537 Lake, FL Orange, FL Osceola, FL Seminole, FL 5990 Owensboro, KY 0.8283 Daviess, KY 6015 Panama City, FL 0.8926 Bay, FL 6020 Parkersburg-Marietta, WV-OH (WV Hospitals) 0.8210 Washington, OH Wood, WV 6020 2 Parkersburg-Marietta, WV-OH (OH Hospitals) 0.8675 Washington, OH Wood, WV 6080 2 Pensacola, FL 0.8907 Escambia, FL Santa Rosa, FL 6120 Peoria-Pekin, IL 0.8854 Peoria, IL Tazewell, IL Woodford, IL 6160 1 Philadelphia, PA-NJ 1.0675 Burlington, NJ Camden, NJ Gloucester, NJ Salem, NJ Bucks, PA Chester, PA Delaware, PA Montgomery, PA Philadelphia, PA 6200 1 Phoenix-Mesa, AZ 0.9562 Maricopa, AZ Pinal, AZ 6240 Pine Bluff, AR 0.7866 Jefferson, AR 6280 1 Pittsburgh, PA 0.9403 Allegheny, PA Beaver, PA Butler, PA Fayette, PA Washington, PA Westmoreland, PA 6323 2 Pittsfield, MA 1.1257 Berkshire, MA 6340 Pocatello, ID 0.9013 Bannock, ID 6360 Ponce, PR 0.5221 Guayanilla, PR Juana Diaz, PR Penuelas, PR Ponce, PR Villalba, PR Yauco, PR 6403 Portland, ME 0.9932 Cumberland, ME Sagadahoc, ME York, ME 6440 1 Portland-Vancouver, OR-WA 1.0792 Clackamas, OR Columbia, OR Multnomah, OR Washington, OR Yamhill, OR Clark, WA 6483 1 Providence-Warwick-Pawtucket, RI 1.0558 Bristol, RI Kent, RI Newport, RI Providence, RI Washington, RI 6520 Provo-Orem, UT 1.0190 Utah, UT 6560 2 Pueblo, CO 0.9104 Pueblo, CO 6580 2 Punta Gorda, FL 0.8907 Charlotte, FL 6600 Racine, WI 0.9413 Racine, WI 6640 1 Raleigh-Durham-Chapel Hill, NC 1.0083 Chatham, NC Durham, NC Franklin, NC Johnston, NC Orange, NC Wake, NC 6660 Rapid City, SD 0.8936 Pennington, SD 6680 Reading, PA 0.9308 Berks, PA 6690 Redding, CA 1.1249 Shasta, CA 6720 Reno, NV 1.0664 Washoe, NV 6740 Richland-Kennewick-Pasco, WA 1.1608 Benton, WA Franklin, WA 6760 Richmond-Petersburg, VA 0.9735 Charles City County, VA Chesterfield, VA Colonial Heights City, VA Dinwiddie, VA Goochland, VA Hanover, VA Henrico, VA Start Printed Page 52368 Hopewell City, VA New Kent, VA Petersburg City, VA Powhatan, VA Prince George, VA Richmond City, VA 6780 1 Riverside-San Bernardino, CA 1.1251 Riverside, CA San Bernardino, CA 6800 Roanoke, VA 0.8703 Botetourt, VA Roanoke, VA Roanoke City, VA Salem City, VA 6820 Rochester, MN 1.2263 Olmsted, MN 6840 1 Rochester, NY 0.9133 Genesee, NY Livingston, NY Monroe, NY Ontario, NY Orleans, NY Wayne, NY 6880 Rockford, IL 0.9456 Boone, IL Ogle, IL Winnebago, IL 6895 Rocky Mount, NC 0.9322 Edgecombe, NC Nash, NC 6920 1 Sacramento, CA 1.1636 El Dorado, CA Placer, CA Sacramento, CA 6960 Saginaw-Bay City-Midland, MI 0.9709 Bay, MI Midland, MI Saginaw, MI 6980 St. Cloud, MN 0.9858 Benton, MN Stearns, MN 7000 2 St. Joseph, MO 0.8099 Andrew, MO Buchanan, MO 7040 1 St. Louis, MO-IL 0.8907 Clinton, IL Jersey, IL Madison, IL Monroe, IL St. Clair, IL Franklin, MO Jefferson, MO Lincoln, MO St. Charles, MO St. Louis, MO St. Louis City, MO Warren, MO 7080 Salem, OR 1.0473 Marion, OR Polk, OR 7120 Salinas, CA 1.4772 Monterey, CA 7160 1 Salt Lake City-Ogden, UT 1.0035 Davis, UT Salt Lake, UT Weber, UT 7200 San Angelo, TX 0.7956 Tom Green, TX 7240 1 San Antonio, TX 0.8649 Bexar, TX Comal, TX Guadalupe, TX Wilson, TX 7320 1 San Diego, CA 1.1247 San Diego, CA 7360 1 San Francisco, CA 1.4288 Marin, CA San Francisco, CA San Mateo, CA 7400 1 San Jose, CA 1.4162 Santa Clara, CA 7440 1 San Juan-Bayamon, PR 0.4706 Aguas Buenas, PR Barceloneta, PR Bayamon, PR Canovanas, PR Carolina, PR Catano, PR Ceiba, PR Comerio, PR Corozal, PR Dorado, PR Fajardo, PR Florida, PR Guaynabo, PR Humacao, PR Juncos, PR Los Piedras, PR Loiza, PR Luguillo, PR Manati, PR Morovis, PR Naguabo, PR Naranjito, PR Rio Grande, PR San Juan, PR Toa Alta, PR Toa Baja, PR Trujillo Alto, PR Vega Alta, PR Vega Baja, PR Yabucoa, PR 7460 San Luis Obispo-Atascadero-Paso Robles, CA 1.1386 San Luis Obispo, CA 7480 Santa Barbara-Santa Maria-Lompoc, CA 1.0588 Santa Barbara, CA 7485 Santa Cruz-Watsonville, CA 1.3630 Santa Cruz, CA 7490 Santa Fe, NM 1.0822 Los Alamos, NM Santa Fe, NM 7500 Santa Rosa, CA 1.3179 Sonoma, CA 7510 Sarasota-Bradenton, FL 0.9367 Manatee, FL Sarasota, FL 7520 Savannah, GA 0.9961 Bryan, GA Chatham, GA Effingham, GA 7560 2 Scranton—Wilkes-Barre—Hazleton, PA 0.8525 Columbia, PA Lackawanna, PA Luzerne, PA Wyoming, PA 7600 1 Seattle-Bellevue-Everett, WA 1.1571 Island, WA King, WA Snohomish, WA 7610 2 Sharon, PA 0.8525 Mercer, PA 7620 2 Sheboygan, WI 0.9229 Sheboygan, WI 7640 Sherman-Denison, TX 0.9334 Grayson, TX 7680 Shreveport-Bossier City, LA 0.8813 Bossier, LA Caddo, LA Webster, LA 7720 Sioux City, IA-NE 0.9138 Woodbury, IA Dakota, NE 7760 Sioux Falls, SD 0.9098 Lincoln, SD Minnehaha, SD 7800 South Bend, IN 0.9902 St. Joseph, IN 7840 Spokane, WA 1.0961 Spokane, WA 7880 Springfield, IL 0.8654 Menard, IL Sangamon, IL 7920 Springfield, MO 0.8510 Christian, MO Greene, MO Webster, MO 8003 2 Springfield, MA 1.1257 Hampden, MA Hampshire, MA 8050 State College, PA 0.9032 Centre, PA 8080 Steubenville-Weirton, OH-WV 0.8893 Jefferson, OH Brooke, WV Hancock, WV 8120 Stockton-Lodi, CA 1.0630 San Joaquin, CA 8140 2 Sumter, SC 0.8607 Sumter, SC 8160 Syracuse, NY 0.9519 Cayuga, NY Madison, NY Onondaga, NY Oswego, NY 8200 Tacoma, WA 1.1052 Pierce, WA 8240 2 Tallahassee, FL 0.8907 Gadsden, FL Leon, FL 8280 1 Tampa-St. Petersburg-Clearwater, FL 0.9238 Hernando, FL Hillsborough, FL Pasco, FL Pinellas, FL 8320 2 Terre Haute, IN 0.8796 Clay, IN Vermillion, IN Vigo, IN 8360 Texarkana,AR-Texarkana, TX 0.8193 Miller, AR Bowie, TX Start Printed Page 52369 8400 Toledo, OH 0.9863 Fulton, OH Lucas, OH Wood, OH 8440 Topeka, KS 0.8952 Shawnee, KS 8480 Trenton, NJ 1.0710 Mercer, NJ 8520 Tucson, AZ 0.8993 Pima, AZ 8560 Tulsa, OK 0.8398 Creek, OK Osage, OK Rogers, OK Tulsa, OK Wagoner, OK 8600 Tuscaloosa, AL 0.8303 Tuscaloosa, AL 8640 Tyler, TX 0.9650 Smith, TX 8680 2 Utica-Rome, NY 0.8633 Herkimer, NY Oneida, NY 8720 Vallejo-Fairfield-Napa, CA 1.3544 Napa, CA Solano, CA 8735 Ventura, CA 1.1209 Ventura, CA 8750 Victoria, TX 0.8814 Victoria, TX 8760 Vineland-Millville-Bridgeton, NJ 1.0296 Cumberland, NJ 8780 2Visalia-Tulare-Porterville, CA 0.9934 Tulare, CA 8800 Waco, TX 0.8802 McLennan, TX 8840 1 Washington, DC-MD-VA-WV 1.0852 District of Columbia, DC Calvert, MD Charles, MD Frederick, MD Montgomery, MD Prince Georges, MD Alexandria City, VA Arlington, VA Clarke, VA Culpeper, VA Fairfax, VA Fairfax City, VA Falls Church City, VA Fauquier, VA Fredericksburg City, VA King George, VA Loudoun, VA Manassas City, VA Manassas Park City, VA Prince William, VA Spotsylvania, VA Stafford, VA Warren, VA Berkeley, WV Jefferson, WV 8920 Waterloo-Cedar Falls, IA 0.8970 Black Hawk, IA 8940 Wausau, WI 0.9882 Marathon, WI 8960 1 West Palm Beach-Boca Raton, FL 0.9929 Palm Beach, FL 9000 2 Wheeling, WV-OH (WV Hospitals) 0.8053 Belmont, OH Marshall, WV Ohio, WV 9000 2 Wheeling, WV-OH (OH Hospitals) 0.8675 Belmont, OH Marshall, WV Ohio, WV 9040 Wichita, KS 0.9571 Butler, KS Harvey, KS Sedgwick, KS 9080 Wichita Falls, TX 0.8023 Archer, TX Wichita, TX 9140 Williamsport, PA 0.8624 Lycoming, PA 9160 Wilmington-Newark, DE-MD 1.1287 New Castle, DE Cecil, MD 9200 Wilmington, NC 0.9471 New Hanover, NC Brunswick, NC 9260 Yakima, WA 1.0676 Yakima, WA 9270 2 Yolo, CA 0.9934 Yolo, CA 9280 York, PA 0.9140 York, PA 9320 Youngstown-Warren, OH 0.9485 Columbiana, OH Mahoning, OH Trumbull, OH 9340 Yuba City, CA 1.0310 Sutter, CA Yuba, CA 9360 Yuma, AZ 0.8677 Yuma, AZ 1 Large Urban Area 2 Hospitals geographically located in the area are assigned the statewide rural wage index. Addendum I.—Wage Index for Rural Areas
Nonurban area Wage index Alabama 0.7853 Alaska 1.2323 Arizona 0.8483 Arkansas 0.7670 California 0.9934 Colorado 0.9104 Connecticut 1.2520 Delaware 0.9126 Florida 0.8907 Georgia 0.8254 Hawaii 1.0342 Idaho 0.8799 Illinois 0.8301 Indiana 0.8796 Iowa 0.8395 Kansas 0.7964 Kentucky 0.8079 Louisiana 0.7719 Maine 0.8754 Maryland 0.8855 Massachusetts 1.1257 Michigan 0.8961 Minnesota 0.9249 Mississippi 0.7759 Missouri 0.8099 Montana 0.8567 Nebraska 0.8283 Nevada 0.9519 New Hampshire 0.9882 New Jersey 1 New Mexico 0.8645 New York 0.8633 North Carolina 0.8714 North Dakota 0.7830 Ohio 0.8675 Oklahoma 0.7664 Oregon 1.0408 Pennsylvania 0.8525 Puerto Rico 0.4400 Rhode Island 1 South Carolina 0.8607 South Dakota 0.7895 Tennessee 0.7873 Texas 0.7759 Utah 0.9426 Vermont 0.9402 Virginia 0.8494 Washington 1.0274 West Virginia 0.8053 Wisconsin 0.9229 Wyoming 0.8890 1 All counties within the State are classified as urban. End Supplemental InformationAddendum J.—Wage Index for Hospitals That Are Reclassified
Area Wage index Abilene, TX 0.8534 Akron, OH 0.9685 Albany, GA 1.0658 Albuquerque, NM 0.9372 Alexandria, LA 0.7929 Allentown-Bethlehem-Easton, PA 0.9833 Altoona, PA 0.9300 Amarillo, TX 0.8900 Anchorage, AK 1.2610 Ann Arbor, MI 1.1217 Anniston, AL 0.7983 Asheville, NC 0.9448 Athens, GA 1.0161 Atlanta, GA 0.9985 Augusta-Aiken, GA-SC 0.9981 Austin-San Marcos, TX 0.9529 Barnstable-Yarmouth, MA 1.2894 Baton Rouge, LA 0.8281 Bellingham, WA 1.2139 Benton Harbor, MI 0.9072 Bergen-Passaic, NJ 1.2100 Billings, MT 0.9114 Biloxi-Gulfport-Pascagoula, MS 0.8417 Binghamton, NY 0.8525 Start Printed Page 52370 Birmingham, AL 0.9301 Bismarck, ND 0.7881 Boston-Worcester-Lawrence-Lowell-Brockton, MA-NH 1.1304 Burlington, VT 0.9667 Caguas, PR 0.4453 Casper, WY 0.9655 Champaign-Urbana, IL 0.9334 Charleston-North Charleston, SC 0.8607 Charleston, WV 0.8602 Charlotte-Gastonia-Rock Hill, NC-SC 0.9839 Charlottesville, VA 1.0252 Chattanooga, TN-GA 0.8878 Chicago, IL 1.0953 Cincinnati, OH-KY-IN 0.9354 Clarksville-Hopkinsville, TN-KY 0.8239 Cleveland-Lorain-Elyria, OH 0.9295 Columbia, MO 0.8737 Columbia, SC 0.8990 Columbus, GA-AL (GA Hospitals) 0.8254 Columbus, GA-AL (AL Hospitals) 0.8041 Columbus, OH 0.9521 Corpus Christi, TX 0.8154 Dallas, TX 0.9831 Danville, VA 0.8530 Davenport-Moline-Rock Island, IA-IL 0.8872 Dayton-Springfield, OH 0.9378 Denver, CO 1.0401 Des Moines, IA 0.8908 Detroit, MI 1.0506 Dothan, AL 0.8028 Dover, DE 0.9274 Duluth-Superior, MN-WI 1.0462 Eau Claire, WI 0.9229 Elkhart-Goshen, IN 0.9484 Erie, PA 0.8850 Eugene-Springfield, OR 1.1077 Fargo-Moorhead, ND-MN 0.9564 Fayetteville, NC 0.9055 Flagstaff, AZ-UT 1.0234 Flint, MI 1.1041 Florence, AL 0.7960 Florence, SC 0.8869 Fort Collins-Loveland, CO 0.9923 Ft. Lauderdale, FL 1.0792 Fort Pierce-Port St. Lucie, FL 0.9959 Fort Smith, AR-OK 0.7681 Fort Walton Beach, FL 0.9365 Forth Worth-Arlington, TX 0.9620 Gadsden, AL 0.8684 Grand Forks, ND-MN 0.9338 Grand Junction, CO 0.9824 Grand Rapids-Muskegon-Holland, MI 0.9664 Great Falls, MT 0.9057 Greeley, CO 0.9219 Green Bay, WI 0.9347 Greensboro-Winston-Salem-High Point, NC 0.9131 Greenville, NC 0.9257 Harrisburg-Lebanon-Carlisle, PA 0.9315 Hartford, CT 1.1550 Hattiesburg, MS 0.7759 Hickory-Morganton-Lenoir, NC 0.8958 Houston, TX 0.9746 Huntington-Ashland, WV-KY-OH 0.9251 Huntsville, AL 0.8901 Indianapolis, IN 0.9828 Iowa City, IA 0.9828 Jackson, MS 0.8587 Jackson, TN 0.9032 Jacksonville, FL 0.9225 Johnson City-Kingsport-Bristol, TN-VA (VA Hospitals) 0.8494 Johnson City-Kingsport-Bristol, TN-VA (KY Hospitals) 0.8384 Johnstown, PA 0.0000 Jonesboro, AR (AR Hospitals) 0.7906 Jonesboro, AR (MO Hospitals) 0.8099 Joplin, MO 0.8700 Kalamazoo-Battlecreek, MI 1.0490 Kansas City, KS-MO 0.9809 Knoxville, TN 0.9090 Kokomo, IN 0.9031 Lafayette, LA 0.8392 Lakeland-Winter Haven, FL 0.9170 Las Vegas, NV-AZ 1.1018 Lawton, OK 0.8073 Lexington, KY 0.8629 Lima, OH 0.9515 Lincoln, NE 0.9133 Little Rock-North Little Rock, AR 0.8926 Longview-Marshall, TX 0.8588 Los Angeles-Long Beach, CA 1.2044 Louisville, KY-IN 0.9382 Lubbock, TX 0.7809 Lynchburg, VA 0.9114 Macon, GA 0.9296 Madison, WI 1.0188 Mansfield, OH 0.8989 Medford-Ashland, OR 1.0408 Memphis, TN-AR-MS 0.8667 Miami, FL 0.9878 Milwaukee-Waukesha, WI 0.9901 Minneapolis-St. Paul, MN-WI 1.0969 Missoula, MT 0.9139 Mobile, AL 0.8181 Modesto, CA 1.0606 Monmouth-Ocean, NJ 1.1290 Monroe, LA 0.8191 Montgomery, AL 0.7853 Nashville, TN 0.9283 New Haven-Bridgeport-Stamford-Waterbury- Danbury, CT 1.2520 New London-Norwich, CT 1.1683 New Orleans, LA 0.9050 New York, NY 1.3936 Newark, NJ 1.1546 Newburgh, NY-PA 1.0820 Norfolk-Virginia Beach-Newport News, VA-NC 0.8714 Oakland, CA 1.5324 Ocala, FL 0.9343 Odessa-Midland, TX 0.8910 Oklahoma City, OK 0.8997 Omaha, NE-IA 1.0089 Orange County, CA 1.1726 Orlando, FL 0.9537 Peoria-Pekin, IL 0.8854 Philadelphia, PA-NJ 1.0675 Phoenix-Mesa, AZ 0.9562 Pine Bluff, AR 0.7760 Pittsburgh, PA 0.9268 Pittsfield, MA 0.9869 Pocatello, ID 0.9013 Portland, ME 0.9698 Portland-Vancouver, OR-WA 1.0792 Provo-Orem, UT 1.0088 Raleigh-Durham-Chapel Hill, NC 0.9978 Rapid City, SD 0.8936 Reading, PA 0.9126 Redding, CA 1.1249 Reno, NV 1.0445 Richland-Kennewick-Pasco, WA 1.1209 Richmond-Petersburg, VA 0.9735 Roanoke, VA 0.8703 Rochester, MN 1.2263 Rockford, IL 0.9456 Sacramento, CA 1.1636 Saginaw-Bay City-Midland, MI 0.9709 St. Cloud, MN 0.9858 St. Joseph, MO 0.8300 St. Louis, MO-IL 0.8907 Salinas, CA 1.4772 Salt Lake City-Ogden, UT 1.0035 San Antonio, TX 0.8649 San Diego, CA 1.1247 Santa Fe, NM 0.9927 Santa Rosa, CA 1.2891 Sarasota-Bradenton, FL 0.9367 Savannah, GA 0.9841 Seattle-Bellevue-Everett, WA 1.1571 Sherman-Denison, TX 0.9090 Shreveport-Bossier City, LA 0.8813 Sioux City, IA-NE 0.8736 Sioux Falls, SD 0.8950 South Bend, IN 0.9902 Spokane, WA 1.0770 Springfield, IL 0.8654 Springfield, MO 0.8236 Stockton-Lodi, CA 1.0630 Syracuse, NY 0.9519 Tampa-St. Petersburg-Clearwater, FL 0.9238 Texarkana,AR-Texarkana, TX 0.8193 Toledo, OH 0.9863 Topeka, KS 0.8840 Tucson, AZ 0.8993 Tulsa, OK 0.8398 Tuscaloosa, AL 0.8303 Tyler, TX 0.9249 Vallejo-Fairfield-Napa, CA 1.3544 Victoria, TX 0.8668 Waco, TX 0.8671 Washington, DC-MD-VA-WV 1.0852 Waterloo-Cedar Falls, IA 0.8970 Wausau, WI 0.9710 West Palm Beach-Boca Raton, FL 0.9929 Wichita, KS 0.9235 Wichita Falls, TX 0.7918 Wilmington-Newark, DE-MD 1.0973 Wilmington, NC 0.9336 York, PA 0.9140 Youngstown-Warren, OH 0.9485 Rural Alabama 0.7853 Rural Florida 0.8907 Rural Illinois (IA Hospitals) 0.8395 Rural Illinois (MO Hospitals) 0.8301 Rural Kentucky 0.8079 Rural Louisiana 0.7719 Rural Massachusetts 1.0417 Rural Michigan 0.8961 Rural Minnesota 0.9249 Rural Mississippi 0.7759 Start Printed Page 52371 Rural Missouri 0.8099 Rural Montana 0.8567 Rural Nebraska 0.8283 Rural Nevada 0.9097 Rural Texas 0.7759 Rural Washington 1.0274 Rural Wyoming 0.8890 Footnotes
1. In 2002, we apply a uniform reduction to the transitional pass-through portion of payments for drugs with transitional pass-through status. As a result, the OPPS now pays hospitals about 72 percent of AWP for drugs in this status. The uniform reduction, as discussed in the March 1, 2002 final rule, is to comply with section 1833(t)(6)(E) of the Act, which limits the total projected amount of transitional pass-through payments for 2002 to 2.5 percent of projected total payments under the OPPS in 2002.
Back to Citation2. In fact, because of the effect of prior statutory reductions in payments, the OPPS system was calibrated at its initiation to pay only about 82 percent of hospital costs in the aggregate.
Back to Citation3. In accord with the BBRA amendment that established the pass-through payment methodology, items are only eligible for pass-through payments for 2 to 3 years. After expiration of pass-through status, payments for devices described by these categories will be packaged into APC payments for the procedures with which they are used.
Back to Citation4. If a new device arrives on the market that would have fit in a category formerly in use but subsequently retired, it will not be eligible for pass-through payment.
Back to CitationBILLING CODE 4120-01-P Start Printed Page 52151
[FR Doc. 02-20146 Filed 8-6-02; 12:38 pm]
BILLING CODE 4120-01-P
Document Information
- Published:
- 08/09/2002
- Department:
- Centers for Medicare & Medicaid Services
- Entry Type:
- Proposed Rule
- Action:
- Proposed rule.
- Document Number:
- 02-20146
- Dates:
- We will consider comments if we receive them at the appropriate
- Pages:
- 52091-52371 (281 pages)
- Docket Numbers:
- CMS-1206-P
- RINs:
- 0938-AL19: Changes to the Hospital Outpatient Prospective Payment System and Calendar Year 2003 Payment Rates (CMS-1206-F)
- RIN Links:
- https://www.federalregister.gov/regulations/0938-AL19/changes-to-the-hospital-outpatient-prospective-payment-system-and-calendar-year-2003-payment-rates-c
- Topics:
- Administrative practice and procedure, Health facilities, Health professions, Hospitals, Kidney diseases, Laboratories, Medicare, Reporting and recordkeeping requirements, Rural areas, X-rays
- PDF File:
- 02-20146.pdf
- CFR: (3)
- 42 CFR 405.371
- 42 CFR 410.43
- 42 CFR 419.66